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

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



Case Details (Reverse Sorted by Onset Date)

This is page 193 out of 8,010

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VAERS ID: 1694805 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Lethargy, Syncope, Throat irritation
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Lethargic, syncope, dizzy, itchy throat


VAERS ID: 1694820 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Dry mouth, Flushing, Hyperhidrosis, Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: not applicable, patient escorted to ED for further evaluation by provider
CDC Split Type:

Write-up: Chest pain, left arm tingling, rash, dry mouth, diaphoretic, flushed-


VAERS ID: 1694831 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3952 / 1 LA / IM

Administered by: Private       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: any
Other Medications: none
Current Illness: none
Preexisting Conditions: hx of temporal lobe disorder that causes syncope with sharp sensation on skin
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt has known history of syncope with vaccinations. sts she has a temporal lobe abnormality that causes her to have syncopal episodes with any sharp touch. administered vaccination, pt awake and conversating 1 min after injection. pt loses concuiousness 1 min after injection (roughly 12:41PM) Hr 55. pt secure on exam table. pt regains conciousness within 15 seconds, reoriented to room. BO 110/62 at this time and HR 76. monitored patient for 30 min and felt well enough to leave at 1:25 PM. pt sts this was a normal episode for her. pt was escorted to car by her brother and he sts he is driving her home.


VAERS ID: 1694834 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: The patient received her first dose of the Pfizer vaccine at 12:02PM. At 12:07, the RN checked on the patient to see how she was doing. The patient complained of feeling dizzy with a slight headache. She stated that she also felt nauseous. The patient stated she did not have any food or drink all day prior to vaccination. The treatment provided was giving the patient ice packs that she applied to the back of her neck and on her belly. She was encourage to drink water and was given crackers and a protein bar. Her BP was taken - 124/74, HR - 74. The patient remained in the observation area until 12:40pm when she was feeling better and felt safe to drive home.


VAERS ID: 1694838 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: Swollen and redness at the site of reaction which was spreading. Patient was not feeling dizzy. She had no hives. Patient was observed for about 45minutes and she left the facility, No medication was administered.


VAERS ID: 1694856 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-21
Onset:2021-09-13
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hypoaesthesia
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: Unk
Current Illness: unk
Preexisting Conditions: unk
Allergies: Unk
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness that radiates from the ring finger and pinky finger on her right hand


VAERS ID: 1694858 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-09-13
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Photophobia, Pyrexia, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Initial symptoms were fever and chills immediately 24-48 hours from second vaccine. As of reporting date (today), I cannot see clearly and see spots in my vision. Bright colors and light is triggering it.


VAERS ID: 1694864 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FCS3184 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site rash, Pain, Pain in extremity, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: * Ketotifen 2mg twice daily (am/pm) * Diamox 125mg, once daily (pm) * Cardiamin once daily, multivitamin (pm) *Vitamin D3 100mcg (pm) * Zofran 4-8mg as needed * Famotidine 20mg once daily (am) * Diltiazem 90mg three times daily * Duloxetin
Current Illness: None
Preexisting Conditions: POTS (dysautonomia), hypermobile Ehlers Danlos Syndrome, Mast Cell Activation Syndrome, IBS, interstitial cystitis, endometriosis, adenomyosis, idiopathic intercranial hypertension without papilledema
Allergies: Latex, Aleve, chloroprep
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Right arm was throbbing, so I looked at it and noticed it was breaking out into a petechiae rash from just below the injection site down to my hand.


VAERS ID: 1694871 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN AT THIS / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Medicated face wash; topical hydrocortisone cream for face; tylenol
Current Illness: none reported
Preexisting Conditions: dry skin on face
Allergies: Lime, applesauce, Acai
Diagnostic Lab Data: none needed
CDC Split Type:

Write-up: Pt with no history of high blood pressure suddenly with elevated blood pressure 142/89


VAERS ID: 1694882 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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? 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: 22 year old female received 1st dose of Pfizer COVID 19 vaccine on 13 Sept 2021 at approx. 1545. Patient stated she''s incredibly nervous with shots. Immediately following the shot the patient stated she was lightheaded. Approx. 20 seconds after the show the patient had a syncope episode. Patient stated feeling nauseous approx. 30 seconds following the shot. The vaccine team called for assistance at this time. Vital signs were taken. Approx. 5 minutes after the episode the patient stated she feels completely better. Patient/Father of patient was informed that they would be taken to the Emergency Room based on the hospital protocol.


VAERS ID: 1694895 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

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

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

Write-up: Client experienced itching in upper and lower extremities 20 minutes after vaccination.


VAERS ID: 1694907 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Past history of acute lymphoblastic leukemia as a child.
Allergies: Vancomycin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient had received Johnson and Johnson vaccine on 3/24/21, but inadvertently received a dose of Moderna vaccine on 9/13/21 (today). No immediate adverse effects noted. Patient currently incarcerated and will be monitored for adverse effects. Patient reported that he had not been previously vaccinated with any formulation of the COVID vaccine, and staff did not perform due diligence in reviewing administration history. We are reporting this as error as it constitutes an administration error.


VAERS ID: 1694913 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Imprisonment, Interchange of vaccine products
SMQs:, Hostility/aggression (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: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had received Johnson and Johnson vaccine on 3/24/21, but inadvertently received a dose of Moderna vaccine on 9/13/21 (today). No immediate adverse effects noted. Patient currently incarcerated and will be monitored for adverse effects. Patient reported that he had not been previously vaccinated with any formulation of the COVID vaccine, and staff did not perform due diligence in reviewing administration history. We are reporting this as error as recommended it constitutes an administration error.


VAERS ID: 1694930 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-09-13
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 RA / IM

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1694936 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Consciousness fluctuating, Disorientation, Dizziness, Hot flush, Hypotonia, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Minutes after receiving the shot, the patient began to feel light headed. Shortly after, she slumped over in the chair where we ask patients to sit after the shots are administered. The staff pharmacist attended to the patient immediately and stayed with her throughout the incident. She was unresponsive at first, but eventually would rotate between moments of consciousness and syncope. She had to vomit once, had hot flashes, and was disoriented. We focused on trying to keep her attention and preventing her from losing consciousness again. We provided an ice pack to help with her hot flashes. An ambulance was notified shortly into the event when it was apparent that she was not improving. When the paramedics arrived, we provided as much information as we could. We were able to get in touch with a family member, and the paramedics left with her on a stretcher.


VAERS ID: 1694939 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-03
Onset:2021-09-13
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MADERNA / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Antibody test negative, Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, Vitamin D, and a Probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Lab Report shows zero antibodies.
CDC Split Type:

Write-up: Since the vaccine (Maderna), magnets stick to my body all over. Not just the injection site. I also have no antibodies since having the vaccination.


VAERS ID: 1694942 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / IM

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

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

Write-up: Massive rash on both sides of my neck Headache


VAERS ID: 1694948 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Feeling abnormal, 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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient states that he does not take any other medications. He takes Tylenol occasionally as needed
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: BP: 160/110, 150/110
CDC Split Type:

Write-up: Patient received vaccination and walked without issue to observation area. Shortly after patient sat for observation patient stated they began to "feel funny" and stood to talk to technician. He took a few steps and then lost consciousness. Patient fell and landed on his side. Patient does not remember falling or hitting the floor. BP take and was 160/110 and then was 150/105. ED was called and paramedics arrived on scene for assessment within 10 minutes of call. EMS stated patient did not need to be taken by ambulance to ED as he was alert and oriented but advised that he have someone take him and get checked out. Patient states that he will follow up at ED or Urgent Care


VAERS ID: 1694953 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 05927 / 1 LA / SYR
FLUA3: INFLUENZA (SEASONAL) (FLUAD) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Bone pain, Dizziness, Feeling abnormal, Headache, Mobility decreased, Muscle discomfort, Musculoskeletal discomfort, Neck pain, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Motrin
Current Illness: No
Preexisting Conditions: No, just asthma & food/chemical allergies
Allergies: Yes, nitrates, sodium bicarbonate, citric acid, preservatives, cucumbers, oysters, cilantro, bananas
Diagnostic Lab Data:
CDC Split Type:

Write-up: Major bone pain, throbbing of every joint, bone & musle. Still neck, arms, legs with throbbing pain, massive headache, zero ability to get up out of bed, brainfog & lightheaded, stomach ache.


VAERS ID: 1694971 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 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? 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: WE WERE SUPPOSED TO GIVE MODERNA, ENDED UP GIVING PATIENT PFIZER VACCINE.


VAERS ID: 1694986 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 RA / IM

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

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

Write-up: PATIENT WAS GIVEN THE SECOND DOSE OF MODERNA VACCINE AT 20 DAYS INSTEAD OF 28 DAYS. WHEN PATIENT CAME TO THE PHARMACY FOR HER VACCINE, PATIENT WAS ASKED IF SHE WAS GETTING A FIRST OR SECOND DOSE AND PATIENT STATED THEY WERE GETTING A FIRST DOSE. AFTER PATIENT WAS ADMINISTERED THE VACCINE, PATIENT STATED THAT SHE WAS ACTUALLY GETTING HER SECOND DOSE AND IT WAS DISCOVERED THAT HER FIRST DOSE WAS GIVEN ONLY 20 DAYS PRIOR. NO ADVERSE EFFECTS WERE NOTED AFTER VACCINATION.


VAERS ID: 1694993 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Cold sweat, Fall, Gait disturbance, Loss of consciousness, Muscular weakness
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT WAS ADMINISTERED THE COVID 19 (MODERNA) VACCINE TODAY 9/13/2021 AT 3:30PM. AFTER NEEDLE WAS REMOVED AND BANDAID WAS APPLIED PATIENT STARTED TO STAGGER AND GO DOWN TO THE FLOOR. PATIENT WAS ASSISTED TO CHAIR BY VACCINE ADMINISTRATOR. PATIENT THEN PASSED OUT FOR APPROXIMATELY 10 SECONDS. PATIENT THEN STARTED TO COME TO. DR WAS NOTIFIED IMMEDIATELY AND CAME TO ASSESS THE PATIENT. PATIENT HAD PATENT AIRWAY AT ALL TIMES - NO ASSISTANCE NEEDED FOR THAT. NO CPR NEEDED. PATIENT THEN BEGAN TO FEEL SICK TO HIS STOMACH AND BECAME VERY CLAMMY TO TOUCH. NO EMESIS. PATIENT WAS GIVEN COOL COMPRESS AND WATER. PATIENT WAS MONITORED FOR 45 MIN. DR. GAVE THE OK FOR PATIENT TO GO HOME WITH PARENTS AND TO BE MONITORED AT HOME. INSTRUCTIONS GIVEN THAT IF PATIENT HAS ANY CHANGES TO IMMEDIATELY CALL 9-1-1 TO GET TO THE NEAREST EMERGENCY ROOM. PATIENTS PARENTS ACKNOWLEGDED INFORMATION PROVIDED. PATIENT WAS ABLE TO STAND (BUT STILL WEAK IN THE LEGS) PRIOR TO LEAVING THE FACILITY. PATIENT WAS ABLE TO COMMUNICATE TO VACCINE ADMINISTRATOR NAME, DATE OF BIRTH AND LOCATION. PATIENT BELIEVES HE DID NOT EACH MUCH THROUGH THE DAY AND THINKS THAT MIGHT HAVE BEEN WHAT CAUSED THE FAINTING BUT NOT SURE.


VAERS ID: 1695011 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Student reported not feeling well. At that time she became non- responsive. She remained safe in the chair and a nurse at her side. Student then became responsive and opened her eyes, as well as began speaking. Student received apple juice and remained with the nurse for 30 minutes. Student showed no further signs of difficulties. Mother informed of the above, stated this is common for her. She needs to eat prior to vaccines. Stated she will see that she eats before the next vaccine.


VAERS ID: 1695024 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Nausea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)

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

Write-up: pt. with history of anaphylaxis, c/o sudden onset of nausea, and "feeling throat tight", epi given


VAERS ID: 1695033 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Malaise
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: after I gave him the vacc (5 mins later) he said he is not feeling well and light headed and can not breath . I gave him Epinephrine 0.3 mg in the thigh and called 911. he feel better and they take him to pekin hospital.


VAERS ID: 1695038 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate 2.5 mg Oral Tab Folic Acid 1 mg Oral Tab Lisinopril (PRINIVIL/ZESTRIL) 5 mg Oral Tab Atorvastatin (LIPITOR) 40 mg Oral Tab Nortriptyline (PAMELOR) 75 mg Oral Cap Hydroxychloroquine (PLAQUENIL) 200 mg Oral Tab Melatonin (MELATIN
Current Illness: None
Preexisting Conditions: ATRIAL FIBRILLATION, PAROXYSMAL BILAT MACULAR PUCKER CASE / CARE MGMT, SPECIAL NEEDS PROGRAM CKD STAGE 3A (GFR 45-59) HTN (HYPERTENSION) HX OF APPENDECTOMY HX OF EMBOLIC STROKE PERIPHERAL NEUROPATHY RHEUMATOID ARTHRITIS WEAKNESS
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received un diluted vial of Pfizer.


VAERS ID: 1695039 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

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

Write-up: allergic rash from neck to injection site- itchy- cold compress and benadryl


VAERS ID: 1695235 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Dizziness, Fall, Headache, Nausea, Pain in extremity, Sitting disability, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, unknown other meds
Current Illness: denies any previous illness
Preexisting Conditions: NA
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became dizzy lightheaded, fell over, N&V, Headache pain 8/10. BP 179/102, HR 93, SaO2 100 %. Unable to sit up. Began to complain of chest pain 3/10 lt arm pain, called 911 for transport


VAERS ID: 1695240 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Decreased appetite, Dizziness, Fatigue, Hyperhidrosis, Lymphadenitis, Malaise, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament 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: Influenza
Other Medications: Bupropion 300mg
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Dairy intolerance
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Woke up at 2am with sweating followed by vomiting, fever of 101F, joint/ muscle pain, lightheadedness. Later the next day lymphadenitis in left axilla (same arm vx was given) fatigue, general malaise, inappetance, persistent fever.


VAERS ID: 1695250 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 RA / IM

Administered by: Other       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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient came in for second dose of Moderna vaccine. We at the time are out of Moderna and person checking patients in was told a couple of times. Inadvertently patient given Pfizer for second dose. Patient was told of the incident. Vaccine person told him that she had given wrong vaccine and that she had not double checked before giving vaccine. He was also told that was his second dose and did not need to come for another vaccine. Patient said he understood. Patient was monitored for about 20 minutes and no adverse reactions occurred. Patient left clinic feeling good.


VAERS ID: 1695251 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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: Birth Control
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: No medical tests. The ER told me not to come in.
CDC Split Type:

Write-up: 12 hours after the vaccine I developed a fever of 102. I took ibuprofen and three hours later my temperature got to 104. My 16 year-old daughter witnessed me having a seizure, but I don?t remember it. She called the ER and they suggested she pack me in ice and alternate Tylenol and ibuprofen. It took 6 hours to get my fever down to 100 and it?s been at 100 all day?24-36 hours after the vaccine. I have never had a seizure in my life.


VAERS ID: 1695257 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / N/A LA / IM

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

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

Write-up: On 9/13/2021 the patient had been sitting in a chair by the pharmacy after his Janssen COVID vaccine for almost 15 minutes and then got up to stand at the counter to ask the tech if he could leave yet. The tech told him he just had a little bit of time left to wait (maybe 3 more minutes?) when the patient fainted and fell to the floor. Another customer thought he hit his head on the way down. I was alerted by the tech & went to the patient who was lying on the floor unconscious but was breathing and had a strong carotid pulse. I told the tech to call an ambulance. After maybe a minute the patient started to make bending movements upwards with his legs and stretched one arm out and up. Then he started to lift his head a little and wake up. I told him to stay down on the floor and rest since he had fainted and may have hit his head. He said he was nauseous after another couple minutes. I gave him a wastebasket and he sat on the floor and threw up. After a few minutes the EMS crew came in and took over. They took him to the hospital.


VAERS ID: 1695267 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-09-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tdap , approx 7 years ago anaphylaxis .
Other Medications: Benadryl 50mg, metoprolol
Current Illness: allergic reactions multiple times a month unknown etiology
Preexisting Conditions: HTN, SVT, VTACH, raynauds , Lyme disease
Allergies: Tdap, red dye #40, cipro , morphine , levaquin , hydrocodone , Lexapro , gadolinium , doxycycline , corn, mold
Diagnostic Lab Data:
CDC Split Type:

Write-up: With 10 minutes post vaccination full body hives . 40minutes later throat itching . + fatigue , headache , nausea . Benadryl 50mg chewed , hydrocortisone cream applied , Zantac 50mg taken . Will do Benadryl around the clock for 24hr?s . Epi not advised due to Hx of SVT and VTACH. Epi pen on hand if allergic reaction worsens .


VAERS ID: 1695275 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LL / IM

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

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

Write-up: as soon patient received the vaccine he complained of nausea, dizziness and hot. I asked the patient has he eaten and drink anything prior to receiving the vaccine. patient states he has not eaten since yesterday morning. I gave him turkey sandwich, Hersey''s chocolate to eat and he drink sprite, 10 minutes later patient was fine. I kept the patient for 45 minutes to make sure he was ok before going home. The patient left with his sister


VAERS ID: 1695283 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose, Wrong technique in product usage process
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: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syringe was inserted into left arm without medication. Syringe did not contain air or vaccine. Syringe was withdrawn without injecting anything. Bleeding occurred.


VAERS ID: 1695467 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Patient reported previously unknown date or what vaccine of fainting due to frightened of needles per pt wife
Other Medications: NON ON PROFILE N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: FIRE ANTS / BEE/ HORNETS
Diagnostic Lab Data:
CDC Split Type:

Write-up: vasovagal symptoms: low bp 87/71 sweating, nausea, but alert and awake stayed with patient until EMS arrived


VAERS ID: 1695475 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA IRRELEVANT / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syringe issue, Underdose
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: VACCINATION ERROR: PARTIAL ADMINISTRATION. NEEDLE WAS NOT SECURED ON SYRINGE FROM MANUFACTURER RESULTING IN VACCINE LEAKING AT LEUR LOCK. THE PATIENT AND I PERCEIVE SIGNIFICANTLY LESS THAN HALF OF THE VACCINE WAS DELIVERED BUT WE CANNOT BE CERTAIN.


VAERS ID: 1695481 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: finger stick 158
CDC Split Type:

Write-up: presyncopal episode lasting 30 minutes


VAERS ID: 1695484 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 3 RA / IM

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

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

Write-up: Customer came in for a third Moderna dose with vaccination card showing she had received 2 doses of moderna. Upon billing, it was discovered that she received the J&J COVID vaccine. This was verified in information system. She withheld information to the pharmacy. She has not experienced any side effects that I am aware of.


VAERS ID: 1695486 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, Product container issue
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: Vitamin D
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer COVID vaccine vial was punctured at 8:40 am on 9/13/21 and last dose from vial was administered to patient at 3:06 pm on 9/13/21, 26 minutes after expiration time. Patient was monitored for 1 hour. No adverse signs or symptoms occurred.


VAERS ID: 1695488 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NONE/ PT HAS SESEASONAL ALLERGIES ONLY PER PT.
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT FAINTED A MIN OR LESS AFTER VACCINE ADMINISTRATION. PT SAID DID NOT HAVE ANYTHING TO EAT ALL DAY. 911 CALLED, CAME TO SEE PT AND LATER LEFT. PT WERE NOT TAKEN TO HOSPITAL OR ER.


VAERS ID: 1695491 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose of covid 19 vaccine. About 2 minutes after receiving dose when she was waiting her 15 minutes patient passed out and fell on floor. Went out to take of patient, took her pulse which was 88 and her blood pressure which came back at 48/69. Patient then passed out again. Grabbed patient orange juice and patients mom wanted us to call emergency services which we had already done. Stayed with patient until EMS came. Her blood sugar was fine, and blood pressure went up after drinking the orange juice.


VAERS ID: 1695499 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Needle issue, 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: LIPITOR 40MG, LISINOPRIL2.5MG, TOPROL XL 50MG
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: INJECTION WAS MADE WITH A 5/8 INCH NEEDLE INSTEAD OF A 1 INCH NEEDLE. NO ADVERSE SYMPTOMS OR SIGNS.


VAERS ID: 1695500 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 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? 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: On the consent form signed by the patient, patient marked the answer "No" to question 4 that asks if patient has ever received a dose of Covid - 19. Patient was given Moderna 1st dose, as requested, but when billing we discovered patient was given a dose of Janssen Covid - 19 vaccine on April 7, 2021


VAERS ID: 1695508 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Euphoric mood, Feeling abnormal, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient became pale, heavily perspirating, and felt faint within about 5 minutes of shot. Gave patient bottle of water, bottle of sunny d and cheese cracker to eat. Within 5-10 minutes, he was feeling much better. Patient said he still felt "weird" as if he was "high" but his other symptoms had disappeared after 20 minutes. I told mom to call if she needed anything.


VAERS ID: 1695527 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Injection site mass, Injection site pain, Malaise
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (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: Clonazepam .05mg daily; Paxil 20mg daily
Current Illness: None
Preexisting Conditions: Depression/anxiety/asthma/ hip dysplasia
Allergies: Medical tape
Diagnostic Lab Data:
CDC Split Type:

Write-up: Over 24 hrs after my 2nd vaccine I have a very unwell feeling and temp of 100. Also lump and severe pain at injection site.


VAERS ID: 1695720 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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: FELLING DIZZY AFTER ANY VACCINE
Other Medications: AUROVELA FE 1/20
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BLOOD PRESSURE 100/60 PULSE 60
CDC Split Type:

Write-up: PATIENT SEIZED FOR 5 SECONDS NOTHING ELSE HAPPEND, OFFERED TO CALL 911 , PATIENT REFUSED AND SAID THAT SHE IS FINE, BLOOD PRESSURE WAS 100/60, PULSE 60. WE WATCH THE PATIENT FOR 20 MORE MINUTES AND SHE LEFT FINE.


VAERS ID: 1695721 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Palpitations, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allegra
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: dust, dustmites. bees, cats, pollens and grasses
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart Palpitations, 104 fever, severe red rash on both thighs, chills


VAERS ID: 1695726 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-03-09
Onset:2021-09-13
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Breast mass, Ultrasound breast abnormal
SMQs:

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: Medication: Allegra Supplements: Iron, vitamin D, vitamin B12
Current Illness:
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data: Ultrasound on August 18th, 2021. Results mentioned above.
CDC Split Type:

Write-up: I noticed an abnormal growth in my left breast when doing my monthly self-examination. I mentioned it to my obgyn and she mentioned that it could be related to the site that I received the vaccine. She requested an ultrasound and the results showed that my breasts have denser tissue than average but nothing to be concerned about. The left breast was denser than the right breast.


VAERS ID: 1695734 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Was not there to receive covid vaccine, was there for influenza and was administered wrong vaccine by accident.


VAERS ID: 1695735 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Confusional state, Fall, Feeling hot, Head injury, Loss of consciousness, Nausea, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None Known
Current Illness: None Known
Preexisting Conditions: None Known
Allergies: NKDA
Diagnostic Lab Data: EMS performed vital signs and blood glucose test during evaluation
CDC Split Type:

Write-up: Approximately 3-4 minutes after receiving vaccine, patient became hot, nauseous. Then patient slumped over and passed out and fell out of chair onto the floor bumping her head. Patient had an approximately 20 second seizure. During this time 911 was called and EMS was activated. Patient came to, sat up, and was confused about whereabouts after seizure. She was informed of what happened and continued to have a conversation while waiting on EMS. Patient was provided a water and assisted into chair where RPH observed and monitored patient until EMS arrived. EMS arrived and checked vitals, asked her medical history, her diet for the day, and performed a blood glucose test. EMS performed an evaluation for possible head injury. After about 10-15 minutes EMS and the patient made the decision to not transport to hospital. EMS informed patient and fiance to seek emergency care if status changed. Patient was able to leave the Pharmacy and store without assistance.


VAERS ID: 1695738 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-24
Onset:2021-09-13
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 - / IM

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

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

Write-up: PT REPORTED RASH, IE HIVES TO BOTH OF HER FOREARMS FROM HER 1ST COVID VACCINE. PT WAS TREATED BY DR. WITH TOPICAL STERIOD PER PT. MD CLEARED PT TO RECEIVE HER 2ND DOSE. ADVISED PT TO TAKE BENADRYL PRIOR TO SECOND VACCINATION AND TO CONTINUE FOR A FEW DAYS AFTER HER 2ND COVID VACCINE.


VAERS ID: 1695741 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Confusional state, Cough, Fatigue, Feeling abnormal, Impaired work ability, Myalgia, Nausea, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament 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: Flu shot approximately 15 years ago. I got the flu really bad after the shot. I was in my late 20s at the time. I haven''t tak
Other Medications: NAC, perilla pearls, L-glutathione, ultra omega, melatonin, seriphos
Current Illness: None
Preexisting Conditions: None
Allergies: Meds: SSRI , MAOI drugs Food: none Other: mold
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: High fever, chills, body aches, sore muscles, brain fog, mental confusion, can''t work, fatigue, nausea, new onset of cough. All started at around 2am. I took ibuprofen around 11am. Brought fever down and I have slightly more energy. Other symptoms still present.


VAERS ID: 1695746 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: over 42 days, 1st dose 05/28/2021, 2nd dose 09/13/21


VAERS ID: 1695749 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

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

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

Write-up: Pt was accidentally given the Moderna vaccine for the first dose instead of the Pfizer vaccine which is approved for pt''s under 18.


VAERS ID: 1695754 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syringe issue, Underdose
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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: VACCINE LEAKED/DRIBBLED OUT WHILE ADMINISTERING THE IM INJECTION INTO HIS LEFT ARM. I BELIEVE OVER 1/2 THE DOSE WAS ADMINISTERED BUT THERE IS NO WAY FOR ME TO COMPLETELY VERIFY THIS. I SPOKE TO HIS MOTHER, ABOUT WHAT HAD JUST OCCURRED AND SHE, ALONG WITH THE PATIENT, DID NOT FEEL IT WAS NECESSARY TO ADMINISTER ANOTHER IMMEDIATE DOSE TODAY. THEY STATED THEY WOULD BE BACK FOR THEIR 2ND DOSE IN 3 WEEKS.


VAERS ID: 1695756 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Feeling hot, Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pt has MS and a history of seizures
Preexisting Conditions: MS
Allergies: Allergy to Strawberries, Pickles and Cucumbers
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was sitting out in front of the pharmacy so that we could observe her for the 15 minute wait period. (Dose given 3:44pm) Pt stated that she felt like her throat was tight, she was hot and that she was light headed. (3:46pm) We grabbed an ice pack to place on the back of her neck. She then stated that she felt like her tongue was swelling and that she was having trouble breathing and she was afraid she might faint. We helped her to the floor and had her lay down flat to see if that would help her breathing. It did not help, and her shortness of breath became apparent. We called 911 and administered 1 Epi-pen dose. (3:48pm) The Epi-pen did help and she began to have stronger breaths and she said that she could feel that it was helping with the swelling as well. The paramedics arrived and took over treatment at that time. She was transported to the hospital by ambulance.


VAERS ID: 1695764 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METFORMIN ER
Current Illness: NONE
Preexisting Conditions: TYPE 2 DIABETES
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient fainted for seated position and fell face forward onto the floor 5 minutes after receiving vaccine. hit chin and chipped tooth. patient cleared by EMS to leave with her mom and seek medical treatment on their own.


VAERS ID: 1695785 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-31
Onset:2021-09-13
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: Seasonal Allergies
Diagnostic Lab Data: I reached out to the Ophthalmologist and also went to the Emergency but I have been unable to get results.
CDC Split Type:

Write-up: Two minutes after receive the Covid 19 Vaccine 1st Dosage by Pfizer my vision has been blurry. My vision has continued to be blurry and it is now 13 days later.


VAERS ID: 1695794 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Lymph node pain, Lymphadenopathy, Oropharyngeal pain, Pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, sertraline, bupropion, Probiotic, daily vitamin, zinc/ vitamin c
Current Illness:
Preexisting Conditions: Hypothyroidism, asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, enlarged and sore lymph nodes under jaw on right side, sore throat, body aches, and chills


VAERS ID: 1695802 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Feeling hot, Headache, Injection site pain, Injection site paraesthesia, Paraesthesia, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient stated she takes normal generic vitamins and supplements that are common and not unusual, for no specified reason and not for any health issues.
Current Illness: None known.
Preexisting Conditions: Patient states after trying acupuncture in her 20s, she developed a tendency to have syncope when having blood drawn or having other procedures involving needles. She states she had syncope twice, and came close to it two additional times, while having blood draws or similar procedures. Patient states she has no medical history beyond this.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 0.5mL of Janssen COVID-19 vaccine lot 204A21A administered via intramuscular injection into patient''s right deltoid at approximately 1834 on 9/13/2021. Estimated 3 minutes after vaccination while still seated and talking with vaccinator, pt felt subtle headache, then hot, then dizzy. Pt gently lowered to floor onto pillow then sleep mat, and otherwise felt well. Dizziness improved, little to no nausea. Pt felt better, sat back in chair. Pt accepted water once seated. Estimated 7 minutes after vaccination, pt''s right arm got brushed near where they were vaccinated, and they felt a resurgence of symptoms. Pt laid back on floor. Patient felt better, but we had her lay down for more time anyway. Estimated 30 minutes after vaccination, with pt seated in waiting area, pt''s right arm was bumped by their child. Pt exclaimed that she felt like she needed to lay down, then immediately experienced syncope and fell face-first out of chair with her left side more towards the ground. Observation area staff caught the patient, slowing her fall and protecting the patient''s head from injury. Fall was controlled enough that no injury was suspected, so patient was rolled to supine. Patient had eyes open, pupils about 6mm and not obviously responsive (lighting conditions remained constant), before pt regained consciousness and began making eye contact with me about 10 seconds after beginning of syncope. 1cm of foam put under pt head to protect from hardness of ground, pt knees elevated, then both knees and feet. Pt A&O, PERRL, mildly diaphoretic with pink skin that was warm but not hot, respirations fine, HR in mid 50s with O2 97, pt felt warm, icepack applied to forehead helped, HR quickly improved to 60s and BP of 120/62, then HR up to 70s and improvement in symptoms. Pt reported a mild tingling or burning feeling at site of injection coming in waves that was very mild and not radiating, made worse by thinking about it or having the area she received the injection in bumped. Patient rated the severity of her symptoms as a 2/10 and that the overall experience was not any worse than she had previously experienced. Patient stated NKA, and no med hx aside from syncope twice and near-syncope twice from blood draws and injections, beginning in 20s after trying acupuncture. Pt states she takes vitamins and supplements but nothing unusual or special, and not for any health conditions. Called Health Officer. She advised that due to complex pattern of symptoms we should have EMS assess. Pt wheeled to a cot. EMS arrived and assessed pt. Pt seemed to be doing well and they felt she had improved. EMS and I walked patient towards her vehicle, she felt well and said she felt some tingling in her arms and legs but was not alarmed, and we got her to the passenger seat of her car by 1943. I called the patient at 2122 and she states she felt some of the tingling while being driven home, but got home, ate something, and now "felt 100% better."


VAERS ID: 1695817 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Joint range of motion decreased, Mobility decreased, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: HPV vaccine, ages 12 and 13 at doses. Events included temporary paralysis in arm that was injected (left), fever, muscle pain, f
Other Medications: Adderall 10mg twice Dailey Metoprolol 50mg twice Dailey Vistaril 50mg as needed for panic attacks Ambien 10mg at night before bedtime Daily Iron Supplement
Current Illness: None
Preexisting Conditions: PCOS, ADHD, PTSD, Panic Disorder, Insomnia, Iron-Deficiency Anemia, Hypertension
Allergies: Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shoulder pain in left arm resulting in hindrance in range of motion and usage. Cannot lift left arm or perform small circular movement. Cannot perform basic usage such as opening a door or lifting a small object. Other symptoms reported are fever, muscle aches, and fatigue.


VAERS ID: 1695818 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Injected limb mobility decreased, Myalgia, Oropharyngeal pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, tiredness, headaches, sore throat, muscle pain, and inability to move the left arm.


VAERS ID: 1695820 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Electrocardiogram, Troponin
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: shellfish and shrimp
Diagnostic Lab Data: On 9/13 CXR, troponins and EKG were obtained, reassuring results.
CDC Split Type:

Write-up: chest pain, NSAIds given with no improvement.


VAERS ID: 1695827 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram abnormal, Blood lactic acid increased, Computerised tomogram abdomen abnormal, Emphysematous pyelonephritis, Flank pain, Hypertension, Pyrexia, Sepsis, Vomiting
SMQs:, Acute pancreatitis (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No acute illnesses, but is chronically on Chemotherapy
Preexisting Conditions: LYMPHOMA on chemotherapy. Diabetes, HTN
Allergies: NKDA
Diagnostic Lab Data: Sepsis protocol, CT scan.
CDC Split Type:

Write-up: Received 2nd Pfizer vaccine at 1430, at 2330 developed severe left flank pain with vomiting. Patient febrile on arrival to ER with HR 130''s and very hypertensive. Sepsis protocol initiated with CTA abdomen/pelvis ordered which showed Emphysematous Pyelonephritis on the left. Patient with severe sepsis with lactic acid elevated.


VAERS ID: 1695831 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3183 / 1 LA / SYR

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

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

Write-up: Fever, chills, fatigue


VAERS ID: 1696038 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acyclovir, Atorvastatin, Carvedilol, Clopidogrel, Gabapentin, Isosorbide Mononitrate, Levothyroxine, Lisinopril, Metformin, Omeprazole
Current Illness:
Preexisting Conditions: High cholesterol, High blood pressure, Thrombosis, chest pain, neuropathy, Diabetes
Allergies: Clindamycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states that about 24 hours after the shot, she had severe back pain appear. It has resolved somewhat, but then her legs started to have pain also. Tylenol or Ibuprofen help somewhat but patient still has pain. I called to get info on resolution but no answer from patient as of yet.


VAERS ID: 1696045 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-09-13
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 LA / IM

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

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

Write-up: Breakthrough case. Positive covid PCR test on 9/13/2021.


VAERS ID: 1696082 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Glossodynia, Neck pain, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothroxine, liothroynine, cabergoline, combination of calcium, magnesium and zinc supplements. Vitamin D. Ambien prn (took night before vaccination).
Current Illness: No
Preexisting Conditions: Hyper cholesterol, hyperprolactinemia
Allergies: Statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt soreness run down left arm, left leg, left side of neck and tongue. This was the first couple hours after. Than felt achy all over. Next day having fever, body aches and weakness.


VAERS ID: 1696104 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: Syncope after vaccination, stable and all symptoms resolved before going home


VAERS ID: 1696129 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: Syncope after vaccination, observed with improvement, patient was stable and able to return home


VAERS ID: 1696132 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: PT WAS GIVEN FIRST DOSE OF COVID 19 VACCINE (PFIZER). DURING 15MIN OBSERVATION PERIOD, SHE STARTED FEELING DIZZY, LIGHT HEADEDNESS AND BLURRED VISION (FELT LIKE FAITING). PARAMEDICS WERE CALLED. WHEN PARAMEDICS WERE ARRIVED, HER VITALS BECAME NORMAL. SHE STATED THAT SHE FEELS A LOT BETTER AND SHE WAS ABLE TO GO HOME WITHOUT FURTHER EVALUATION. INFORMED DR OFFICE FOR THE ADVERSE EVENT. SHE''LL DOCUMENT IT ON PT''S CHART FOR REFERENCE.


VAERS ID: 1696135 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

Write-up: Sweating/dizziness


VAERS ID: 1696140 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: Patient said one side of face felt numb as if she was having dental work done. She took Benadryl, and said she would contact her physician if didn''t feel better. I followed up with patient next day and she said she was feeling fine.


VAERS ID: 1696144 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Gaze palsy, Oral herpes, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Ocular motility disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acyclovir 800mg 4x a day for 7 days (Started 9/14/21) Zyrtec 10mg daily in AM Tylenol 325mg Q4h PRN
Current Illness: None
Preexisting Conditions: None
Allergies: No known drug or food allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Lip vesicles (Cold sores) occurring on upper and lower lip. Started on 9/13/21 - noted to be painful. Of note, pt has had similar lesions in the past. Pt also has had fever Tmax 101.4 that started on 9/11/21 x 2 days, headache x 2 days, body aches x 2 days, fatigue x 2 days (all symptoms started approx 6h post 2nd vaccine according to mom).


VAERS ID: 1696192 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Yellow fever - localized arm pain, swelling, heat
Other Medications: Metoprolol Pradaxa Allegra Nasacort QVAR 80 Phillips Probiotic D3 Krill Oil L-Lysine Zinc Pepcid
Current Illness: Chronic allergies
Preexisting Conditions: Intermittent atrial fibulation High blood pressure Asthma Allergies History of Non-Hodgkins Lymphoma (in 2000)
Allergies: Meds: Sulfa antibiotics, CT contrast (iodine) Foods: All legumes (soy, peanuts, cashews, beans, peas, lentils), cilantro, oats
Diagnostic Lab Data: None (except Kardia EKG taken at home)
CDC Split Type:

Write-up: Tachycardia (109 bpm) last night for about 20 minutes - EKG taken at 9:52 PM on 9/13/21 Very slight headache


VAERS ID: 1696212 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, Paraesthesia, Pharyngeal hypoaesthesia, Pharyngeal swelling, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Patient came for 2nd dose Moderna vaccine at 11:45. on 9/13/21 After reviewing her form, I noted that she had a PCN allergy, she said she got hives when taking PCN. I let her know that we would need to watch her 30 minutes after her vaccine. 12:07 - gave 2nd dose of Moderna Vaccine Lot#: 050C21A into left deltoid. 12:10 Had patient sit on bench outside pharmacy to keep an eye on her. 12:15- checked on TC, she said she was feeling fine. 12:33 - patient approached counseling window and said her left arm was itching and she felt like her arm had gone numb but wa now getting better, but thought her left side of her throat was numb. I brought patient back to the counseling room where she said she was feeling itchy. - Gave 50mg of benadryl, and grabbed Epi pen. Shortly after taking benadryl she said she felt like the left side of her throat was swollen and felt like she was getting worse. I told her that I would need to administer the epi pen, and gave first dose into her left thigh. I asked Becca to call 911. -Monitored patient. She said her legs were feeling tingly, so i elevated her legs using the other chair in the clinic. After 3 minutes she said she was having a hard time breathing, that her throat felt like it was swelling on the other side, and thought she might faint. -Administered 2nd Epi pen, - Had patient do some deep breathing in through her nose and out through her mouth -monitored - After another 5 minutes or so she said it wasn''t getting any worse, maybe a little better. I sat and held her hand, and talked with her. EMS arrived shortly after and took her via ambulance.


VAERS ID: 1696230 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

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

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

Write-up: Patient had an allergic reaction to the vaccine and the pharmacist administered Benadryl by the pharmacist.


VAERS ID: 1696243 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-12
Onset:2021-09-13
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, 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? 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: Patient developed breakthrough COVID-19 post-immunization requiring hospitalization.


VAERS ID: 1696256 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Fatigue, 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: Vitamin C, Vitamin Dk3, CoQ10, Salmon oil & Ceylon Cinnamon
Current Illness: No illnesses
Preexisting Conditions: Pre-diabetic , no medications
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: A lot of body aches? neck , back, legs & arm & underarm & a feeling of being tired, heaviness ir sluggish.


VAERS ID: 1696265 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Menstrual disorder, Muscle spasms, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: migraines, back-pain
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: abnormal menstrual bleeding, severe cramping, dizziness, nausea, diarrhea


VAERS ID: 1696267 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-30
Onset:2021-09-13
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Chest pain, Confusional state, Cough, Electrocardiogram abnormal, Sinus arrhythmia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Per ED Note: Chest pain that began this morning. Cannot describe the pain. Rated as 8/10. Also noting feeling more confused. Called EMS. Initial rhythm unremarkable. Patient did have sudden change to wide-complex sinus rhythm while in route to the ED concerning for acute STEMI. Patient received aspirin and 1 dose of nitroglycerin via EMS. After receiving nitroglycerin dose EKG changes returned back to baseline. Patient states that she is still having some chest pain. Otherwise has no complaints. She did receive both of her COVID-19 vaccines. She is coughing but states that she has been coughing for a long time and this is gradually improving. She does not smoke, drink alcohol, or recreational drugs. Patient has had quadruple bypass in the past and has a history of heart failure.


VAERS ID: 1696285 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-05
Onset:2021-09-13
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN62060 / 2 - / IM

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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: GI bleed, CAD s/p coronary stent in 7/2021, CABG, chronic diastolic heart failure, pulmonary hypertension, metastatic, breast cancer, hypertension, hyperlipidemia, diabetes mellitus, COPD, hypothyroidism, CKD, and anemia
Allergies: Levofloxacin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/13/21: Patient arrived at the ER due to shortness of breath getting progressively worse over the last 3 hours. Patient was given breathing treatment at home by family, with no improvement. She just also received her flu vaccine on 09/10/2021. She endorses mild fevers at home. Patient received first dose Pfizer vaccine on 3/15/2021 Lot # EN6198 and the second dose on 4/05/2021 Lot # EN62060


VAERS ID: 1696286 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-24
Onset:2021-09-13
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest discomfort, Cough, Dyspnoea, Dyspnoea exertional, Fatigue, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
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), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No significant past medical history
Allergies: Zithromax
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/13/21: Patient arrived at the ER due to worsening cough and shortness of breath. Per patient she returned from traveling on last Tuesday and since then experiencing worsening shortness of breath with exertion and dry cough. Associated with chest tightness and congestion and fatigue. The patient also reported recurring fevers. The patient was exposed to COVID-19 cases while traveling. The patient went to Clinic on Friday, COVID test was negative and the patient was started on doxycycline. Despite taking the medication her symptoms were getting worse therefore she decided to come to the ER. Patient tested positive for COVID on 9/13/21.


VAERS ID: 1696287 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral ischaemia, Cerebrovascular accident, Embolic stroke, Hemiparesis, Internal capsule infarction, Magnetic resonance imaging head abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Acetaminophen, Atorvastatin, Calcium Carbonate, Clopidogrel, Cyclobenzaprine, Folic Acid, Lisinopril, Methotrexate, Metoprolol, Nitroglycerin, Prednisone, Triamcinolone nasal spray
Current Illness:
Preexisting Conditions: rheumatoid arthritis, coronary artery disease, hypertension, hyperlipidemia, patient is a smoker
Allergies: Allergy to Bactrim
Diagnostic Lab Data: MRI: "multifocal areas of acute ischemia in a pattern suggestive of thromboembolic stroke."
CDC Split Type:

Write-up: Patient received 2nd dose of COVID vaccine on 9/11/21. Presented to hospital on 9/13/21 with worsening right-sided weakness. Teleneurology consult assessment with findings of "stroke, probably left posterior limp interal capsule/small vessel."


VAERS ID: 1696295 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-29
Onset:2021-09-13
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 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: Pfizer on 4/8 and 4/29. Positive on 9/13


VAERS ID: 1696298 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-23
Onset:2021-09-13
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 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: Pfizer on 4/2 and 4/23 and 8/18. Positive on 9/13


VAERS ID: 1696300 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-14
Onset:2021-09-13
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-09-14
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 3/17 and 4/14. Positive on 9/13


VAERS ID: 1696315 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-16
Onset:2021-09-13
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CETIRIZINE, POLYETHYLENE GLYCOL
Current Illness: NONE
Preexisting Conditions: ALLERGIC RHINITIS, OBESITY, CONSTIPATION, CHRONIC TENSION-TYPE HEADACHE
Allergies: NKA
Diagnostic Lab Data: 09/13/21: POSITIVE POC SARS COVID RAPID ANTIGEN (QUICKVUE)
CDC Split Type:

Write-up: NASAL CONGESTION, CHEST CONGESTION, COUGH, BODY ACHES, FEVER


VAERS ID: 1696322 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Erythema, Headache, Impaired work ability, Nausea, Pain, Pleurisy, Pollakiuria, Pruritus, Pyrexia, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Severe headache and severe arm immobility for about a week after pertussis (TDaP?) in 2018
Other Medications: Levothyroxine 25mcg qam, vitamin d 50,000 units qw, flexeril 10mg prn
Current Illness: None
Preexisting Conditions: Fibromyalgia, Hashimotos, Interstitial Cystitis, Anxiety, Depression, Migraine, Vitamin D deficiency
Allergies: cymbalta, penicillin, sulfa, dust mites, seasonal allergies
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Within 30 minutes I was very nauseous (10 on a scale of one to ten). Then headache started in frontal lobe area (reminds me of when I had covid in 2/2020 and doesn''t respond to anything). Slight itchiness. Lots of pain (widespread body pain not body aches). By 10 hours the pain was preventing sleep and the chills were causing shivering. Fever is steady between 101-102. I''m very itchy now (arms, chest, face, legs 6 on a scale of one to ten) with slight redness to chest/face. Briefly had pain with deep breaths but that has stopped. I''ve got major frequent urination (about every 30mins, not drinking much due to nausea). Shoulders are both hurting and stiff (not necessarily uncommon). I literally feel worse than having covid and I had to call in to work.


VAERS ID: 1696335 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-01-08
Onset:2021-09-13
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: I tested positive for COVID 9/8/21 and have developed an uncommon symptom of COVID which is intense burning sensation in nostrils


VAERS ID: 1696345 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: I''ve had blood transfusions in the past due to anemia.
Allergies: penicillin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: I began to feel a rush of heat, body tingling, dizziness, and shortness of breath. I laid down on the floor immediately, and was clammy and sweating profusely through my head and shirt. The pharmacist called the ambulance.


VAERS ID: 1696346 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: Client was given Pfizer for her second dose in the series but was given Moderna for the first dose. No adverse reactions noted.


VAERS ID: 1696358 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ENO183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: steroids, oral anti-inflammatory
Current Illness: COVID, Delta varient
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: extreme, severe, sudden onset headache six hours after shot extreme muscle soreness at injection site starting overnight


VAERS ID: 1696396 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 RA / IM

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

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

Write-up: reports rash chest, R armpit down to buttocks and thighs. Itchy and irritating when sweating at work.


VAERS ID: 1696397 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Dizziness, Dyspnoea, Electrocardiogram normal, Inflammation, Presyncope, Troponin increased, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Labs showed elevated CRP and troponin consistent with a post vaccine inflammatory response.
CDC Split Type:

Write-up: Pt received 2nd dose Pfizer vaccine on Fri, 9/10. She did feel lightheaded after the vaccine, but that went away while waiting her 15 min. She played a soccer game on Sat, 9/11, and became lightheaded during the game, but attributed it to the heat and humidity. Monday morning, was going to lift weights and had severe substernal chest pain lasting about 2 hours, causing her to have a difficult time breathing. Went to the ED and had a near syncopal episode with BP in the 90''s. EKG done was normal, but Troponin level was elevated at 1516. Pt is stable and pain is under control.


VAERS ID: 1696399 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-07
Onset:2021-09-13
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Aspartate aminotransferase increased, COVID-19, Chest X-ray abnormal, Computerised tomogram thorax, Cough, Dyspnoea, Fibrin D dimer increased, International normalised ratio increased, Lung infiltration, Malaise, SARS-CoV-2 test positive, Tachycardia, Tachypnoea
SMQs:, Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin (Aspirin Low Dose) 81 mg tablet,delayed release (DR/EC) Directions: 1 tablet oral daily (Active) ciprofloxacin HCl 500 mg Tablet Directions: 1 tablet oral twice a day Extended Instructions: Stop 9/14/21 (Active) foLIC Acid 1 m
Current Illness:
Preexisting Conditions: Asthma, HTN; Rheumatoid arthritis. Smoking Status Light Tobacco Smoker.
Allergies: Penicillin
Diagnostic Lab Data: SARS-CoV-2 Antigen (+) on 9/13/2021
CDC Split Type:

Write-up: 63-year-old male with a medical history of hypertension and rheumatoid arthritis reports to the ER today with complaints of shortness of breath. The patient reports that Friday he started not to feel well he was coughing and over the weekend he developed shortness of breath. This morning he went to see his primary physician who instructed the patient come in urgently to the ER. Here in the ER the patient retested for covid19 it was positive patient noted to have oxygenation of 96% and tachypnea into the 20''s as well as tachycardia 116. Chest x-ray completed shows bilateral infiltrates. Labs were significant for elevated D-dimer of 361, INR 1.21, elevated AST. The pt is vaccinated with Moderna. Patient received IV fluids and Lovenox in the ER, CT of the chest was done not yet resulted will follow-up. Admit to tele for covid management.


VAERS ID: 1696406 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-24
Onset:2021-09-13
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalization - acute hypoxemic respiratory failure due to COVID-19


VAERS ID: 1696410 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-11
Onset:2021-09-13
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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: positive covid PCR and symptomatic


VAERS ID: 1696412 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-24
Onset:2021-09-13
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dyspnoea, Fatigue, Nausea, Oropharyngeal pain, Pain, Pyrexia, SARS-CoV-2 antibody test, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine 10 mg po daily Rosuvastatin 10 mg po daily Alprazolam 0.5 mg po daily PRN
Current Illness:
Preexisting Conditions: HLP, HTN, anxiety denies any cardiac hx, no hx MI or CAD. Appendectomy Smoking Status Never Smoker.
Allergies: NKDA
Diagnostic Lab Data: Outpatient (+) testing 9/9/21 SARS-CoV-2 Antigen and PCR (+) on 9/13 SARS-CoV-2 IgM 0.06, and IgG 0.01 on 9/14/21
CDC Split Type:

Write-up: 53 year old male with hx HTN, HLP, anxiety, presents for evaluation of high fever of 105 today, fatigue, weakness, aches, dry cough, sore throat, mild shortness of breath. He started with symptoms 9 days ago and got worse and went to clinic last thursday 9/9/21 and was told he was positive COVID 19 by PCR. He was concerned due to his high fever so he presented here. He also had intermittant nausea and vomiting, no diarrhea or loss of taste or smell. He has been vaccinated with Moderna back in february 2021.


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