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From the 9/17/2021 release of VAERS data:

Found 711,579 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 2 out of 7,116

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VAERS ID: 1705291 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: On 9/16/2021 at 4:07pm patient and parents arrived to drive thru vaccination site requesting Moderna Covid-19 vaccines. After completion of consent forms, the nurse administered Moderna 0.5ml vaccine to patient''s left deltoid. Shortly after documenting, the nurse noticed the patient was 17yrs old and had received the Moderna vaccine. The nurse monitored the patient for 20 minutes without any signs of distress, hives, itching, redness or swelling noted. Patient denied pain or discomfort. Parents and patient were made aware that patient received Moderna instead of Pfizer vaccine for her age. Patient was seen by medical provider via telehealth visit on 9/16/21.


VAERS ID: 1705478 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: The patient arrived at the clinic w/ HHA w/most translation and interaction completed by HHA due to the patient''s limited language ability. The HHA and the patient were informed that Moderna covid-19 is given every Tuesday and Thursday. The patient and HHA want to proceed w/ vaccination. Questionnaires were screened and the patient received the first dose of Moderna w/ a 15 minutes observation. The patient completed the observation without any complication or discomfort and HHA were given the CDC vaccination card at the 15 minutes mark. The HHA returns one hour later without the patient and violently screams that the patient was not here for covid-19 vaccine instead the Flu shot. The HHA connected the patient''s daughter via phone and the daughter further explained that the patient had completed the covid-19 vaccination of Pfizer approximately 02/2021. The daughter reported no adverse reaction and was informed of the EUA signs and symptoms to monitor, when to call 911 and emergency contact for the provider given. The daughter was informed that such missed communication resulted in this event and department of health will be contacted and report such event. The Health and Department of Health Covid-19 hotline were both reported of the event. The daughter was told of what DOH had informed.


VAERS ID: 1705480 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / N/A OT / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injury associated with device
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: I have reported the accidental needle stick per company guidelines and will be going for blood testing for HIV and Hepatitis B on tonight 9/16/21.
CDC Split Type:

Write-up: I am a pharmacist, and I administered a Covid vaccine to a patient around 6:12pm. After administering, I pulled back the syringe and needle from the patient''s arm and accidentally stuck myself with the needle into the right fingertip of my index finger.


VAERS ID: 1705483 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Pain, Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient reports trouble/hurting when lifting arm after receiving second vaccination.


VAERS ID: 1705492 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ687AA / 1 RA / IM

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

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

Write-up: Approximately 5 minutes after receiving her covid vaccine, the patient was feeling unwell, dizzy, and lightheaded. She then lost consciousness for 30-60 seconds. The patient was assisted into a laying position on the floor and was provided with a pillow, ice packs, and a water bottle. The patient continued to improve over the next 10 minutes and we allowed her to sit on the floor while leaning against a wall. As she continued to improve, we allowed her to sit in a chair but asked that they stay in the pharmacy area a little longer for observation. Within 5 minutes of this the patient lost consciousness again and did experience some muscle rigidity, which was short-lasting, and the patient was assisted to the ground and the same interventions taken. The patient left in an ambulance out of an abundance of caution but required no further medical intervention. The patient is at home and well per a phone conversation later in the evening.


VAERS ID: 1705676 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: About 15 minutes after administration of the vaccine, the patient approached the pharmacy counter saying he felt dizzy and light-headed and he fainted seconds later. He was unconscious for only a second or two. He continued to lay on the ground for about 30 minutes until he felt okay enough to leave. Patient was advised to contact doctor in the morning and was told what symptoms to look for in case he needed to visit the ER.


VAERS ID: 1705680 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pharyngeal swelling, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: flu shot last year anaphylaxis
Other Medications: hydrocodone/acetaminophen
Current Illness:
Preexisting Conditions: Diabetes
Allergies: Keflex contrast
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was faint, light headed, throat swelling, had a history of anaphylaxis, gave epinephrine injection in left thigh, called 911 and ems took her to hospital


VAERS ID: 1705682 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), 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 was mis-administered second covid shot. Should have received moderna but was given pfizer. Sore arm is only reaction currently.


VAERS ID: 1705684 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-13
Onset:2021-09-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ataxia, Basal ganglia stroke, Dysarthria, Ischaemic stroke, Magnetic resonance imaging head abnormal
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Taking Probiotic, hydrocodone/acetaminophen, donepezil, omeprazole, warfarin, gabapentin, and losartan at the time of vaccination. Augmentin was started 9/15/21 (2 days after vaccine was given and 1 day before the adverse event).
Current Illness: Dental caries requiring root canal
Preexisting Conditions: Lupus anticoagulant with hypercoagulable state, deep vein thrombosis, dementia, hypertension, hypercholesterolemia, prostate cancer, radiation cystitis, neurogenic bladder, arthritis, idiopathic peripheral neuropathy, osteoporosis, sleep apnea
Allergies: None
Diagnostic Lab Data: MRI brain without contrast with acute left basal ganglia ischemic stroke 9/16/21
CDC Split Type:

Write-up: Acute left basal ganglia ischemic stroke confirmed on MRI. Presented with slurred speech and ataxia. Woke up the morning of 9/16/21 with symptoms after going to bed normal the night before.


VAERS ID: 1705687 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Unknown  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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:
CDC Split Type:

Write-up: patient received 2nd moderna vaccine and developed dizziness and fainted for a short period in front of pharmacy. Medical help was called. Patient''s blood pressure was low and he was pale, but no serious injury.


VAERS ID: 1705688 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3148 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Feeling hot, Flushing, Nasal congestion, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: PATIENT STATED THAT SHE HAD A HISTAMINE REACTION. WARM FEELING THROUGH WHOLE BODY, TURNED RED AND FLUSHED, SORE THROAT, AND CONGESTION. PATIENT TOOK BENADRYL WHICH HELPED RESOLVE ISSUES.


VAERS ID: 1705693 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-15
Onset:2021-09-16
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 RA / IM

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

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

Write-up: admitted to hospital for supportive care


VAERS ID: 1705940 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Rash, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 . I?m healthy
Allergies: None
Diagnostic Lab Data: No tests at this time
CDC Split Type:

Write-up: Arm is sore with a rash and it?s hot and swollen.


VAERS ID: 1705958 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Feeling hot, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadedness-Mild, Systemic: Nausea-Mild, Systemic: Weakness-Mild, Additional Details: Rph Iman gave vaccine, approx 5 min later pt stated feeling nauseous, tired and warm. Pt was instructed to elevate feet. 1st BP was taken (67/34) HR 62. 10 min later 2nd BP was taken (97/50) HR 80 and pt stated feeling better and left with no side effects.


VAERS ID: 1705960 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301301A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: pt recovered and left after 15 min


VAERS ID: 1705965 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Hypertension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Hypertension-Severe


VAERS ID: 1705966 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Hypotension, Mydriasis, Pallor, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: pupils got dilated and pt stated he couldn''t see. BP runs low and skin got pale-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Visual Changes/Disturbances-Medium, Additional Details: by the time when 911 arrived, his skin came back normal and reported that he was able to see. He was concious whole time. this happened for about 20 min until he got back to normal status.


VAERS ID: 1705968 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

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


VAERS ID: 1705969 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E2WT / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Breast pain, Cough, Headache, Insomnia, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Lipodystrophy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Left arm very sore, radiating pain down to breasts, painful joints, headache, coughing, insomnia.


VAERS ID: 1706453 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-11
Onset:2021-09-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dysmenorrhoea, Dyspnoea, Headache, Heavy menstrual bleeding, Postmenopausal haemorrhage, Rash
SMQs:, Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Joint pain, headache, rash, trouble breathing, and unexpected period with heavy flow and pain. (Menopausal woman without period for almost a year now.)


VAERS ID: 1706909 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-15
Onset:2021-09-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I woke up with sores on roof of my mouth.


VAERS ID: 1707999 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Dizziness, Flushing, Headache, Hyperhidrosis, Hyperventilation, Nausea, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium, Systemic: Hyperventilation-Medium, Systemic: Nausea-Medium, Systemic: Tachycardia-Severe


VAERS ID: 1708002 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 LA / IM

Administered by: Pharmacy       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: Error: Booster Given Too Early-


VAERS ID: 1708004 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Tachycardia-Severe


VAERS ID: 1708005 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Hypertension-Severe, Systemic: Tachycardia-Severe


VAERS ID: 1708024 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Additional Details: PT PASSED OUT SOON AFTER VACCINE STAYED IN CHAIR DID NOT FALL CAME TO IN A FEW SECONDS


VAERS ID: 1699852 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Burning sensation, Chills
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 9 hours late, woke up with intense chills, temp that got up to 103, eventually turned in feeling of body on fire


VAERS ID: 1699875 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3183 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Nausea, Pyrexia, Skin warm, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar to current symptoms, much more mild. 19 years old. Reaction to first Covid 19 dose.
Other Medications: birth control zyxol
Current Illness: no
Preexisting Conditions: n/a
Allergies: seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever of 103, shaking, chills, uncontrollable nausea, hot skin.


VAERS ID: 1700063 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Anxiety, Breast tenderness, Confusional state, Depression, Dizziness, Dysmenorrhoea, Dyspnoea, Fatigue, Feeling cold, Heart rate increased, Heavy menstrual bleeding, Hot flush, Insomnia, Mood swings, Rash
SMQs:, Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Fertility disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu shot - extrememly sick had to go to hospital
Other Medications: singular proair
Current Illness: none
Preexisting Conditions: after I got the vaccine I am having female issues ( extremely long periods/anxiety/depression...), light headedness and confusion . I also had breathing issues, fast heartbeat slight rash was extremely tired but couldnt sleep thru night for the first couple weeks after the shot but that has gone back to normal. Pharmacy told me these were normal symptons and if didnt go away to go to my doctor which is what I did. My doctor has put me on medicine to help with the female issues.
Allergies: bioxin eggs poultry & bees slight allergy to latex and dairy
Diagnostic Lab Data: Pharmacy said normal symptons and if doesnt go away to talk to my doctor He put me on medication and also did blood test. I was pre-diabetic and now I am type 2 diabetic.
CDC Split Type:

Write-up: put this in previous spot......rash fast heartbeat light headedness confusion, went from almost no periods to long painful periods, tender breasts, breathing issues, depression, anxiety, mood swings, hot/cold flashes,


VAERS ID: 1700110 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Nausea, Pain, Pain in extremity, Tinnitus, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tri-Lo-Mili birth control, Dextroamp-Amphet ER 30 MG,
Current Illness: Non
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: My entire left arm started to throb at 1:00am. I then started to get nauseous and vomited. After I vomited I was walking to the couch and started to feel very light headed and my knees were starting to buckle and my ears were ringing. I felt like I was going to pass out. I laid down and went to sleep. When I woke up at 7:00 am my entire left arm was sore all the way to my wrist and the soreness was going to my shoulder down my left side all the way down to my thighs. My entire left side is sore. I am also having stomach cramps.


VAERS ID: 1700134 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi-vitamin, vitamin E
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I was on a backpacking hike on the AT and had a great hike the evening before the event. The next morning, I couldn''t hike more than 5 steps up all the gentle inclines & had to stop & try to catch my breath. This happened throughout the morning until I was able to get off trail. I am a former ultra marathon runner & long distance hiker. I''ve hiked the trails at high altitude & snowy passes without ever having an issue such as this one. The next day, I was able to continue unimpeded. A very strange occurrence. I''m late in reporting this, as I originally didn''t attribute this to the vaccine, but now feel this may be the contributing factor.


VAERS ID: 1700187 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Dizziness, Immediate post-injection reaction, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Covid 19 first dose, disclosed swelling of throat with dose 1 after the second dose was given and reaction started
Other Medications: None
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Reaction including dizziness, vomiting, loss of vision immediately after vaccine. Called EMS and sent to local hospital.


VAERS ID: 1700189 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

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

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

Write-up: Dose of Pfizer given mistakenly in a patient whose first dose was with Moderna (5/7/21). Instructed patient to not pursue any additional doses of mRNA vaccine unless he meets indication for 3rd dose.


VAERS ID: 1700198 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: Atorvastatin, EC ASA, niacin, vit c , vit d3, zinc
Current Illness: N/A
Preexisting Conditions: hypercholesterolemia
Allergies: thimerosal
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: tinnitus


VAERS ID: 1700214 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 LA / IM

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

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

Write-up: 1007a c/o headache, lightheaded, BP 143/89 P 80 1022a BP 134/78 P 75 1024a placed in recliner 1033a Bp 142/87 P 74 pt reports feels like this when he gets a migraine 1035a ambulated to Exit with (Security)


VAERS ID: 1700231 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Musculoskeletal chest pain, Pain in extremity
SMQs:, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Ibuprofen
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: I was fine the same night, my arm was getting sore. But about an hour after I woke up, my left side below the ribs started getting extreme pain. It still hurts after 3 hours, it?s knocked me to my knees a few times. I took tylonel an hour ago and it hasn?t helped at all.


VAERS ID: 1700268 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-31
Onset:2021-09-15
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament 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:
Current Illness:
Preexisting Conditions:
Allergies: Penicillins
Diagnostic Lab Data: none yet, referred her to PCP
CDC Split Type:

Write-up: Painful, swollen left arm


VAERS ID: 1700272 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Palpitations, Tinnitus
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hearing impairment (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: Diazepam, levothyroxine, baclofen, Hydroxyzine
Current Illness:
Preexisting Conditions: Graves disease, Fibromyalgia, Hepatitis C (treated)
Allergies: bactrim
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Ringing ears within 10 minutes after vaccine given and lasting an hour. Started feeling out of breath at 11:30 am 9/15/21 and like my heart is racing.


VAERS ID: 1700273 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-31
Onset:2021-09-15
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Headache, Hypoaesthesia, Nausea, Pain, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Extreme body pain, shaking, chills, fever, nausea, headache, numb legs and a feeling that something is "off"


VAERS ID: 1700278 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Nausea, Pharyngeal swelling, Tachycardia, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (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 (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Pt c/o feeling like "throat swelling" and difficult to swallow approx 5 min after receiving vaccine. Also c/o nausea, tachycardia and shaking.


VAERS ID: 1700302 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient received first Moderna COVID Vaccine on 8/30/2021, Patient received 2nd dose today 9/15/2021 earlier than the recommended 28 day interval for COVID vaccine.
Current Illness: None.
Preexisting Conditions: COVID-19 4/2021.
Allergies: NKDA/NKA.
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: No adverse event occurred, patient observed for 30 minutes. Patient received Moderna Covid-19 vaccine 2nd dose on day # 16 instead of recommended date of day #28


VAERS ID: 1700361 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

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

Write-up: Patient was given Pfizer for the second dose, instead of Moderna.


VAERS ID: 1700384 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

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

Write-up: Dizziness and Vertigo. Began upon waking and has continued throughout the day.


VAERS ID: 1700403 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyst, Pain in extremity
SMQs:, 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: Metformin tumeric
Current Illness:
Preexisting Conditions: DM
Allergies: Sulfa, Green and red peppers
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: I woke to pain in hands. I have cysts on right hand to third and fourth fingers on palm to left hand and on on right hand4th finger palm. Left arm pain.-


VAERS ID: 1700419 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / SYR

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

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

Write-up: One day after the shot a developed a large lump in my left arm bit. The lump was painful. It still has not subsided. I contacted the pharmacy and they knew not of any side affects regarding lumps in the arm pits. I subsequently looked online and read a article talking about swollen lymph nodes. I can?t believe that the people who are given the responsibility of injecting this poison into peoples bodies don?t know the current side affects or have any treatment options other then call your doctor.


VAERS ID: 1700422 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaccine positive rechallenge
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: 31, MODERNA, 8/13/21
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: CEFZIL
Diagnostic Lab Data:
CDC Split Type:

Write-up: AFTER ADMINISTERING THE INJECTION I IMMEDIATELY SAW A RAISED AREA ABOUT THE SIZE OF A QUARTER WHERE THE INJECTION WAS GIVEN. THE PATIENT STATED THAT HIS ARM WAS NUMB IN THE INJECTION ARM. HOWEVER, HE STATED THAT THIS HAD OCCURED WITH THE FIRST VACCINE AND IT LASTED TWO DAYS.


VAERS ID: 1700448 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Memory impairment, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 25 mcg 1/day Lovastatin 40 mg 1.5/day Zetia 10 mg 1/day Letrozole 2.5 mg 1/day Losartan 25 mg 1/day Aspirin (costed) 81 mg 1/day Calcium 600 mg 2/day Vitamin D3 2000 IU 1/day
Current Illness: none
Preexisting Conditions: Had bypass surgery in 2012. Being treated Breast Cancer since Dec 2017. Generally healthy.
Allergies: Lipitor causes skin rash
Diagnostic Lab Data: none, so far.
CDC Split Type:

Write-up: Fainted at 7:45am on 9/15/2021. She lost total control. I (husband) happened to be near by and held her. After 45-60 seconds I took her to sofa and she lied down for about 10-15 mins. During the time she was sweating a lot. After that no issues so far. She does not remember 45-60 second period at all.


VAERS ID: 1700517 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arrhythmia, Blood test, Electrocardiogram, Palpitations, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pred-Forte ophthalmologic use
Current Illness: NA
Preexisting Conditions: Asthma
Allergies: Penicillin
Diagnostic Lab Data: EKG, blood tests performed. Awaiting results of blood tests.
CDC Split Type:

Write-up: Less than 48 hrs post vaccination, patient awoke at 1AM with heart racing at 188bpm for 10 minutes, then continued to have tachycardia or arrhythmia event for 1 hr. Patient visited her healthcare provider the morning after to report event and to be evaluated.


VAERS ID: 1700579 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, Tachycardia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: adderal 15 mg daily, nuva ring, (BCP)
Current Illness: none
Preexisting Conditions: palpitation when 4-8 yo. saw physician and was told to stop caffeine. resolved since a child.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Awoke with swollen upper lip and is having intermittent tachycardia to the 130''s at rest. Has taken Benadryl. Lip looks a little better now at 2:25 PM than this AM. Slightly scratchy throat. Has no allergies to meds, foods etc.


VAERS ID: 1700597 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Feeling cold
SMQs:, Anaphylactic reaction (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: CLONAZEPAM, 0.5 mg
Current Illness: None
Preexisting Conditions: None
Allergies: Tylenol 3
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Anxiety, cold feeling on chest.


VAERS ID: 1700602 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Eye swelling, Eyelid oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: na
Preexisting Conditions: unknown
Allergies: nka
Diagnostic Lab Data: NONE; PATIENT WENT TO PCP TO BE SEEN AND TREATED.
CDC Split Type:

Write-up: SWELLING TO LEFT EYE LID AND LOWER LID INCLUDING A POCKET OF FLUID UNDER THE LEFT EYE.


VAERS ID: 1700616 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 RA / IM

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

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

Write-up: After giving patient his first COVID vaccine, he fainted. He was only out for about five seconds, but was weak and had low BP upon awakening. We gave ice packs, he sipped on water, then orange juice. We then laid him down on yoga mat and elevated feet to help blood pressure recover. Initial BP was 91/37, then 76/32. After lying him down in floor BP increased to 119/67, then 120/71. He declined going to the hospital. After about 20-25 minutes, he said he felt fine and left.


VAERS ID: 1700629 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Head injury, Joint injury, Loss of consciousness, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient passed out less than 1 minute after receiving the shot - she said her arm begin to tingle and her vision went out. She hit her head and elbow on the floor. We called emergency services and provided first aid till they arrived.


VAERS ID: 1700639 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Joint lock, Muscle spasms
SMQs:, Dystonia (broad), Hypersensitivity (narrow)

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

Write-up: Pfizer vaccine was given in the right deltoid. Almost immediately after receiving the pfizer dose 1 in pts left arm, pt felt arm lock up and he could not extend his arm from the elbow. After about 10 seconds, he regained use of his arm and was able to shake his arm around. Pt also complained of muscle spasms in his shoulder a few minutes later. After waiting 15 minutes in the waiting area, pt said he felt fine and was left under his own power without complaint.


VAERS ID: 1700659 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Oropharyngeal pain, Paraesthesia oral, Tinnitus, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirizine 10mg PO daily Saline Nasal Spray daily PRN Clear Eyes eye drops daily PRN
Current Illness: N/A
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Three minutes after receiving vaccine patient experienced ringing in ear for approximately one minute, dizziness, blurry vision. These symptoms all resolved after four minutes. She then began to experience sore throat and tingling around her mouth which lasted five minutes. All symptoms resolved after 10 minutes. Vital signs stable. No other complaints or issues voiced. No rapid weak pulse, difficulty breathing, shortness of breath, wheezes, stridor, pain with swallowing, cough, chest pain, palpitations, nausea/vomiting, confusion, hives, itchiness, flushing of skin, swelling of lips/tongue, runny nose, or swelling of conjunctiva.


VAERS ID: 1700663 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia oral, Pruritus
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: singulair, gabapentin, hydrocodone, xolair, estradiol
Current Illness:
Preexisting Conditions: osteoporosis, neuropathy, chronic pain syndrome, bipolar disorder, fibromyalgia
Allergies: penicillin, azithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving vaccine, patient reported an "odd feeling" in her tongue and itching all over.


VAERS ID: 1700677 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Hyperhidrosis, Loss of consciousness, Nausea
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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: not aware of any illness
Preexisting Conditions: hypothyroidism
Allergies: augmentin allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within just a few minutes patient(nurse) leaned back in chair and appeared to pass out(while seated the entire time)- came to in just a few seconds and was confused and slightly upset and began sweating. WE fanned pt and got her a bottle of cold water, wet paper towel and cold pack for her neck. (pt also requested a Sprite and saltine crackers while waiting on her ride-which we provided to her) Two associates stayed in the booth with pt until 10:56 when she felt better (then just one associate stayed with her) and was just waiting on her ride to pick her up. Pt blood pressure was 107/65 with pulse rate 65. Pt was refused ambulance multiple times. Pt left feeling better with her ride around 11:20. Called pt around 1:21 pm and she stated that she was doing her homework and felt better but was still experiencing slight nausea off and on $g


VAERS ID: 1700680 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0193 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Breast pain, Lymph node pain, Pain, Pain in extremity
SMQs:, Lipodystrophy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Extreme pain in left shoulder. Left first or pointer finger...achy felt sprained. Throbbing pain in left forearm before elbow. Pain in left armpit/breast/lymph nodes. Pain in lower left leg, through knee and thigh.


VAERS ID: 1700690 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 - / IM

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

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

Write-up: Tachycardia resting heart rate 125


VAERS ID: 1700703 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0114214 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax, Echocardiogram, Fibrin D dimer, Musculoskeletal chest pain, Pericardial effusion
SMQs:, Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (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: none
Allergies: sulfa
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: Developed chest wall pain along with stabbing pain LLLobe that lasted a week before I saw MD. Had positive Ddimer. CT chest showed moderate peri-cardial effusion. Confirmed on echocardiogram. After seeing cardiologist and rheumatologist there is no answer as to why this occured. Thats why I thought it should be reported since I am otherwise a very healthy person.


VAERS ID: 1700735 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Rash erythematous
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: Unknown
Other Medications: Multi vitamin, fish oil, vitamin D, Singulair, Flonase, Zyrtec
Current Illness: Heart fluttering from the first Covid dose on 8/12/21
Preexisting Conditions:
Allergies: Clindamysin
Diagnostic Lab Data:
CDC Split Type:

Write-up: When I woke up this morning (9/15/21), I noticed a large red rash around the injection site-above and below the injection site . I looked online and found that this is what?s called ?Covid Arm.? I went to the pharmacy, and the pharmacist said it will last 7-10 days.


VAERS ID: 1700748 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, 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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient is not taking any medications
Current Illness: None
Preexisting Conditions: Arrhythmias
Allergies: patient is not allergic to anything
Diagnostic Lab Data: No medical study was performed
CDC Split Type:

Write-up: 48 year old patient female comes to center for her first dose of PFIZER Lot FF2589, it is administered at 2:37pm by agent. Patient at 2:43pm refers feeling dizzy and at 2:45pm she lost consciousness, quickly the paramedic takes vital signs.


VAERS ID: 1700749 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP: 158/90, HR: 96% , RR: 24 BP: 138/90, HR: 100%
CDC Split Type:

Write-up: Patient stated that she was experiencing body itching that comes and goes.


VAERS ID: 1700759 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Unknown  
Location: Iowa  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Eye swelling, Lip swelling, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: buspar zoloft
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: tingling and swelling of eyes and lips


VAERS ID: 1700784 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM

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

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

Write-up: Patient feel a bit dizzy after vaccinated. Feel better after 5 minutes and cleared.


VAERS ID: 1700793 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site pain, Pain, Pyrexia, Sluggishness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, body aches, pain at the injection site, sluggish


VAERS ID: 1700802 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / IM

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

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

Write-up: Patient stated arm was numb and tingly


VAERS ID: 1700809 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

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

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

Write-up: Patient was given his second Moderna vaccine 3 weeks after his first dose instead of 4 weeks.


VAERS ID: 1700840 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN A20121A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Feeling hot
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: Lightheaded, hot, elevated blood pressure


VAERS ID: 1700844 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: Valsartan, Pantoprazole, Levothyroxine
Current Illness:
Preexisting Conditions: Lupis
Allergies: None listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out briefly in RPH arms, came to but was weary. Patient stopped responding for a moment. EPI was administered. EMS took patient away.


VAERS ID: 1700852 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Global wellness immunoshield; Vitamin c 1,000mg
Current Illness:
Preexisting Conditions: Hyperthyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right jaw swelling and numbness.


VAERS ID: 1700853 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Anxiety, Dizziness, Dyspnoea, Nausea, Rash
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), 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: Birth control pills, topical eczema cream
Current Illness: None
Preexisting Conditions: Eczema
Allergies: No known allergies
Diagnostic Lab Data: Vitals : 10:15 AM - BP 142/88, HR 133, SPO2 99% 10:45 AM - BP 112/76, HR 106, SPO2 99%, BGL 86
CDC Split Type:

Write-up: Approximately 20 minutes after inoculation, patient reported feeling extremely anxious, dizzy, nauseous and reported difficulty breathing. Pt was assessed and vitals obtained : BP 142/88, HR 133, SPO2 99%. Pt was AOX4, had clear and equal lung sounds, no swelling/obstruction of airway visible. Pt had small eczema rash on the inner elbow (she stated this was present the night prior) but no other skin issues/hives present. No discoloration, swelling, or other abnormalities present at injection sight. Pt was also assessed by RN (school nurse), Fire Department, and Personnel. Pt stated she believed these symptoms to be stress-induced and psychosomatic in nature. Pt was coached to slow her breathing and she called her mom on the phone for some comfort. Vitals at this time as follows : BP 112/76, HR 106, SPO2 99, BGL 86). Risks and benefits of transport explained to Pt, she refused transport and was picked up and taken home by family.


VAERS ID: 1700858 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Peripheral swelling, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Multivitmins
Current Illness: None
Preexisting Conditions: None other then allergies
Allergies: Albuterol, amoxicillin, anethesia, celebrex, keflex, clindamycin, codeine, demerol, doxycycline, flonase, Morphine, Nasonex, Niacin, Rhinocort
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of the arm and vomiting and headache and nausea


VAERS ID: 1700867 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Within minutes after receiving the vaccine, the patient became dizzy, lightheaded and had blurred vision. Additionally, her skin tone was pale and she was sweating. At roughly the 5-10 minute mark, her blood pressure was 120/80. I gave her an ice pack to place on her forehead and neck. As she started to feel better, I gave her crackers to snack on. After about 40 minutes, she stated that she was doing much better and left with her fiance.


VAERS ID: 1700895 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-11
Onset:2021-09-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), 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: none provided
Current Illness: none
Preexisting Conditions: none provided
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient noticed swelling in left arm down to the hand 9/15/21


VAERS ID: 1700901 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Feeling cold, Feeling hot, Headache, Limb discomfort, Malaise, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: After the 2nd dose of Moderna vaccine, I was exhausted for about two weeks.
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin, keflex
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Moderna COVID?19 Vaccine EUA? I did errands after the shot and noticed my legs felt heavy. Kind of achy (head, muscles) when I went to bed. I took 3 ibuprofen and slept. Late in the morning on 9/15, I was chilly, achy, and felt sick to my stomach, with a temp of 100.7. Took a nap after lunch, hot. Temperature was 100.4 when I woke up. I took two ibuprofen and am drinking some water


VAERS ID: 1700903 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Lymphadenopathy, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil, Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: Shellfish
Diagnostic Lab Data: Will go to urgent care/ER if they continue to get bigger OR do not go down within a few days.
CDC Split Type:

Write-up: Supraclavicular lymphadenopathy on my left side (same side as injection site) I have 1 large swollen bump and 2 smaller ones just above my clavicle bone. Red, and sore they hurt to the touch.


VAERS ID: 1700905 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Other       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 received Moderna on 1/8/21 and 2/5/21 at a separate vaccination clinic. Patient received Pfizer 3rd dose on 9/15/21. Nurse vaccinated patient before forms were given to screener and submitted to check-in to be put into system; thus, it was missed that patient received Moderna instead of Pfizer. We informed patient of the mistake and how there currently is no evidence on mixed vaccination series and to look out for signs and symptoms that would require immediate medical attention such as difficulty breathing, wide spread rashes, fainting, chest pain, swelling, etc.


VAERS ID: 1700912 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Erythema, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: NONE
Allergies: UNKNOWN
Diagnostic Lab Data: BP taken at 4:17 pm and was 126/99.
CDC Split Type:

Write-up: Patient lost consciousness. He began struggling to breathe and turned very red. He was audibly gasping for air. An epi-pen 0.3 mg was administered to the right leg. He resumed breathing and laid down on the ground.


VAERS ID: 1700913 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: syncope, vomiting


VAERS ID: 1700917 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Heart rate decreased, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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:
CDC Split Type:

Write-up: Shortly after receiving vaccine the patient began feeling healrt racing. Took BP and HR. BP was 137/97 and HR originally was 117 @9:57, then quickly began to drop. @9:59 HR was 85. Received water and a granola bar and was monitored.


VAERS ID: 1700924 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Previous stroke in past
Preexisting Conditions: none
Allergies: Aspirin, milk, fish-derived, clavulanate acid
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Tingling and numbness of gums and palate after 10 minutes of administration. After 25 minutes she stated that it was diminishing.


VAERS ID: 1700952 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: 1707 patient sat down in monitoring area after vaccination. 1737 patient left after 30 minutes of monitoring (was being monitored for half an hour due to Zithromax allergy that results in itching and rash) 1750 patient came back to monitoring area reporting tingling in left face, left arm, and left leg. Vital signs taken by LPN. BP 171/91. O2 sat 100% on Room Air. Pulse 70. Respirations 19. 1753 Ate 2 graham crackers and drank 711 ml of water. 1754 Vaccine Clinic Team Lead RN made aware of patient reporting symptoms. 1756 patient reported worsening tingling to bilateral arms, legs, and back of head. 1757 Code called. 1800 patient taken to ER in wheelchair by Emergency Room RN. Nursing Supervisor present.


VAERS ID: 1701098 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / SYR

Administered by: Pharmacy       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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: steroids and EpiPen was given at ER
CDC Split Type:

Write-up: Rash all over body


VAERS ID: 1701101 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Rash, Visual impairment
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP: 120/78 , HR: 128, O2: 96 BP: 120/80 , HR: 120 , O2: 98 BP: 110/80, HR: 120, O2:98
CDC Split Type:

Write-up: Patient started feeling dizzy, lightheaded, slit rash and see finger prints in vision.


VAERS ID: 1701107 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: after receiving the 2nd Moderna vaccine and was waiting for 15 minutes, patient started feeling rapid heartbeat, dizzy and was nauseated. She was given a bottle of water to sip on and was monitored. After another 15 minutes she felt a little dizzy but not the other symptom. after 30 minutes patient said she was fine and was told we will follow up with her. 2 hours later patient said she was having pain in her chest while breathing and it was a 6-7 on a scale of 1-10. Told the patient to contact her doctor and she said that she did not have a regular doctor. Informed the patient to go to the emergency room and she said will try to go to the ER. Will follow up with the patient tomorrow


VAERS ID: 1701109 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known of
Current Illness: none listed
Preexisting Conditions: none listed
Allergies: amoxicillin
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Patient got dizzy after vaccine administration and needed to lie down. Paramedic on-site checked her blood pressure and it had dropped a bit but patient never lost consciousness.


VAERS ID: 1701110 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185-H / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling hot, Hypersensitivity, Oropharyngeal discomfort, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt reported feeling warmth in throat and mouth, following vaccination of Pfizer vaccine. Pt denied SOB, Observed patient to have good color, no signs respiratory distress and able to converse in clear strong tone. VS 1012 BP 140/90, SPO2 99, HR 63 Pt had verbalized hesitation and nervousness with receiving the vaccine but ready to proceed after informed consent had been received from RN. Per Pt baseline BP 110s/70s. Pt reported no history of anxiety but had confirmed anxiety associated with vaccine. Pt provided water and apple juice, legs supported on chair and encourage deep breathing. F/U VS at 1017 BP 110/78 HR 67 SPO2 99. Pt maintained good communication with no increase in symptoms. Pt ambulated to couch to sit with legs elevated and administered Benadryl. Pt was monitored for an additional 15 min without any increasing signs distress or respiratory symptoms. VS 1040 SPO2 98 HR 68. Provided education and support to Pt and coworker about S/S anaphylaxis and what to do if any new onset of allergic reaction. PT and coworker confirmed understanding and Pt left in stable condition with coworker.


VAERS ID: 1701115 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Myalgia, Respiratory tract congestion, Vaginal haemorrhage
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: muscle aches, malaise, unexpected vaginal bleeding, joint pain, congestion, general feeling of being run down and unwell


VAERS ID: 1701117 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 4 LA / IM

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

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

Write-up: Per verbal order by MD client received a 4th dose Moderna COVID vaccine LOT 014F21A. Client''s previous doses are as follows: 1st Dose Pfizer COVID vaccine: 01/31/2021 LOT EL9262 2nd Dose Pfizer COVID vaccine: 02/21/2021 LOT EN6198 3rd Dose Janssen COVID vaccine: 08/11/2021 LOT 201A21A Client remained for a 30 minute observation without incidence and left the vaccine site on his own accord and with a steady gait.


VAERS ID: 1701125 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: A patient was given a pfizer covid vaccine and fainted after reaching the waiting chair. The patient fainted approximately 5 minutes after receiving the vaccine. She slumped over and hit her head on a post. Patient did have history of seizure disorder and fainting after bloodwork. The EMS were called and arrived to pharmacy after 10 minutes. The paramedics asked the patient questions in regards to her orientation and where-abouts. They checked her blood pressure and pulse. Everything was found to be fine and they released the patient. The patient left for home with her father.


VAERS ID: 1701128 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

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

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

Write-up: Pt felt lightheaded and dizzy several minutes after receiving the vaccine. She sat down for a few minutes, blood pressure was 114/92. She was given a cold bottle of water. After a few minutes, she felt better . Her blood pressure was normal -124/80. She was able to walk out with no adverse feelings.


VAERS ID: 1701130 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: No Known Allergies
Diagnostic Lab Data: BP 115/74, Pulse 62 and Oxygen 99%
CDC Split Type:

Write-up: Patient was sitting in a chair during monitoring period. Patient fell out of chair onto the floor on their face. He had lost consciousness. Monitoring personnel reported the event to the pharmacy. The pharmacist grabbed the first aid kit and blood pressure machine to assess the patient. The patient was no conscious and speaking. Color was pale. Pharmacist assessed client and gave them water to drink and snacks to eat. Client said they were looking at their phone and then were all of a sudden looking at the carpet. Pharmacy called EMS during this assessment. Patient had stated he was feeling warm. A nurse with the clinic in the building came to assist. The nurse took the clients blood pressure and it was 115/74, pulse 62 and oxygen was 99%. Client stated they hadn''t eaten for over 12 hours and had consumed large amounts of THC the night previously. The Fire Department/EMT personnel arrived and performed their assessment of the patient. They found him to be similar blood pressure and advised him if he wasn''t feeling well that they could bring him to the hospital. Patient decided to stay until feeling better and then leave to home. They asked him to go to the hospital if it occurs again. Pharmacist gave client a card to call with any other events and asked the patient to not drive home and stay until they felt much better. Patient agreed and left with a friend when better.


VAERS ID: 1701136 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device connection 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient came in today to receive their 2nd dose of Pfizer. The patient completed their forms and had the vaccine processed through insurance. I called the patient back to the immunization room and verified the patients information, answered concerns/questions, and also verified that the proper vaccine was going to be administered both by myself and the patient using the actual vial drawn upon. During administration into the patient''s left arm an indeterminate amount of vaccine was delivered due to the needle not being securely fastened to the syringe. I was somewhat confident that at least half the dose was administered and the patient waited the 10-15 minute period. During this time, I began looking up recommendations for errors such as this and decided that I could not, with certainty, certify that I had given at least half the Pfizer dose. Due to the CDC''s administration errors and deviations guidelines on accidental dosing errors, specifically dealing with lower than half volumes or indeterminate volumes, it is recommended to give the authorized volume as soon as possible in the opposite arm. I decided it would be prudent to administer another dose, so I called the patient, whom had already drove home, and had them return to the pharmacy for a correct dose. I did, in fact, give this correct, authorized dose to the individual in their opposite arm (right). No adverse reaction or harm was viewed after having the patient wait another 10-15 minute period at the pharmacy.


VAERS ID: 1701300 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Incorrect dose administered, Pain in extremity, Product preparation issue
SMQs:, Tendinopathies and ligament disorders (broad), 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: Adult Low Dose Aspirin, Allergy Relief, Bisoprolol fumarate, duloxetine, fenofibrate Nano crystallized, levothyroxine, losartan, multivitamin, omega 3 fatty acids, solifenacin, Stool softener, Symbicort, Ventolin hfa, vitamin b-12, vitamin
Current Illness: N/A
Preexisting Conditions: congestive heart failure, COPD, GERD, sleep apnea, hypoxia
Allergies: NSAIDS, Statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Medical Assistant drew up 1.8 mL of the 0.9% sodium chloride and then drew up 0.3mL of the Pfizer vaccine vial and mixed them together in one syringe and injected that to patient. When Vaccine coordinator noticed this mistake it was reported immediately to supervisor and COO. Patient had left clinic already before we could notify of the error that had occurred. Provider called her at home and notified her of error, patient was feeling fine at the time of the call. Supervisor and vaccine coordinator called poison control and stated that patient would just have three times more of reaction than the usual. Nothing to do for patient but to monitor. Called patient again on Saturday and she reported feeling some what fatigued and a sore arm on the vaccinated side.


VAERS ID: 1701302 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Nausea and Projectile Vomiting


VAERS ID: 1701318 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION UJ723AA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Dizziness, Feeling hot, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt was okay immediately following the shots. She became hot, lightheaded and weak about 15 minutes later. BP and HR were very slightly elevated, but not of a concerning value. She lied down and rested. Family member came to pick her up to go home.


VAERS ID: 1701323 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: BGM- 96 mg/DL
CDC Split Type:

Write-up: Patient received second dose of Covid-19 vaccine. Post vaccine, patient complained of dizziness, numbness and tingling to the Left arm and R Jaw. Initial VS 135/105, HR 98, RR 20, o2 sat at 99% on room air. Patient continued to complain of dizziness and said she''s going to pass out. V/S 140/110, HR 140, RR 21, o2 sat at 99% on room air. 911 paramedics were activated and arrived at 5:15, report given and endorsed the patient for acute care follow up.


VAERS ID: 1701331 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-14
Onset:2021-09-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Headache, Myalgia, Pain, Pain in extremity, Pyrexia, Sinus disorder, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe Headache, vomiting, severe diarrhea, muscle aches, fever 101, sinus issues, severe sore arm, sharp pains in body


VAERS ID: 1701339 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: Early menstruation. Regular cycle ended approximately one week before vaccine. I just began spotting today, enough to require a sanitary napkin.


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