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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 193 out of 4,799

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VAERS ID: 1377691 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tri sprintec Montelukast 10mg Prozac 20mg Levothyroxine 50mg Metformin 500mg Clonidine 0.3mg (x2)
Current Illness:
Preexisting Conditions:
Allergies: Sulfa and anything with lavender
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives broken out on left arm. Red and very sore to the touch. Radiating heat. Since June 4th to present


VAERS ID: 1377693 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 LA / IM

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

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

Write-up: pt is a resident of a long tern care facility. Vaccination requested by facility. Facility unaware that patient was previously fully vaccinated before request was made and patient was inadvertently given a 3 dose of vaccine. Error found after administration.


VAERS ID: 1377717 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Electrocardiogram normal, Heart rate increased, Laboratory test normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Patient stated 3 and a half hours after her Moderna Covid-19 vaccine she felt dizzy, heart beating fast, and chest pain. She went to the ER/urgent care. The did an EKG and blood work. All results were normal.


VAERS ID: 1377722 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLUOXETINE 20 MG
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: AFTER PARAMEDICS EVALUATION SHE WENT HOME WITH HER MOM.
CDC Split Type:

Write-up: PATIENT FAINTED AND FELL TO THE GROUND COUPLE OF MINUTES AFTER RECEIVING HER VACCINATION. SHE HAD SEIZURES ASSOCIATED WITH SYNCOPE.


VAERS ID: 1377739 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 RA / IM

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

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

Write-up: pt is a resident of a long tern care facility. Vaccination requested by facility. Facility unaware that patient was previously fully vaccinated before request was made and patient was inadvertently given a 3 dose of vaccine. Error found after administration.


VAERS ID: 1377752 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179-H / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179_H / 1 LA / IM

Administered by: Other       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: None Reported
Current Illness: None Reported
Preexisting Conditions: None Reported
Allergies: None Reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Guest had two failed vaccination attempts with the vaccine running down his left arm and the third vaccination was successful. No indicated treatments for this event at this time. Guest with active ROM. Education on signs and symptoms of infection at the injection sites. No untoward outcomes known at this time.


VAERS ID: 1377763 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / SYR

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

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

Write-up: The day after the second dose was injected, my upper left arm was red, warm, painful, and swollen. The swelling was beyond the injection site and involved the whole muscle. The adverse event began to clear three days after the second dose was received. The redness, pain, warmth, and swelling was significantly reduced.


VAERS ID: 1377782 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Chills, Dysphagia, Eye pain, Fatigue, Injection site induration, Injection site mass, Injection site pain, Nausea, Pain, Pyrexia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: chronic acid reflux; intermittent asthma; intermittent migraines
Allergies: no
Diagnostic Lab Data: Already had this scheduled for today: Skin test for doctor office - allergist was pretty concerned about abdominal pain - and it being a reaction to the vaccine. He wants this to be watched closely. He gave him an extended abdominal exam at the office. He wants patient to go to ER if it gets worse.
CDC Split Type: vsafe

Write-up: Fever - up to 102 - lasted until yesterday - it was back down to normal yesterday. He has had a sore arm - at injection site; the arm also was hard - a lump that was a little bit palpable - which is gone now; - body aches - gone now, chills, difficulty swallowing. He didn''t have trouble breathing, but he felt his throat tighten when he swallowed (still has this); upper right abdominal pain - that is the real bad symptom still. His eyes hurt when he moved them around. Fatigue. He''s been glued to the couch since Friday. I had given Advil and Tylenol. After the prolonged fever, I eventually called into the doctor''s office. The pediatrician said it was common and said to wait it out but seek treatment if it got worse. He is able to eat but is awful nauseous. He is eating what sounds good. The pain stays the same when he eats.


VAERS ID: 1377785 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site reaction, Muscle spasms, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever of 99.1, along with full body muscle aches on 4 June, treated with 800mg of ibuprofen. Fever of 99.6 along with some muscle aches in arms and legs on 5 June, treated with 800 mg of ibuprofen. Intermittent muscle spasms in arm/shoulder near injection, started early morning of 7 June, has not stopped yet (been 10 hours since it began)


VAERS ID: 1377787 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Cardiac flutter, Chest discomfort, Oropharyngeal discomfort, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

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

Write-up: Patient reported palpitations, throats feels "funny", heart fluttering, heavy chest @ 9:19a. EMS called @ 9:22a. Diphenhydramine 12.5 mg PO administered @ 9:23a. Symptoms resolved in throat per patient @ 9:28a. Patients blood pressure was elevated at 9:20a at 154/111, pulse 85, O2 Sat 97% on outside air, respirations 16. EMS arrived at 9:32a. Patient not transported to hospital. EMS departed. Patients status when leaving was A+O x 4, clear speech, walking, all symptoms resolved.


VAERS ID: 1377790 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Decreased appetite, Disorientation, Dizziness, Fatigue, Flushing, Headache, Hyperhidrosis, Nausea, Night sweats, Pain, Pallor, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: Blood pressure and blood oxygen saturation administered by on site EMS. Results were not recorded by patient.
CDC Split Type:

Write-up: 5 minutes after initial injection I became increasingly lightheaded, nauseous, dizzy, disoriented, and fatigued. 10 minutes after initial injection I experienced a short fainting event in passenger seat of vehicle. Immediately after regaining composure I began sweating profusely and became very pale/flushed color in face at which point I exited the vehicle and flagged EMS to assist me. EMS monitored blood pressure and blood saturation before releasing me on my own recognizance approximately 25 minutes later. Tingling sensation felt in left arm after fainting approximately 10 minuets after initial injection. Next 48 hours after injection I experienced severe body chills, body aches, headache, nausea, loss of appetite, and night sweats. 72 hours after injection I am close to fully recovered but still experience fatigue and night sweats.


VAERS ID: 1377791 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Patient reported feeling nauseous and vomited a few minutes after receiving his second dose of pfizer. Pt looked pale and reported feeling lightheaded. Pt did not show any signs of respiratory distress: no swelling of the throat, face or mouth observed. Vital signs were within limit: BP 125/72, HR 60, RR 12 (at 3:45pm), BP 120/74, HR 62, RR 13 (at 3:45). Patient reported feeling better after vomiting. Observation nurse took vital signs, offered water and Gatorade. Pt left our site at 3:50 (Patient''s mother was driving).


VAERS ID: 1377793 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oral birth control, over-the-counter iron supplement, over-the-counter store brand allergy
Current Illness: Chest congestion with runny nose and cough
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: I noticed a large bump in my left armpit, which I realized was swollen lymph nodes. Today (6/7/2021) I noticed the swelling going down.


VAERS ID: 1377795 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-16
Onset:2021-06-04
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fatigue, Parosmia, Pulmonary congestion, SARS-CoV-2 test positive, Taste disorder
SMQs:, Cardiac failure (broad), Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bupropion, Nuvaring, fluticasone Nasal, Advair Diskus
Current Illness:
Preexisting Conditions: Frequent headaches, asthma, hypercholesterolemia, chronic neck pain, depression with anxiety, seasonal allergies, LGSIL on pap smear of cervix.
Allergies: Vicodin, environmental (unspecified)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received both doses of the Moderna COVID-19 vaccines, one on 1/19/21 and the second on 2/16. No lot number is located either in patient chart or state vaccine electronic registry (WIR). For location, there was only a number listed, "11029", on both entries. Writer will be unable to obtain any further vaccination information. Pt then tested positive after a trip. Pt was negative on 5/27/21, and then tested positive via PCR on 6/4/2021 at an outpatient drive through testing site. Pt reports chest congestion, altered taste and smell, and fatigue, since 5/31/2021. No other symptoms, pt was not ill enough to be hospitalized. Sample will be submitted via state testing for variant testing.


VAERS ID: 1377797 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Brain natriuretic peptide normal, C-reactive protein increased, Chest X-ray normal, Chest pain, Computerised tomogram head, Computerised tomogram normal, Computerised tomogram thorax, Dyspnoea, Electrocardiogram normal, Headache, Intensive care, Seizure, Troponin normal, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Dx studies: troponin, BNP, EKG, chest XR, spiral chest CT, head CT (all negative), CRP (elevated). EEG ordered. MRI likely.
CDC Split Type:

Write-up: Chest pain, headache, shortness of breath. Now with convulsive movements and periods of unresponsiveness. Work up for seizures and encephalopathy in progress. Dx studies: troponin, BNP, EKG, chest CT, head CT (all negative), CRP (elevated). Currently in Pediatric ICU and work up in progress (6/7)


VAERS ID: 1377799 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Malaise, Pallor, Presyncope
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: About 5 minutes into his post-vaccination observation, patient felt unwell and tried to get up to get help. We are on-site pharmacy located inside the Health Center. At the time, a nurse is monitoring patients at the observation area. He noticed the patient was pale and he reached over to grab the patient as he was about to fall/faint. The nurse took him back into one of the patient''s room. His blood pressure was very low. Patient was given 2 boxes of apple juices and some Gatorade. He rested for another 30 minutes and he felt better. Then he left.


VAERS ID: 1377874 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: Patient had a skin reaction (cellulitis) after Moderna vaccine. After a discussion with physician and patient and pharmacy the patient was instructed to receive a Janssen vaccine


VAERS ID: 1377921 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-12
Onset:2021-06-04
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: Xarelto 15 mg, Rivaroxaban 20 mg tablet, losartan 100 mg tablet, atorvastatin 40 mg tablet, meloxicam 15 mg tablet. aspirin 325 mg delayed release tablet, one a day men''s vitamin
Current Illness: N/A
Preexisting Conditions: Vitamin B12 deficiency, Atherosclerotic heart disease of native coronary artery without angina pectoris, osteoarthritis of knee, major depressive disorder single episode moderal, metabolic syndrome, nonrheumatic aortic (valve) stenoisis with insufficiency, obstructive sleep apnea, actinic keratosis, type 2 diabetes mellitus without complications, hypertension
Allergies: None
Diagnostic Lab Data: Confirmed by ultrasound 06/04/21
CDC Split Type:

Write-up: Developed DVT of right leg


VAERS ID: 1377924 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

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

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

Write-up: Patient thought they were receiving Moderna vaccination, received Janssen vaccine instead.


VAERS ID: 1377933 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia, Asthenia, Basophil count decreased, Blood pressure decreased, Body temperature increased, Condition aggravated, Dysstasia, Eosinophil count decreased, Gait inability, Hereditary spherocytosis, Lymphocyte count, Mean platelet volume increased, Monocyte count decreased, Platelet count normal, Red cell distribution width normal, Reticulocyte count normal, Reticulocyte percentage normal, Vomiting, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: hereditary spherocytosis
Preexisting Conditions: hereditary spherocytosis
Allergies: nkda per our records however we do not have full profile
Diagnostic Lab Data: date: 6/4/2021: 10:08am WBC: 10.0 Reticulocytes: 7.81% Reticulocyte Abs: 0.30 RDW-CV: 12.7% RDW-SD: 53.2 platelets: 157 MPV: 11.5 lymphocytes, Abs: 0.24 monocytes, Abs: 0.38 Eosinophils, Abs: <0.03 Basophils, Abs: 0.03
CDC Split Type:

Write-up: did well acted right, felt right up until 5 AM this morning (6/4/21), she woke up throwing up over and over again, she couldn?t keep even a dissolvable Zofran down. $g I immediately contacted her Hematologist and he told me to take her to the E.R. $g blood disorder, ?Hereditary Spherocytosis? came to life, flared up. $ggot extremely sick, where she could not walk or stand by 8:00 am this morning, when we arrived at the E.R. she had to be placed in a wheelchair because she was so weak. $g Fluids, Pain medicine, Motrin, and nausea medication were given, plus rotating cool rags on her head to get her body temperature down. $g CBC, was off the charts, she has developed Anemia and was diagnosed this morning. $g blood pressure dropped to 91/42. $g I spoke with two hematologist on top of speaking with the 2 E.R. Doctors. $greached over 110% immunity if not more. $g Both Hematologist I spoke with plus the E.R. doctors determined she was at 100% immunity with just the first dose. $g Due to her reaction her Oncologist/Hematologist are communicating with other hematologist in the U.S. about a reaction of a ?12 year old pediatric patient with Hereditary Spherocytosis?, further research will begin according to the Director of Onoccologist/Hematologist in the next few weeks to help other pediatric patients with Heriditary Spherocytosis in the U.S., the main point of this research is determining that one dose of Covid vaccine reaches 100% immunity vs 2 doses which would be equivalent to ?2 doses plus 2 booster shots of Covid vaccine? to someone with hereditary spherocytosis. $g $g After 8 hours of going through this, she was able to walk and stand. She was back to her old self. $g If you can please reach out to CDC and let them know about a 12 year olds patient with Hereditary Spherocytosis reaction to second dose of Phizer Vaccine.


VAERS ID: 1377938 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Pelvic pain, Urinary tract infection
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: Multi vitamin, probiotic, chromium picolinate, ALA, d-mannose (preventive dosing)
Current Illness: None.
Preexisting Conditions: Occasional mild symptoms of UTI that would flare up this spring after antibiotic treatment for first UTI in a decade fall of 2020 - so using a doctor prescribed preventative dosing of d-mannose around travel, intense exercise, intimacy etc.
Allergies: Family history of red dye sensitivity, and cephlex (?) family of antibiotics. No personal experience. Personal sensitivity to some sunflower oil products. GF, dairy, sugar free - mostly Mediterranean diet.
Diagnostic Lab Data: Pending
CDC Split Type:

Write-up: Pelvic pain, increased UTI symptoms


VAERS ID: 1377950 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxyzine 25 mg qhs Zyrtec qhs Buspar 15 mg qhs Neurontin 600 mg t.i.d. *on Rinvoq, Arava, Plaquenil (all stopped 1 week prior to vaccine per doctor''s advice. Will resume taking it on June 11)
Current Illness:
Preexisting Conditions: chronic pancreatitis, lupus, ra, Sjogren''s syndrome. mctd, fibromyalgia, Raynaud''s, about a dozen spinal issues, anxiety/ptsd, migraines.
Allergies: PCNs, Cephlasporins, Naproxen, Percocet, Morphine, Steroids, Vancomycin, Reglan, Latex, adhesives of any kind, proteins in milk. Adverse reactions also to Lyrica, Fentanyl, wool, polyester
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache (still on day 4) & horrible itchy, hives (despite being on 2 antihistamines daily). Hives are on my face, neck, chest, & both arms. The incessant itching is keeping me awake at night. Nothing is helping.


VAERS ID: 1377959 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Hypoaesthesia, Paraesthesia, Pyrexia, Skin discolouration
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: back surgery 3 weeks prior
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The husband came to pharmacy to receive his COVID vaccine and informed us of his wife experiencing a possible adverse reaction from her Janssen COVID shot. He said the patient experienced fever of 101 and tingling/sharp prickling of the face the night of the vaccine and the following morning. She took an unknown fever reducer with success. The following day her legs began looking dark and bruised and she was numb and tingling in the legs. As of today (the next day), the bruising (dark color) has reduced and she only has slight numbness and tingling in the legs. He said she had back surgery 3 weeks ago so is unsure of the cause. We informed him that she should be taken to a doctor as soon as possible to rule out the possibility of blood clotting. He acknowledged and said they will discuss immediately when he gets home and either take her to the ER or keep a close eye on her and take her to PCP on Monday morning.


VAERS ID: 1377972 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-04
Onset:2021-06-04
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 6/4/2021-SARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: Pt developed SOB, presented to the ED and tested positive for COVID 19. She was admitted to inpatient care, non ICU.


VAERS ID: 1377973 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pt felt dizzy. Had a syncopal event. Recovered after 15seconds. VSS 118/79, HR 76, RR 16. Pt provided water and snack. Pt had not eaten. Pt stayed an extra 15mins/ Pt stable and discharged from vaccination site with mother.


VAERS ID: 1377993 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 6-4-2021 15:30. Subjective: This 17 y/o male pt presented to the vaccine administration site and was administered his first dose of the Pfizer Covid-19 vaccine. Prior to receiving the vaccine the patient had made a comment in regards to not liking needles. Following vaccine administration the pt stated that he began to feel dizzy and ?then things went dark.? The patient was seated vertically in a chair and had fallen forward onto the ground. Patient care was immediately administered and the patient was moved supine with his lower extremities elevated. The patient regained consciousness immediately and asked if he had ?fainted?? The patient then stated that he was very warm and had not eaten or drank very much today. The patient attempted to then sit up rapidly from a supine position causing him to have a second vasovagal syncopal episode. The patient was placed in a supine position following this and cold packs were administered as well as vitals were taken. The patient remained A&O X4 with a GCS of 15 for the remainder of patient contact. EMS was called and the patient was then transported with consent of his legal guardian to the nearest E.D. Objective: Pt was noted to have two consecutive vasovagal syncopal episodes following his first dose of the Pfizer Covid-19 vaccine. The patient stated he had not eaten or drank very much today. Assessment, PE,VS: The patient was noted to have a small abrasion to the right side of his face secondary to his glasses striking him after he had fallen. The patient''s BP was noted to be 100/60 mmhg with a pulse of 64. The patient was A&O X4 with a GCS of 15 following his two separate syncopal episodes. HEENT: All findings normal, pt?s pupils PERRLA at 4mm. Cardiac: Normal Pulmonary: Normal, however verbal respiratory rate control was advised to the pt. Abdomen: Normal, cold compress applied. Extremities: Normal, Cold compress applied. Plan: Pt was continuously monitored and transferred to EMS care for transport to the nearest


VAERS ID: 1378004 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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: Patient thought they were receiving Moderna Vaccine, received Janssen vaccine instread.


VAERS ID: 1378011 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-14
Onset:2021-06-04
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 6/4/21- SARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: tested positive for COVID 6/4/21


VAERS ID: 1378019 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Pallor, Passive smoking
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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 a 15 yo female. She came with her mother to get the 1st Pfizer vaccine. She was fine the vaccination room. However, after 15 minutes after the vaccine, she started to having a shortness of breath. Her face started to turn pale, she ended up passing out for 2 second which also led to 2-3 seconds of seizure. Two minutes after the event, she still look tired, mother ask to call 911. Paramedic came and check on patient as well as conducting a series of questions. After roughly 15 minutes, paramedic left and patient''s mother refused to transport to the hospital. Paramedic inform patient to check with pediatric as soon as possible. Patient looked okay and back to normal state.


VAERS ID: 1378021 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

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

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

Write-up: Vaccine was drawn up at 9:30 AM on 06/03/2021 and was administered to patient at 04:25 PM on 06/04/2021. Reached out to patient several times, phone number out of service. Contacted manufacturer and CDC for recommendation. If able to get into contact with patient, will recommend patient to come in and to get a re-dose of the vaccine in the opposite arm to ensure proper efficacy.


VAERS ID: 1378025 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Unknown       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? 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: "Pt received first dose Pfizer, immediately c/o dizziness and sweating after vaccination at approximately 2:57PM. Pt brought to triage area, NP and on-site clinic lead notified. Pt on recliner chair and was provided water, upon request. Pt denied SOB, chest pain, and any other abnormal sxs. V/S @ 2:57PM: BP - 125/74, HR - 82, RR - 22 Continued to monitor pt for approximately 30 min, and pt verbalized improvement to sx. V/S @ 3:35PM: BP - 132/66, HR - 79, O2 - 98% Pt denied experiencing any more abnormal sxs. Per NP instruction, pt okay to leave when comfortable. Pt verbalized that she is ready to leave clinic. Pt left in stable condition, stable gait. ED precautions provided."


VAERS ID: 1378038 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was brought to the triage area with c/o chest tightness, weakness, and mild SOB. No CP, non-radiating. VS taken: (1:47 PM) BP 141/97, HR 108, Resp 20, O2 sat 100 on R; (1:52 PM) BP 147/98, HR 106, Resp 18, O2 sat 100% on RA. Pt no in apparent distress, speaks in full sentences, mentating well. Nurse manager and attending MD at triage area to monitor pt. Advised pt to go to ED but pt refused. Pt stated that he will be fine and just need to go home and rest. ED precautions discussed. Pt verbalized understanding and signed AMA form. Pt left the triage area with no assistance, ambulating well, with steady gait.


VAERS ID: 1378059 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Back pain, Brain natriuretic peptide increased, Chest pain, Drug screen negative, Echocardiogram normal, Electrocardiogram normal, Fibrin D dimer increased, Full blood count normal, Hospitalisation, Hyperhidrosis, Metabolic function test, Pain, SARS-CoV-2 test negative, Troponin increased, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad), COVID-19 (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: asthma and obesity
Allergies: none
Diagnostic Lab Data: 6/5- EKG showed normal sinus rhythm. elevated troponin and d-dimer. CR and CTA of chest normal. UDS negative. Rapid Covid negative. CBC and CMP WNL. Elevated BNP 6/6- Echo normal. EKG normal sinus rhythm, still had elevated troponin, last troponin level was 426 before discharge
CDC Split Type:

Write-up: two days of recurrent sudden, severe, crushing right sided chest pain lasting 10 min to 3 hrs that occurred 2 days after second dose of covid vaccine. pain radiation to back presented to ED, found to have elevated troponin and d-dimer. also endorsed emesis and diaphoresis. Denies sob. discharged two days after hospitalization.


VAERS ID: 1378138 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-06-04
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), 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), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Acute kidney failure, unspecified


VAERS ID: 1378141 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: headache/tired/red spot/swollen(bee stin)


VAERS ID: 1378155 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Erythema, Headache, Pruritus, Pyrexia, Vaccination site pain, Vaccination site swelling, Vaccination site warmth
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: Covid-19
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling, itching, pain, burning, redness, and warm to the touch at vaccination site on upper left arm. Fever fluctuating between 100 and 102 lasting 3 days. Headache for 3 days. Chills on first day of symptoms lasting about 10 hours. Sporadic pain in center of chest on second day of symptoms lasting about 8 hours.


VAERS ID: 1378162 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blood glucose decreased, Dehydration, Hyperhidrosis, Hypoglycaemia, Pallor
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not aware
Current Illness: Not known
Preexisting Conditions: Asthma
Allergies: No known allergies
Diagnostic Lab Data: Blood glucose checked was ~63mg/dl
CDC Split Type:

Write-up: Patient appeared anxious when he came in to get vaccinated. He complained of not really wanting to get the vaccine, but was compelled by his employer. About 15 minutes after vaccination, he started sweating profusely, complained of dehydration, looked pale and asked to lay down. Ice pack was given to the patient and 911 was called. EMT checked his blood glucose and was found to be hypoglycemic. He was later transported to the ER by the EMT.


VAERS ID: 1378165 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-29
Onset:2021-06-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Magnetic resonance imaging abnormal, Myocardial infarction, Neurological symptom, X-ray
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI, CT, x-ray and bubble test
CDC Split Type:

Write-up: Heart attack, stroke like symptoms


VAERS ID: 1378179 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: "Janssen COVID-19 Vaccine EUA About 7 minutes after the patient received Janssen covid-19 vaccine, he started complaining about his throat feeling tight and difficulty breathing. I quickly give him one dose of epinephrine 0.3mg on the right thigh and about five minutes later he recovered. I requested to call 911 but the patient declined. I asked him to wait longer but he left .


VAERS ID: 1378183 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Electrocardiogram, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pt got transported by EMS to the ER but patient left er without being seen.
CDC Split Type:

Write-up: TRIAGE CALLED due to syncopal episode 1:31pm pt got administered 1st Moderna covid vaccine and immediately passed out. RN called triage immediately after at 1:31pm and doctor arrived at seen 1:32 pm. 1:33 pm EKG done NSR, BP 110/90 HR 78 (lowest was 37 HR), temp 98.3, O2 97%, Blood sugar 104. 1:38 pm 911 called Time of EMS arrival and transport pt is awake, alert, oriented. Of note, pt states she usually passes out during vaccinations.


VAERS ID: 1378186 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Needle issue
SMQs:, Medication errors (broad)

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

Write-up: During an injection procedure, syringe came dislodged from the needle. It was determined by the vaccinator that majority of the vaccine had been injected. No additional dose was given.


VAERS ID: 1378209 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Pruritus, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Vitamins. Pepcid AC
Current Illness: NKH
Preexisting Conditions: ASMA, Sinusitis
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Local Rash around the stomach area. Itching and reddish.


VAERS ID: 1378213 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bed rest, Fatigue
SMQs:

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

Write-up: Time: 3:00 PM Adverse event: Fatigue Treatment: bed rest for 8 hours Outcome: no longer fatigued


VAERS ID: 1378229 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, No adverse event, Pregnancy, Product preparation issue
SMQs:, Extravasation events (injections, infusions and implants) (broad), Normal pregnancy conditions and outcomes (narrow), Medication errors (broad)

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

Write-up: Patient was given an undiluted dose of Pfizer vaccine. Patient is currently pregnant, due 6/25/2021 with a scheduled induction on 6/14/2021 due to gestational diabetes. Patient has had no adverse reaction to undiluted vaccine as of 6/7/2021. Patient has been contacted and notified of the undiluted dose given, only report is soreness at the injection site on 6/5/2021 but much better today 6/7/2021.


VAERS ID: 1378245 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Flushing, Paraesthesia oral, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonidine and duloxetine per patient profile.
Current Illness: None reported.
Preexisting Conditions: Depression.
Allergies: NKA.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of facial flushing, tingling lips, and his throat feeling like it was tightening. Nurse administered 25mg IM Benadryl per clinic protocol. The reaction resolved after administration of IM Benadryl.


VAERS ID: 1378248 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Soreness, Fatigue, Headache, Sweats, Muscle Aches, Chills -- symptoms subsided within 24-48 hrs.


VAERS ID: 1378254 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Dizziness, Full blood count, Laboratory test normal, Troponin normal
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Past medical hx includes stroke (during pregnancy), pre-eclampsia, Dysphagia, Diverticulosis, Diverticulitis, Chronic Diarrhea, abnormal Pap Smear. Past surgical hx hysterectomy, appendectomy.
Allergies: Pt w/ hx of allergy to ammonia (anaphylaxis, SOB), Pollen Extracts (anaphylaxis), Iodinated Contrast Media (Rash), Bleach (SOB - Subjective SOB if smell cleaning products).
Diagnostic Lab Data: In ED, Troponin Negative x1, Panel 7 WNL, Hemogram w/ diff WNL, Chest XR unremarkable.
CDC Split Type:

Write-up: Pt and pt''s daughter were in triage area, post-vaccination (1st dose PFIZER), c/o dizziness and non-radiating chest pressure located in midsection of chest, at approximately 7:50PM. On-site NP and clinic lead notified. Pt denied experiencing SOB or any other new/abnormal sx. Pt denied hx of smoking or taking BP meds. Pt was offered and given water. V/S @ 750PM: BP - 150/102, HR - 86, O2 - 98% V/S @ 758PM: BP - 167/106, HR - 90, O2 - 99% V/S @ 800PM: BP - 160/102, HR - 90, O2% - 99% Continued to monitor pt. Pt denied experiencing improvement to sxs. V/S @ 810PM: BP - 155/95, HR - 97 Pt denied experiencing any improvement to sxs. ED precautions given. Pt was encouraged to see ED. Pt agreed and requested to be transferred to ED via w/c. Pt was accompanied by NP, RN, and pt''s daughter to ED. Report given to ED nurse.


VAERS ID: 1378275 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-06-04
Onset:2021-06-04
   Days after vaccination:365
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction, Hypoxia, Pain, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Facial swelling, Mild hypoxia, body aches. Anaphylaxis


VAERS ID: 1378278 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / IM

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

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

Write-up: Pt was reported to be "anxious and nervous" about receiving her first dose of Moderna vaccine "all day" by her husband. Pt c/o feeling nauseous 10 minutes after receiving vaccine and vomiting once in restroom after completing the required 15 minute observation period at vaccine site. Pt walked back into POD to be evaluated by writer (clinical lead), pt reported a headache after vomiting, denied any blood in her vomit. Denied any dizziness, chest pain, fever, chills, difficulty breathing, rashes, itching, difficulty speaking or swallowing, abdominal pain, weakness, numbness, tingling, or diarrhea. Pt was given water and evaluated by writer (clinical lead at site, and co-leads) and observed for and additional 30 minutes while obtaining history. Pt tolerated water PO and did not vomit in the presence of writer. Vital signs were stable and pt reported feeling "better". Physical exam was unremarkable: lungs clear, no increased work of breathing or accessory muscle use noted, airway patent, no facial, lip, or tongue swelling noted, no rashes observed, and abdomen soft and non-tender. Pt was discharged home from vaccine POD after evaluation completed. No additional vomiting or new symptoms were reported by pt or husband while still on the vaccine POD premises. Instructions provided to pt were to remain hydrated with clear liquids, advance to BRAT diet as tolerated, and pt instructed to go to ER if any new symptoms arise or anything worsens. Pt and family member emphasized understanding, and all questions were answered.


VAERS ID: 1378317 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-27
Onset:2021-06-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Chest pain, elevated troponin, suspected myocarditis


VAERS ID: 1378341 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Angiogram normal, Blindness unilateral, Computerised tomogram head normal, Computerised tomogram neck, Eye pain, Magnetic resonance imaging head normal, Optic nerve cupping, Retinal artery occlusion, Retinal oedema, Retinal pallor, Scan with contrast normal, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Glaucoma (narrow), Optic nerve disorders (narrow), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT Head and Neck with contrast and MRI/MRA were normal. Ophthalmology Physician diagnosed as arterial occlusion of ophthalmic artery despite patent arteries on imaging
CDC Split Type:

Write-up: Patient developed painful blurry vision in left eye that progressed to painless blurry vision in same eye within 24 hours after onset of symptoms. Patient had edematous and pale retina with swollen optic cup. Patient has had complete vision loss in his left eye since.


VAERS ID: 1378342 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-30
Onset:2021-06-04
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site bruising, Injection site erythema, Injection site induration, Injection site inflammation, Injection site pain, Injection site pruritus
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: No known drug allergies. Allergies: eggs, peanuts, dairy, white beans
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seven days following the immunization my arm began to itch and burn forming a 7cm x 5cm area of induration. This well demarcated area was maroon in color with bruising at 1 o''clock. I applied ice to the area, elevated my arm and took Tylenol 1000mg every 6-8 hours. The visible inflammation has subsided after 60 hours (2.5 days). My arm continues to burn and itch but is no longer indurated, or maroon. I am continuing to have dull headaches, beginning 5 days after immunization. No fever.


VAERS ID: 1378365 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500mg bid; duloxetine 60mg qam; simvastatin 40mg qpm, olmesartan 40mg qam; methocarbamol 750mg tid prn; nabumetone 500mg bid prn; omeprazole 40mg qam
Current Illness: none
Preexisting Conditions: diabetes, high blood pressure, fibromyalgia
Allergies: no known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient developed redness on her arm the morning following the vaccine. Patient waited through the weekend and called physician''s office on Monday 6/7/21 and was advised to go to the walk in clinic. Patient was seen by provider and was told cellulitis and given a 10 day course of augmentin 875mg.


VAERS ID: 1378395 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-30
Onset:2021-06-04
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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: ASA, CA, Diovan, Fish oil, Gentamicin-prednisolone, Insulin, Metformin, Multivitamin, Omeprazole, rosuvastatin, valsartan Vit C.
Current Illness: unk
Preexisting Conditions: diabetes, HTN, kidney disease
Allergies: none
Diagnostic Lab Data: COVID19 Detection BDMAX
CDC Split Type:

Write-up: breakthrough COVID 19


VAERS ID: 1378396 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-25
Onset:2021-06-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Retinal migraine, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), 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: N/A
CDC Split Type:

Write-up: 06-04-2021 developed headache and vision changes. Dx with occular migraine.


VAERS ID: 1378425 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fall, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (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: B12, Zrytec, Calcium x 4, Curamed, Super Adrenal Stress Formula by Dr. Wilson, Fish Oil, Adrenal C Formula, Tegretol XR 200mg bds, Singulair, DHEA, Strontium, estrogen/progestin combo, selenium 200mcg,
Current Illness: respiratory problems
Preexisting Conditions: Hashimotos Disease, Leaky Gut, Asthma, Allergies,
Allergies: multiple allergies: - oats, orange, walnut, pecan, peanuts, mushrooms, shellfish, egg yolks, - allergy tested- out of 91 needles she is allergic to 69 things - avalox, Biaxin, clarithromycin, doxycycline, erythromycin, Levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt developed chills and shaking the night after getting the vax. She took tylenol and went to bed. When she woke up she had chills and shaking. She got up to take another tylenol but her body collapsed and she fell to the ground stating she had no control over this. She had to lay and wait a little while before she could get herself up. She was weak the next day but feeling some better today.


VAERS ID: 1378446 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Hallucination, Hypoaesthesia, Malaise, Nausea, Pyrexia, Vasoconstriction, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C gummy?s
Current Illness: None
Preexisting Conditions: None
Allergies: Anaphylaxis with ketorolac
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fever, 104.1 Temporel thermometer, nausea vomiting, malice fatigue, lightheaded dizziness, hallucinations with the fever, Vasoconstriction that included numbness of hands and extremities. Fever exceeds the 48 hour mark only brought down by ibuprofen and acetaminophen alternating Q3 hours then bringing the fever down to 100.1 on average between doses


VAERS ID: 1378514 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-23
Onset:2021-06-04
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Appendicitis
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gabapentin, propranalol, omeprazole, Daisy (birth control), stool softener, Metamucil
Current Illness: none
Preexisting Conditions: lower back pain, knee pain
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Appendicitis appeared 2.5 months after 2nd dose.


VAERS ID: 1378523 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Disturbance in attention, Feeling abnormal, Headache, Hot flush, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Headache, Nausea, hot cold flashes, fever, dizziness, foggy thought and trouble concentrating


VAERS ID: 1378562 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Cardiac monitoring, Heart rate decreased, 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:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none known
Diagnostic Lab Data: EMTs checked blood glucose, heart rate, blood pressure. Heart monitor applied due to low heart rate.
CDC Split Type:

Write-up: Patient received vaccine and within 5 minutes he lost consciousness. He came to and was oriented to place and time. Called 911. He was monitored and refused to go to hospital. He left pharmacy about 30-45 minutes later and felt ok.


VAERS ID: 1378573 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-06-04
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 COVID


VAERS ID: 1378743 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #EW0187 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Glossodynia, Injection site induration, Pain, Pain in extremity, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin, Lisinopril-HCTZ, 81 mg Aspirin, Loratadine, Wixela 250, Restasis, Refresh, Vyzulta,
Current Illness: None
Preexisting Conditions: Asthma, hypertension
Allergies: Shellfish, perfumes, different scents/cleaning products,
Diagnostic Lab Data:
CDC Split Type:

Write-up: The left side of my throat started swelling around 2:30 pm, on Friday, ?June 4, although my breathing and swallowing were not impacted. I put a piece of hard candy in my mouth, hoping this would clear up. The area beneath my tongue on the left side began to be painful about 10 minutes later. This was evident whenever I swallowed or moved my tongue, such as in swallowing and speaking. (Note: these continued until 1:30 am; I tried to stay awake until it all dissipated but I felt drained and exhausted.) After 35 minutes I left the ?recovery? area, reported my symptoms and took a bottle of water. In my car I used my inhalant, finished my water and waited another ten minutes. The coolish water helped the swelling feel better. Once home I hydrated a lot with water, and found the cool water eased symptoms only if temporarily. As the night progressed the symptoms eased a little. When I awoke the next morning, Saturday, June 5, the swelling had gone down a lot and the under-tongue pain was much lighter. My arm, though, was achy when I moved my arm around but I did not feel the need to take pain relief medication. I continued to use and move my arm and the pain decreased. By the end of the night there was little discomfort, but the injection site muscles started to harden. Ar3 these all normal currencies?


VAERS ID: 1378754 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-29
Onset:2021-06-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram head, Computerised tomogram thorax abnormal, Deep vein thrombosis, Dizziness, Headache, Pain, Pyrexia, Ultrasound Doppler abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Vestibular 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: HTN
Allergies: None
Diagnostic Lab Data: CT Scan Head/CT Chest/US Leg
CDC Split Type:

Write-up: Headache, dizziness, pain, aches and fever. DVT in right leg causing extreme, unbearable pain. Has never had history of clotting.


VAERS ID: 1378756 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Feeling abnormal, Headache, Immediate post-injection reaction, Injection site pain, Lymphadenopathy, Pain, Sleep disorder
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: At time of injection I got an instant headache. Next day felt odd, headache still there, injection site very sore, noticed extremely puffy lymph nodes in left armpit. Took Tylenol 500mg, no help. That night armpit more puffy and noticed lymph?s in left side of neck were puffy, still had headache. Could not sleep on left side because of pressure of body on arm. Next day still had headache and even more puffy lymph?s in arm and sore, took 600mg ibuprofen, eased headache, took 1000mg Vita C. Later took another 600mg ibuprofen, headache went away. Overnight still too puffy and sore to sleep on that side. Next day took 1000mg Vita C, 600mg ibuprofen. Went to work, noticed in the afternoon that the puffy swelling had reduced a little and not tender in the armpit, Neck still the same.


VAERS ID: 1378760 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Pfizer COVID19 vaccine
CDC Split Type:

Write-up: Myocarditis


VAERS ID: 1378781 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: BP taken and was 100/69
CDC Split Type:

Write-up: pt fainted within a couple of minutes and then appeared to have a seizure (brought arms towards body), this was witnessed by patient''s mother. Vaccinator arrived and while talking to pt the same thing happened.


VAERS ID: 1378805 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Injection site pain, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Areds capsules 2 capsules daily Eye promise dry eye 2 capsules daily Blink gel eye drops two drops daily
Current Illness: Right eye ulcers
Preexisting Conditions: Dry eyes
Allergies:
Diagnostic Lab Data: No tests and no labs.
CDC Split Type:

Write-up: Headache and nausea at 3:00am on 04jun2021. No treatment given. Drank plenty of water throughout the day. Headache and nausea resolved approximately 8:00pm 04Jun2021. Left arm soreness at time of injection at injection site.


VAERS ID: 1378806 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Injection site erythema, Injection site reaction, Injection site swelling, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Supplemental vitamin D
Current Illness: Iron deficiency anemia, low vitamin D
Preexisting Conditions: n/a
Allergies: nkda
Diagnostic Lab Data: 1920 110/66 73bpm 14 99%
CDC Split Type:

Write-up: Patient is a 15 year old female who presents following administration of the second dose of Pfizer COVID19 vaccine in the left deltoid. Patient states that she developed a tender, pruritic, red rash at the site of the injection about 10 minutes following the administration. She relates that she also developed smaller red rashes on the left distal portion of the arm. She states that this did not happen with her first dose of Pfizer vaccine. She states she also feels slightly dizzy, but relates that she only at a grilled cheese for lunch and minimal water intake. She denies a history of anaphylaxis and denies allergies to medications, foods, other vaccines. She affirms a past medical history of low vitamin D (currently treated with supplemental vitamin D gummies) and low iron (untreated). She further relates that she had her tonsils removed about 1 year ago. She denies chest pain, difficulty breathing, swelling of the face/lips/tongue/throat, skin rash/itching, cramping abdominal pain, nausea, and vomiting. Exam (update as needed): GEN: Alert and oriented x 4, NAD. HEAD: NCAT EYES: PERRL, EOMI ENT: Ears normal, Nose normal, OP normal with exception of no tonsils noted, no evidence of angioedema NECK: Supple, without LAD. CV: RRR, no m/r/g PULM: Clear to auscultation bilaterally, no accessory muscle use ABD: Soft, no tenderness. SKIN: Skin warm and dry. 0.5mm ecchymosis noted 2 cm below the AC joint and in the correct anatomical position for IM injection. Roughly 5cm of erythema and edema of the left deltoid injection site. The area is mildly tender to palpation, but nonfluctuant. Two 0.5cm erythematous macules located on the left forearm that are nonfluctuant and nontender to palpation. MSK: FROM, MS 5/5 NEURO: Alert and oriented x 4, CN 2-12 grossly intact, no ataxia, gait steady Clinical Impression/Field Tx: Vaccine site reaction. Vital signs within normal limits. Physical exam otherwise normal. Gave patient 10mg OTC Zyrtec from her personal supply. About 30 minutes following administration, the vaccine site was significantly less erythematous and edematous. Patient did not develop any other symptoms. Patient felt comfortable leaving the site. Advised patient and parent that patient should take 25mg diphenhydramine PO once, once they arrive at home. Instructed patient to consult the patient?s PCP regarding the post-vaccination reaction. Patient instructed to go to emergency department should she develop chest pain, difficulty breathing, swelling of the face/lips/mouth/tongue/throat, worsening skin rash, or cramping abdominal pain with nausea/vomiting. Patient and parent demonstrated understanding of post-vaccination instructions. Medications administered: Patient self administered 10mg of Zyrtec. Disposition: Home


VAERS ID: 1379010 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Head discomfort, Headache, Impaired work ability, Pain, Pain in extremity
SMQs:, Dementia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin zinc, potassium, K-2, magnesium, and COQ-10
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Head ace the next day could not work, had to go home. Felt like my head had a lot of pressure. Body was aching really bad and my legs were also in pain. Got home and just took a nap, but felt like if I was not all there. Head was hurting so I took Advil every 8hrs on Friday. Saturday was better and head pressure went down, but most of Saturday I was recovering


VAERS ID: 1379024 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was administered 2nd dose on day 16. earliest date should be day 17


VAERS ID: 1379067 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspepsia, Electrocardiogram, Epigastric discomfort, Laboratory test, Troponin normal, X-ray normal
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: 64-year-old female with history of angina nitrates presents from vaccine clinic with chest pain slightly different than her classic chest pain. Also has history of fibromyalgia and chronic neck pain. Initial complaint was of epigastric discomfort and burning however given her history EKG obtained initial enzymes. EKG with some flipped T waves that have flipped back and forth in prior EKGs as well. She had a negative troponin. During her stay she had that pain resolved and that her chronic pain returned, this improved as well with nitro and morphine, EKG did not change on repeat and repeat troponin continued to be negative. Given patient''s history she is already on significant risk factor modification, is requesting to be discharged and I believe that close follow-up with her cardiologist is a reasonable plan given serial negative troponins. Low suspicion for PE dissection or other acute pathology. X-ray unremarkable.


VAERS ID: 1379529 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Feeding disorder, Feeling abnormal, Headache, Insomnia, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prozac magnesium vitamin b complex
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 6/4/21 at 9:20pm
CDC Split Type:

Write-up: symptoms: fever (up to 102) chills headache dizziness naesous body aches treatment: ibuprofen outcome: miserable, couldn?t sleep or eat and the fever wouldn?t break. the ibuprofen made the headache go away


VAERS ID: 1379530 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cardiac imaging procedure abnormal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Fatigue, Headache, Hyperhidrosis, Myocardial oedema, Pyrexia, Troponin increased, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not applicable
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/1/2021, EKG showed diffuse ST elevations. Echo done was normal . Troponin was intially 4.63 and trended up to 18.80. Cardiac MRI was done 6/5/21 which revealed edema.
CDC Split Type:

Write-up: Patient started having generalized weakness, fatigue, fever and headache after the second dose of his Moderna Covid-19 vaccine. These symptoms persisted throughout the next day. However, two days after the second Covid-19 shot patient developed severe chest pain that resulted in presentation in the ED. There was associated shortness of breath and diaphoresis. He was treated with Colchicine and Ibuprofen. He was also started on metoprolol because he had an 11-beat run of non-sustained ventricular tachycardia. He was discharged home on the fourth day to follow up with cardiology as outpatient.


VAERS ID: 1379720 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Full blood count normal, Heart rate increased, Metabolic function test normal, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Keflex 500mg BID
Current Illness: None
Preexisting Conditions: None
Allergies: Augmentin
Diagnostic Lab Data: Only CBC and CMP in ER which came back normal.
CDC Split Type:

Write-up: Nausea and vomiting started just after midnight, every 30 minutes, then increased to constant every 5 minutes by 0500. 0630 intractable and heart rate in 130s. Taken to ER where 2 boluses of fluids and Zofran given. 1200 she still could not get an ice chip down without vomiting and heart rate remained between 110-140. Admitted to pediatric floor for observation and fluids. About 1600 she was able to hold down spoonful of fluids. By 1900 she was totally back to feeling good and was able to hold down mac-n-cheese, ice cream, crackers with no nausea.


VAERS ID: 1379727 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-28
Onset:2021-06-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pustule, Rash, Rash pruritic
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: Amitriptyline 25mg, Topiramate 25mg, Sumatriptan 50mg, and Alprazolam 1mg
Current Illness:
Preexisting Conditions: Migraine headache, depression, anxiety
Allergies: no known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s husband reported that patient noticed on 6/4/2021 bumps and itchy rash on her stomach , side of torso, and back (not as prominent on back). Bumps and rash have grown in size and seem pustule and "zit-like". Patient will continue to monitor rash size and temperature. If any drastic changes in temperature or rash size/status, patient will seek medical attention.


VAERS ID: 1379741 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-29
Onset:2021-06-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Injection site bruising
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: I felt pain on the right side of my abdomen on June 4th. I see a bruise on the site on June 7th.


VAERS ID: 1379747 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Immediate post-injection reaction, Injection site pain, Wrong technique in product usage process
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Medication errors (narrow)

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

Write-up: Shot was placed too high on arm. Shot was given too high/too deep. Experience immediate intense injection pain. Likely pierced bursa. Improper and poor technique. Reported to administrator of shot and emt on site. 3 days later having shoulder pain.


VAERS ID: 1379750 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Electrocardiogram ST segment elevation, Laboratory test, Nasopharyngitis, Nausea, Red blood cell sedimentation rate increased, Troponin increased, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: none
Current Illness: mild cold symptoms started the day after the vaccine given-lasted for 2 days
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 6/7/2021: Troponin- 30; ESR- 35; CRP- 3.5; EKG- ST elevation; other labs from ER in process
CDC Split Type:

Write-up: Pt started with mild cold sxs the day after the vaccine. Then 2 days after the vaccine in the evening developed chest pain - mid sternal - when going to bad. Vomited x1 and pain resolved and fell asleep. Next day also with an episode of chest pain in the pm but more severe and also with n/v; took to ER but left before evaluation done bc pain resolved. The following day 2 more episodes of chest pain less severe. 5 days later sought care for follow up- EKG and labs abnormal so sent to ER for further evaluation.


VAERS ID: 1380226 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Insomnia, Nervousness, Oropharyngeal discomfort, Pain, Pain in extremity, Paraesthesia oral, Pharyngeal hypoaesthesia, Pyrexia, Throat tightness, Tongue disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (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:
Other Medications: vitamin E, Fish oil
Current Illness: None
Preexisting Conditions: Psoriasis on my feet=was not taking any oral medication, only topical and lotions
Allergies: Penicillin, amoxicillin, shellfish
Diagnostic Lab Data: None taken
CDC Split Type:

Write-up: A couple of hours or so after the second vaccine my body felt achy and feverish. Also started to get the chills and then a headache. The symptoms gradually got worse over the course of time, took a couple of Advil and went to bed. It was difficult to sleep as my legs ached so badly I could not get into a comfortable position. As the night progressed and and fell in and out of sleep, the pain and especially the chills and headache were unbearable. I woke up around 10-11 pm with my throat numb, feeling tight, my tongue was numb at the back and the front area of my tongue was numb and tingling. I was nervous and scared to go back to sleep. My family all asleep and did not want to unnecessarily awaken them. I put myself into an upright position for fear of anaphylaxis. Considered calling 911= but we live in a quiet community and waited to see if it got worse. I did not sleep all night, finally got some rest while sitting upright. The following day all the symptoms were there and fever, chills and body aches worsened. My temp was around 101. Drank a lot of water. Today, my throat does not feel the same. Feels like something is there but cannot describe the feeling. Have been tired these past couple of days. Not usual for me but cannot say it is due to the vaccine. I will comment in that I never had the chills so bad as I had experience with actually being sick. Was horrible.


VAERS ID: 1380687 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Breast cancer (Diagnosed in 2019, in remission since 2020)
Preexisting Conditions: Comments: no known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611869

Write-up: DIZZY; TINGLY ALL OVER BODY; LITTLE NUMBNESS IN TONGUE; NAUSEA; This spontaneous report received from a patient concerned a 40 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included in remission breast cancer, and other pre-existing medical conditions included no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: UNKNOWN) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021, the subject experienced dizzy. On 04-JUN-2021, the subject experienced tingly all over body. On 04-JUN-2021, the subject experienced little numbness in tongue. On 04-JUN-2021, the subject experienced nausea. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from dizzy, tingly all over body, little numbness in tongue, and nausea. This report was non-serious.


VAERS ID: 1381358 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (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: SERTRALINE
Current Illness: Abstains from alcohol; Non-smoker; Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210612348

Write-up: EXCESSIVE BLEEDING; This spontaneous report received from a patient concerned a other, Hispanic or Latino male of unspecified age. The patient''s height, and weight were not reported. The patient''s concurrent conditions included no alcohol, non-smoker, penicillin allergy. The patient experienced drug allergy when treated with clarithromycin for drug used for unknown indication. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: unknown) dose was not reported, 1 total dose was administered on 04-JUN-2021 to right arm for prophylactic vaccination. Concomitant medications included Sertraline (100 mg once daily) used for unknown indication. On 04-JUN-2021, the patient experienced excessive bleeding when he tried to cut his nails and scratch his beard but the bleeding did not stop. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from excessive bleeding. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0.20210612348-Covid-19 vaccine ad26.cov2.s -excessive bleeding . This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1381668 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-06-04
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaemia, Arthralgia, Blood albumin decreased, Blood culture negative, Blood fibrinogen increased, C-reactive protein increased, Complement factor normal, Culture throat negative, Culture urine negative, Fibrin D dimer increased, Haemoglobin, Joint swelling, Mycoplasma test negative, Peripheral swelling, Pyrexia, Rash, Respiratory viral panel, Sterile pyuria, Streptococcus test, Urticaria, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CRP elevated to 74, elevated D dimer, elevated fibrinogen, anemia from Hgb 14-$g10, albumin 2.7, sterile pyuria 25 WBC, normal complements, ASO titer, negative blood, urine, and throat cultures, negative respiratory panel for 15 pathogens, including mycoplasma (6/6-$g6/8/21 for all testing)
CDC Split Type:

Write-up: Fever, urticarial rash to face, neck trunk, and extremities, arthralgias and swelling to hands, feet, ankles, left knee and left elbow occurring 4 weeks after vaccine lasting for 4 days in hospital after 2 days at home. still resolving slowly


VAERS ID: 1381720 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood urine present, Micturition urgency, Pyrexia, Renal pain, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen, progesterone, vitamins D and B, fish oil, turmeric, calcium
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Urine test at 6:00 PM on 6/4/21 showed blood in urine. Waiting for culture to show if infection was present
CDC Split Type:

Write-up: Approximately 48 hours after my second Covid vaccine, I spiked a fever of 101.5 and had extreme kidney pain. Frequent urge to urinate. I ended up going into the doctor to have a urine test checking for a bladder infection. Blood was found in my urine. My doctor put me on an antibiotic. I have not had a bladder infection in over 20 years and I have never had kidney pain.


VAERS ID: 1381764 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / UNK - / IM

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

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

Write-up: patient misrepresented her age twice, once on registration then again when verbally asked.


VAERS ID: 1381807 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-13
Onset:2021-06-04
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Patient received first dose of COVID-19 vaccine (Moderna) on 4/13/21. The second dose of COVID-19 vaccine was Pfizer-BioNTech, which was administered on 6/4/21.


VAERS ID: 1381816 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-25
Onset:2021-06-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood triglycerides increased, Injury
SMQs:, Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Lipodystrophy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo loestrin, Paroxetine, Losartin, Lovastatin, Atomoxetine, Topamax, Melatonin, Omeprezole,
Current Illness: None
Preexisting Conditions: Elevated BP, Elevated triglycerides, Anxiety
Allergies: Oxycodone
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Continuous pain in joints and areas with old injuries


VAERS ID: 1381854 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-05
Onset:2021-06-04
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: C-reactive protein increased, Cardiac imaging procedure abnormal, Catheterisation cardiac normal, Chest pain, Dyspnoea, Dyspnoea exertional, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Myocarditis, Red blood cell sedimentation rate increased, SARS-CoV-2 antibody test, Troponin increased, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ESR -42 6/8/21 CRP 82 6/8/21 Troponin 2.23 6/8/21 Covid Spike Protein Domain Antibody $g250 6/7/21 Echo: 1. Normal global left ventricular systolic function. 2. Left ventricular ejection fraction, by visual estimation, is 55 to 60%. 3. Trivial pericardial effusion.
CDC Split Type:

Write-up: Chest pain, SOB, DOE Pt presented to hospital - transferred to university hospital - underwent LHC which was clean - Troponin rose to 2.23 - ESR, CRP elevated - active chest pain, EKG w/ diffuse ST elevation - myopericarditis - Cardiac MRI - colchicine/ibuprophen - developed NSVT, required beta blockade


VAERS ID: 1381895 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone 10 mg- 3 tabs X 3 days. 2 tab X 3 days, 1 tab X 3 days Benadryl OTC- 1-2 tablets every 4-6 hours Subutex 8mg- 1/2 tab every day
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash


VAERS ID: 1381939 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysphagia, Fatigue, Flushing, Headache, Hyperhidrosis, Incorrect dose administered, Lethargy, Respiratory symptom, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Chills-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: respiratory symptoms-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium, Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1381963 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0049C21A / 2 LA / IM

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

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

Write-up: Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild


VAERS ID: 1381969 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Anal incontinence, Blood test, Cardiac monitoring, Dizziness, Echocardiogram, Electrocardiogram, Heart rate increased, Loss of consciousness, Pyrexia, Slow response to stimuli, Urinary incontinence
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), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (broad), 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: EKG, Echocardiogram, Blood Work, Heart Monitor 6/4/2021
CDC Split Type:

Write-up: Fever the following morning. Then, 38 hours after shot: abdominal cramping, rapid heart beat, dizziness while laying in bed. Then, upon standing, passing out with loss of bowels and bladder and a tonic response.


VAERS ID: 1382003 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Pyrexia, Rash, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole
Current Illness:
Preexisting Conditions: pneumonia a couple years ago
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Complaining of chest tightness in the morning, then it progressed to pain, subjective fever, chest, rashes on arm and face, shivering. Feels throat is tightening.


VAERS ID: 1382008 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle spasms, Nausea
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: arms and legs are cramping feels nauseous, Tylenol 4:30am


VAERS ID: 1382028 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Impaired work ability, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Patient had severe left shoulder/arm pain around the site of injection that continued after injection, worsened by his physical job as a custodian, he had to miss work due to this for several days, still moderate/severely painful to complete physical tasks using the left arm 5 days later (today, 6/8/21)


VAERS ID: 1382035 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Patient denied.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Patient reported intermittent chest pain and numbness in her extremities that began approximately 12 hours after receiving the vaccine and ceased after 24 hours.


VAERS ID: 1382037 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-30
Onset:2021-06-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersensitivity, Pruritus, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES
Allergies: HE HAS A HISTORY OF ALLERGIES, AND food products also. but not to medications. ALLEGIC TO NSAIDS
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PT SAID HE GOT THE SHOT ON 5.30.21, HIS 2ND DOSE, THEN IN 6.4.21,, EARLY IN THE MORING, HE WAS FULL OF HIVES ON HIS ARMS ONLY. BOTH ARMS, THE PT TOOK SOME BENADRYL AND CORTISONE CREAM. IT RELIEF THE ITCHING. HE CAME TO THE PHARMACY ON 6.7.21, TO LET ME KNOW WHAT HAPPEN. HE SHOW ME HIS ARM AND IT WAS AL CLEAR. I TOLD HIM IF HE HAS A BREAK OUT TO FOLLOW WITH HIS DR IF THESE FLAIRS UP AGAIN. HE IS GETTING ALLERGY TESTED, HE SAID HE DINT CHANGED ANYTHING IN HIS DIET, OR NEW MEDICATIONS. ITS SEEMS IT WAS DELAYED HYPERSENSITIVITY REACTIONS TO COVID VACCINE


VAERS ID: 1382039 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram PR segment depression, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Myocarditis, Pericarditis, Troponin I increased, Troponin increased
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin I (initial): 0.519 ng/mL (6/4/21, 1021) (ref range <.034) Troponin I (peak): 31 ng/mL (6/4/21, 2321) EKG: Diffuse ST elevations w/ PR depression in aVR
CDC Split Type:

Write-up: Acute myopericarditis: chest pain, presenting w/ EKG findings of pericarditis and elevated troponins; improved w/ pain medications and supportive care; no significant complications at time of report (patient remains admitted for care coordination)


VAERS ID: 1382041 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Erythema, Fatigue, Hypoaesthesia, Pain, Paraesthesia, Pruritus, Pyrexia, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Chills, fatigue. fever(100.9), bodyaches. Redness, warmth, tenderness, itching, tingling and numbness in right arm and fingers.


VAERS ID: 1382048 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-06-04
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood lactate dehydrogenase normal, Blood uric acid normal, Differential white blood cell count normal, Full blood count normal, Lymph node pain, Lymphadenopathy, Metabolic function test normal
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MMR - 6 months old; rash
Other Medications: Budesonide nasal spray 2 sprays each nostril once daily Miralax prn
Current Illness: none
Preexisting Conditions: Allergic rhinitis Asthma
Allergies: EGGS
Diagnostic Lab Data: CMP, CBC with diff, LDH, uric acid obtained 6/7/21; all labs normal
CDC Split Type:

Write-up: Day 13 after Pfizer vaccine, patient felt a lump below clavicle on R side Saw Dr. 6/5 - per prescriber, ~ 1.5 cm lymph node subclavicle; tender, discrete, moveable No other lymph nodes of concern As of 6/8 - lymph node still same size


VAERS ID: 1382051 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, Hypoxia, Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (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 mom knew of
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: While giving a Pfizer Covid vaccine today, a patient appeared to be fine but after a few minutes suddenly passed out and had a short 3-4 second seizure on the ground. He did hit his head and appeared to be hypoxic. We called 911 immediately and informed store management. The paramedics asked him to walk off on his own power, but they did offer to escort the family to Hospital which I believe was accepted. His mother and sister were present too.


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