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

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



Case Details (Reverse Sorted by Onset Date)

This is page 200 out of 4,799

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VAERS ID: 1371835 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Dysuria, Fatigue, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Triamcinolone prn, famotidine 20mg BID, Flonase, Aripiprazole, Strattera, Depo-Provera, Atorvastatin, Loratadine, Flovent 110 BID
Current Illness: None
Preexisting Conditions: Obesity, GERD, ADHD, Sleep apnea, Asthma, Dyslipidemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever up to 101.9F, fatigue, myalgia, abdominal pain, dysuria, headache. Pt declined treatment, opted to go to ER for evaluation


VAERS ID: 1371837 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

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

Write-up: 53 y/o female with no past medical history who presents with nausea and mild dizziness post vaccination. Patient states that this is her second vaccine in the two-dose series. Patient states that she received todays vaccination to the Left arm. Patient also states that she experienced the same symptoms with the first vaccination to include vomiting and chills lasting a few days. Patient denies headache, vision changes, sore throat, difficulty swallowing, difficulty breathing, shortness of breath or chest pain. NP and Paramedics at patient side. Patient initial vitals, 150/98 BP, 69 HR, 100% RA, 12 Resp. Patient dry heaved for approximately 20 mins with resolution post. Patient stated that symptoms resolved and that she was comfortable being sent home. Patient vital reassessed, 136/90 BP, 68 HR, 99% O2 and 12 Resp. Patient discharged in stable condition, patient ambulated without difficulty.


VAERS ID: 1371854 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 AR / IM

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

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

Write-up: pt had suffered a reported syncople episde according ro rn staff administering shot. pt was with mother//. pt was pale but responsive and ao*4. pt vitasl were taken and pt was considered stable. pt had been eating a cracker and drinking water at time of ems crew arrival. pt then claimed to be "feeling better" pt was considered stable and no indication or report of pt hitting head. pt reportedly "slythered" to the ground by rn staff. pt was deemed stable, however twice more requested ems evaluation. pt and pts mother was advised to accept ems transport. pts mother consented to er rescue transport and pt was transported to hospital by ems.


VAERS ID: 1371861 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Consciousness fluctuating, Dizziness, Hyperhidrosis, Hypertension, Pallor, Tunnel vision
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Optic nerve disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: After administration patient was sitting in post vaccination chair and was passing in and out, sweating very much, pale, high blood pressure, and experienced dizziness and tunnel vision. after about 30 mins patient was feeling much better.


VAERS ID: 1371862 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Asthenia, Blood gases, Blood lactic acid, Brain natriuretic peptide, Chest X-ray, Dyspnoea, Full blood count, Metabolic function test, Oxygen therapy, Procalcitonin, SARS-CoV-2 test, Tremor, Troponin, Urine analysis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apap; asa, trazodone, tamsulosin, fluoxetine, metoprolol, breo ellipta, lactobacillus, donepezil, atorvastatin, folate, thiamine, ferrous sulfate, gabapentin,
Current Illness: PNA last tx date 5/1
Preexisting Conditions: schizophrenia, hep c chronic, hx covid 2020; panlobal emphysema, protein/cal malnutrition, alcohol dependence, cirrhosis, chf, cad, copd
Allergies: thiothixene
Diagnostic Lab Data: 6/3 (at hospital): CBC, CMP, Troponin, U/A, Lactic Acid, Procalcitonin, COVID (rapid and PCR), blood venous gases, bnp , cxr
CDC Split Type:

Write-up: Pt is a resident in a SNF. He went for dose 2 of his Pfizer Covid series at 950am on 6/2. At 12:30am on 6/3 he became weak, anxious, SOB and required oxygen supplementation. He was shaking and weak and transferred to hospital via ambulance.


VAERS ID: 1371871 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Presyncope
SMQs:, Anticholinergic syndrome (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: na
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 6/3 @ about 10:00Am felt warm sensation in my head then 3 bouts of disinyness in succession. I had to sit on the ground for a couple minutes because I felt I was at risk of passing out


VAERS ID: 1371878 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Vasovagal event. Pt fainted and immediately came to. Pt felt better after about 15 minutes and was able to walk.


VAERS ID: 1371896 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-24
Onset:2021-06-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: N/a
Preexisting Conditions: Bone spurs on spine that pinch nerves, migraines, high BP, thyroid issues (mine is too low if I remember correctly) not on meds for any of this.
Allergies: Mangos
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11 days after the shot area around injection site turned red and warm to the touch


VAERS ID: 1371897 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

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

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

Write-up: Patient received first dose on 05/22/2021 (12 days ago) and was given the second dose 12 days after. Patient did not have CDC COVID-19 ID card. As per the vaccinate administrator, computer system could not locate the first dose information on the patient and the second dose was given. patient did not stay for 15 minutes observation and later after the patient had left, it was discovered that the patient had gotten the first dose earlier than the normal waiting interval. The matter was discussed the Pfizer medical information agent over the phone and it was suggested that the no additional dose is needed and there is currently no study done thus far looking at the safety profile of the vaccine given out of the normal interval.


VAERS ID: 1371899 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: Pt was observed for 20 mins after shot (at that time, technician administering did not know about the mix up just yet)
CDC Split Type:

Write-up: patient was given moderna as second shot instead of pfizer.


VAERS ID: 1371900 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoaesthesia, Hypoaesthesia oral, Movement disorder, Musculoskeletal stiffness, Neurological symptom
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: after 12 hours that I took the Janssen vaccine, I woke up around 12 am and sweating a lot. my 2 hands and 2 feels are numb and even my tongue was numb and I can not control my body and my finger can not bend. My husband called 911 and sent me to the ER. After 20 mins my body went back to normal. the symptom is very similar to a mini stroke.


VAERS ID: 1371901 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Dizzy, diaphoretic. Transported via wheelchair to medical screening for evaluation by medic. Left in stable condition at 15:44 p.m. 98/60 114/75 Pulse 95 92 97% 98% Recorded RN.


VAERS ID: 1371906 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperventilation, Hypoglycaemia, Hypotension, Nausea, Tinnitus, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypoglycaemia (narrow), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Tinnitus, blurred vision, nausea, low blood pressure, hypoglycemia Deep breathing, called medics. Sx started subsiding after some time, breathing and paramedic arrival. Bp 95/63 pulse 66. Pt reported not eating much before shot. No prior history of vaccine teaction


VAERS ID: 1371914 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

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

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

Write-up: Patient received COVID-19 (Pfizer) vaccine per vaccine process. Denied received a previous COVID vaccine on pre-vaccination checklist. After receiving vaccine and leaving the clinic, patient spoke to the clinic director to notify her she has previously received two doses of COVID-19 (Moderna). Patient denied side effect or symptoms.


VAERS ID: 1371918 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Patient received a dose of Janssen vaccine today despite a previous completed Moderna vaccine. Moderna was not received here, so there was no knowledge of that previous vaccination.


VAERS ID: 1371920 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 LA / IM

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

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

Write-up: No adverse events seen, patient observed for at least 15 minutes, 15 year old at time of injection


VAERS ID: 1371922 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body ache fever headache weakness


VAERS ID: 1371924 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 3 RA / 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: No
Current Illness: Nkn
Preexisting Conditions: Nkn
Allergies: Nkn
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt accidentally got 3rd dose. Pt was supposed to get hepB


VAERS ID: 1371930 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

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

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

Write-up: There was no adverse event, patient took Moderna as first shot and came in today and received Pfizer as the 2nd dose. performing the injection didn''t know that the 2 vaccines were not to be mixeEd.


VAERS ID: 1371934 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Tinnitus
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hearing impairment (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 reported
Current Illness: None reported
Preexisting Conditions: Prediabetes
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received first dose of Pfizer on 6/3/2021. She said she had ringing in her left ear 10 minutes after. She waited for 15 minutes of observation and left with her husband. She started to feel numbness on the left side of her face, involving her eye, cheek and chin. She decided to come to COVID vaccine clinic rather than return to the clinic where she received the vaccine. Denies shortness of breath or lip/throat swelling. Nurse practitioner on site assessed patient, did a neuro assessment and found it to be normal. Nurse practitioner ordered 10 mg Zyrtec sublingual, it was administered. Symptoms slightly improved but did not subside completely. Patient observed for an hour. Symptoms did not progress. Nurse practitioner discharged patient with instructions to return if symptoms progressed or started to involve airway.


VAERS ID: 1371950 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a typical vasovagal response. She lost conscious for seconds, then regained consciousness. She was slightly dizzy but we had her lay on her back with feet elevated. After 5 minutes she was back to normal. Patient was observed for 20 more minutes with no issues.


VAERS ID: 1371961 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness transient, Chromatopsia, Fall, Syncope, Vision blurred, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal 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: none. just water
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: BP was 96/64 Pulse 54
CDC Split Type:

Write-up: Patient Fainted 2 minutes after vaccine. He was sitting in chair and fell (caught by family) and woke up instantly. As I arrived, 10 seconds after fall, his eyes were open but he could not see anything. He was able to state his name, date of birth, and where he was, just couldnt see. "Everything is all black." After closing eyes for 30 seconds, opened and he could see, but everything was green. Vision color was back to 100% after 20 minutes but still blurry. Patient BP was normal. Sweating.


VAERS ID: 1371963 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-05
Onset:2021-06-03
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

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

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

Write-up: NONE


VAERS ID: 1371966 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

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

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

Write-up: Moderna was given to underage pt (13 years old) instead of Pfizer


VAERS ID: 1371975 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Chest pain, Dyspnoea, Headache, Hyperhidrosis, Nervousness
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna
Other Medications: patient states being on multiple medication including insulin
Current Illness: N/A
Preexisting Conditions: DM, HTN, depression
Allergies: NKDA
Diagnostic Lab Data: blood glucose test: 336 1st set of vital signs BP: 150/90 O2 sat: 99 % P:98 2nd set of vital signs: BP: 172/124 O2 sat: 100% P96
CDC Split Type:

Write-up: Patient c/o chest pain, shortness of breath, headaches, sweaty and shaky. EMS was called and patient refused to go on ambulance and left building with transportation.


VAERS ID: 1371977 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: On the 2nd day after 2nd Pfizer vaccination I experienced dizziness then fainted, with fatigue and nausea


VAERS ID: 1371990 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / N/A UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient is 2months postpartum
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given the Janssen Vaccine, and is only 16 years old. This vaccine has only been given Emergency Use Authorization for individuals 18yr and older.


VAERS ID: 1371993 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

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

Write-up: No adverse event was reported. The patient that was given the vaccine was 17 years old. The form is being filled out as documentation that the patient was given the vaccine outside of the recommended age range.


VAERS ID: 1371994 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Refusal of treatment by patient
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: Albuterol sulfate 90 mcg, Norvasc 10 mg, Lipitor 20 mg, QVAR 40 mcg, Biocotron 5-100 mg/ 5 ml syrup, Vibra-tabs 100 mg, Glipizide 50 mg, Claritin 10 mg, Cozaar 100 mg, metformin XR 500 mg, multivitamin, Bactroban 2% cream, K-DUR 10 mg
Current Illness: Cough, vaginal itch, dermatitis, folliculitis
Preexisting Conditions: schizoaffective disorder, COPD, Asthma, diabetes mellitus type 2, chronic allergic rhinitis, hypertension, low ferritin levels, leg cramps, morbid obesity
Allergies: No Known Allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was accidently given 5 extra doses of the Pfizer Covid Vaccine. Patient was given 1.8 ml of the vaccine instead of 0.3 ml. Patient was monitored by both a Physician Assistant and a Medical Doctor. 911 was called. Patient denied any symptoms and refused to go with the ambulance to the hospital for close observation. Patient signed out AMA. Patient advised by provider to seek medical attention if she developed fever, chills, vomiting, or any severe side effect from the vaccine.


VAERS ID: 1371996 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Dizziness, Eye movement disorder, Feeling hot, Hyperhidrosis, Tremor, Tunnel vision, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad)

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

Write-up: Soon after administration, patient got hot, sweaty, and had tunnel vision/ blurry vision. Checked blood pressure and was 54/40. Called EMS for support. Patient was light headed and shaky, would respond to questions and commands but a bit slow. Eyes seemed to be rolled back in head, but never lost consciousness. 2nd BP check was 94/62. EMS arrived at 11:25, patient began feeling a bit better at 11:30. paramedics arrived at 11:34. Patient moved to ambulance for observation until picked up to return home. Was not transported to the hospital. Checked in on patient at about 4:30 and was feeling well.


VAERS ID: 1371997 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Confusional state, Dyspnoea, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not reported; Son did report pt takes diabetic and blood pressure medications.
Current Illness: None reported.
Preexisting Conditions: None reported.
Allergies: None reported.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Pt''s son reported pt became short of breath and confused while in the waiting area after receiving vaccine. Upon assessment, pt was hypotensive at 90/60 with O2 sat of 91% on room air. EMS called and provided pt with oxygen via nasal cannula. Pt transported to hospital for further evaluation.


VAERS ID: 1372000 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

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

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

Write-up: The patient''s mother called in today saying that the patient was nauseous and throwing up all morning. She received her second Moderna covid shot last night (6/2/21). The mother said that her husband was going out to get pedialyte for the patient, but wanted to know what else I would recommend. I told her to try to keep her hydrated with something along the lines of pedialyte or gatorade. I told her that she should put a phone call into her family doctor as well to see what they might recommend. I said they could prescribe an antiemetic if the N/V continues. I said if it does continue and she is not able to keep anything down that they may want to have her seen at a walkin clinic or ER.


VAERS ID: 1372002 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 RA / IM

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

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

Write-up: The Pfizer vaccine administered to the patient had been drawn up between 6 and 7 hours.


VAERS ID: 1372008 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Nausea, Orthostatic hypotension, Syncope, Vaccine positive rechallenge
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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 reaction every time he has a shot, including at the dentist.
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA.
CDC Split Type:

Write-up: Patient became syncopal within seconds of receiving the shot. Passed out for about 10 seconds. Felt dizzy and nauseous after. Lay pt down on cot, elevated feet. BP supine 110/68 P 66 R 16. Postural drop when seated, lay back down. After about 20 minutes pt maintained pressure when seated and standing, dizziness subsided. Pt declined further treatment or transport and friend drove him home. Advised to call 911 if began to feel worse.


VAERS ID: 1372010 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Altered state of consciousness, Pallor, Seizure
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient here for 2nd dose of Pfizer Covid-19 vaccine. No h/o allergies or significant medical history. LPN arrived on scene after vaccinator was yelling for help. Patient was "in and out of consciousness", awake and alert and then would have LOC for a few seconds and then become awake and alert again. This happened about 4 times with LOC with also some "convulsing like movements in the arms". Emergency responders and clinical lead, RN called. Patient laid back in seat as far as the seat would go, face pale and lips white. Pulse-ox put on and BP taken, 36 bpm (according to pulse-ox) and oxygen level 89%, BP 100/54. LPN gave epinephrine injection at this point at 1151, 0.3mg IM in right thigh. HCP arrived on site, patients VS after epi: pulse 76, 100/76, O2 sats 94% at 1155. Patient awake and alert, oriented to person, place and time. Lips and face pink. Care turned over to Paramedics who arrived on site at 1200.


VAERS ID: 1372014 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 RA / IM

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

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

Write-up: Pfizer vaccine that patient was administered had been drawn up between 6 and 7 hours.


VAERS ID: 1372023 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Diabetes mellitus, Fatigue, Muscular weakness, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Patient received her first moderna vaccine on 6/3/21, pharmacist advised patient to wait in the waiting area for 15 minutes. The patient was waiting near the pharmacy, she went to the restroom and approach one of our associates saying she felt tired. The pharmacist went to check on the patient to see how she was feeling, the patient wanted to leave the store but the pharmacist advised against and had the patient return to chair. Patient informed the pharmacist that her legs and arms were weak. The pharmacist ensured patient knew who she was, where she was, the date and year. Patient then stated that her vision was blurry. The patient was able to answer all of these questions with no problems. Pharmacist asked the patient if she was comfortable with her calling an ambulance to check patient, the patient was resistant to calling an ambulance, the pharmacist did call the patient''s son so he could come to the store to assist his mother. We decided it was best to call an ambulance after multiple minutes of the symptoms continuing. Pharmacist inquired about health condition, patient is diabetic so we attempted to get the patient''s blood sugar and got the patient a soda to help with low blood sugar. Patient stated she felt slightly better after the soda but she was still very weak when ambulance arrived, the EMT advised the patient it was best to go to the ER to be examined. Son of the patient stated that she has episodes before where patient will be overstimulated and gets quite fatigued.


VAERS ID: 1372027 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 7+ RA / IM

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

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

Write-up: patient thought her tongue was swelling , she was given 10 ml''s of benadryl and said she felt fine


VAERS ID: 1372037 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no. PATIENT DID NOT HAVE AN ADVERSE REACTION SHE JUST CAME IN TOO EARLY. HER FIRST DOSE WAS ON 05/14 AND WAS DUE ON THE 11TH. SHE RECIEVED HER DOSE ON 06/02/2021. PER GUIDLINES IT STATES DO NOT REPEAT VACCINE. PATIENT HAS BEEN NOTIFIED
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT DID NOT HAVE AN ADVERSE REACTION SHE JUST CAME IN TOO EARLY. HER FIRST DOSE WAS ON 05/14 AND WAS DUE ON THE 11TH. SHE RECIEVED HER DOSE ON 06/02/2021. PER GUIDLINES IT STATES DO NOT REPEAT VACCINE. PATIENT HAS BEEN NOTIFIED


VAERS ID: 1372042 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hypotension, Immediate post-injection reaction, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), 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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Onset about 1 minute after vaccine, patient was dizzy, nauseated, cold sweats, and low blood pressure. After drinking some water, sitting for a few minutes, and eating some lunch, patient was feeling 100% better.


VAERS ID: 1372044 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:2001-06-03
Onset:2021-06-03
   Days after vaccination:7305
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: methotrexate 2.5mg. vitamin d2 50,000 units
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient felt dizzy after receiving the shot and fell on the floor.


VAERS ID: 1372047 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-30
Onset:2021-06-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Pain, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1 mg Clonazepam/day
Current Illness: N/A
Preexisting Conditions: Reynaud?s
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling & numbness in left leg, right foot, left forearm 10 minutes after vaccine that persisted for 12-14 hours. Prednisone was taken when symptoms did not subside after 2 hours. Some mild aches still persist 4 days later.


VAERS ID: 1372051 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dizziness, Nervousness
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Situation: 21M had an appointment for 2nd dose Moderna (Lot# 007C21A) today. Shortly after being vaccinated, patient started to feel dizzy and eventually complained of chest pain. Background: Patient has NKDA and allergic to pollen and dogs. Denies PMH. The Moderna vaccine was administered at 11:56AM. Pt came to the observation area at 1205. Pt started to feel dizzy and told girlfriend about it. Juice and crackers provided. Pt consumed 2 juice boxes and crackers. Pt felt better initially then started to feel dizzy and shaky again. Assisted to gurney and took to room 7. Assessment: 1215 VS 98.8F, 127/77 (94), 62, 98% RA, 16 and dizzy. Continue to give more juice and water. Pt started to feel better. 1220 Pt looked better, feeling better, conversing to girlfriend, and playing with phone. Manager at bedside talking to pt and gf. Pt stated that he didn?t eat nor drink today. Pt woke up and went straight to the vaccination clinic. Pt does have hx of anxiety episodes. Girlfriend also reported that patient became dizzy after first dose of Moderna but did not disclose to anyone.


VAERS ID: 1372059 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine, Zonagran, Onfi, Flonase, One a day Women?s vitamins, sometimes Metamucil
Current Illness:
Preexisting Conditions: Epilepsy, arthritis, sleep apnea
Allergies: Biaxin, Aspartame
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain from shoulder to elbow in left arm. Seizure next morning


VAERS ID: 1372064 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

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

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

Write-up: after vaccination, patient felt dizzy and lightheaded. after some bottled water and a cold compress, she did not feel better. we elevated her feet, and she still did not feel good, said she felt like she wanted to throw up. Emergency personnel came and took her to the hospital


VAERS ID: 1372068 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Hyperhidrosis, Hypoacusis, Malaise, Pallor, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), 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: Amoxicillin allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt did well before and after vaccination. A few minutes later in the waiting area he started feeling ill and his mom had him sit down and she called 911. He complained of weakness, diminished sight and hearing and lightheadedness. He was very pale and sweaty. With his mom''s permission I activated an ammonia inhalant near his nose. He said he felt better after the 2nd sniff. After a couple minutes he said his symptoms were greatly diminished and he was ok. The paramedics arrived and pt was able to walk to the ambulance for further evaluation. A paramedic came back and said the patient is feeling much better and declined to go to the hospital. I talked to the mom a couple hours later and she said he is all better.


VAERS ID: 1372069 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness, Musculoskeletal stiffness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad)

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

Write-up: Within 5 minutes after vaccine administration, patient reported weakness in the left arm (same arm as the vaccination) from the shoulder to her hand. She also reported stiffness in the left side of her neck. Symptoms did start to improve after 30 minutes.


VAERS ID: 1372070 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 RA / IM

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

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

Write-up: The Moderna vaccine was accidentally given to this 13 year old - rather than the Pfizer vaccine. Both the PCP and the mother have been notified of the error. At the time of this writing, the child has not suffered any adverse event pertaining to the vaccine error.


VAERS ID: 1372072 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

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

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

Write-up: patient states he was very nervous and worked himself up, patient then describes blacking out and urinating on himself, he did not request assistance and left after 15 minute wait time without notifying vaccine/clinic staff. His wife called later to notify us of his adverse effect.


VAERS ID: 1372077 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-22
Onset:2021-06-03
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Blood urine present, Cardiac flutter, Crystal urine present, Dizziness, Dyspnoea, Electrocardiogram normal, Fatigue, Feeling abnormal, Heart rate irregular, Hypotension, Immediate post-injection reaction, Impaired work ability, Loss of personal independence in daily activities, Nausea, Palpitations, Vertigo, White blood cell count increased
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour Thryoid, magnesium, low dose calcium, vitamin d
Current Illness: N/A
Preexisting Conditions: Chronic Kidney Disease Stage III, Chronic Fatigue & Fibromyalgia, Osteoporosis
Allergies: Cipro, Quinolones, Compazine, Celebrex, Statins
Diagnostic Lab Data: ER for low BP - EKG normal at that time. White count up, blood and crystals in urine. EKG 1.5 week later - normal at that time, but a fib and palpitations and fluttering continue, along with fatigue, dizziness, brain fog, nausea, and need for rest, and unable to perform normal physical activities. Heart will go from 48 bpm to 110 bpm in seconds, and while sitting and resting on the couch. No exertion or stress at the time. Then drops, then jumps, and symptoms continue.
CDC Split Type:

Write-up: After second vaccination: Initially: Sudden experience of very low BP - 91/41 - fatigue, shortness of breath, dizziness, unable to go to work. Vertigo. One week later and continuing: heart palpitations, a fib, fluttering, shortness of breath, dizziness, fatigue, nausea, low BP, and unable to go to work.


VAERS ID: 1372078 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Fear of injection, Nausea, Nervousness
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Patient informed me prior to receiving vaccine that he gets nervous about shots and does not want to see the needle. After I administered the vaccine the patient was fine he started to feel nauseous and had to use the bathroom. Upon returning patient was given some watered and allowed to breath without his mask on. After sitting the 15 minute observation period patient was fine. He was just anxious and nervous. His father was with him. Patient was fine upon leaving the pharmacy.


VAERS ID: 1372084 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal
SMQs:, Anticholinergic syndrome (broad), Dementia (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: The patient received his COVID vaccine and about 5 minutes later reported feeling funny. The patient was nervous before getting the vaccine. After the immunization, the patient felt he needed to lay down on the floor. We had the patient lay on the floor and elevated his legs. I also took the patient''s blood pressure which was 90/60, the patient stated his blood pressure always ran a bit low. We also gave the patient an ice pack. 10 minutes later the patient said he was feeling better and got back into his chair. We observed the patient an additional 15 minutes and then he left feeling fine.


VAERS ID: 1372087 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Feeding disorder, Headache, Illness, Myalgia, Nausea, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: We don''t have any health care insurance
CDC Split Type:

Write-up: She had her first shot vaccine yesterday June 2, 21 and today she has sintoms off.. nausea, disiness , can''t eat , headache, and body illness, has well a lot of pain on the arm and body muscles, and difficulty on breathing..


VAERS ID: 1372088 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

Administered by: Public       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? No
Previous Vaccinations:
Other Medications: Lemongrass essential oils and eye drops
Current Illness: Wound on right inner ankle, infected and has leaking
Preexisting Conditions: Near blindness/severe cataracts, self-care neglect /unsafe home environment
Allergies: NA
Diagnostic Lab Data: Went to ER due to past wound on foot
CDC Split Type:

Write-up: Pt is in need of home care. Has severe self- neglect


VAERS ID: 1372089 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient was vaccinated and within few seconds he was feeling disoriented, light headed and dizzy for over 10 minutes. Pt did not loose his consciousness. He was sweating profusely and appeared pale. Could have been possible syncope. Called 911, paramedics arrived at the scene and checked his vitals. Blood pressure was 117/ 70. Pt was was feeling normal when paramedics arrived. Paramedic checked his blood sugar using finger prick.( His blood sugar was around 150) Pt immediately fell little disoriented and dizzy and recovered in 2 minutes. Pt was not admitted to hospital. He was doing well when he left the pharmacy after 30 minutes or so. Pt said that he had similar episode when blood was drawn for some lab tests in the past.


VAERS ID: 1372099 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Ache at site of injection, chills, feverish, fatigue


VAERS ID: 1372104 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Celiac dx
Allergies: Bee stings - anaphylaxis Celiacs Dx
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Approximately 5 minutes after receiving first dose of Pfizer covid vaccine c/o left arm itching at the injection site. Injection site warm, red and tender to touch with redness extending from below injection on deltoid to shoulder. Macular rash did not extend beyond upper arm and shoulder, not noted on back or chest. Denies nausea, dizziness, throat constriction or difficulty breathing. Treatment - Ice appled to macular rash for 20 minutes with re-application after 5 minutes. Redness significantly decreased on arm and shoulder after 40 minutes. Injection site red and warm to touch, arm and shoulder cool. Patient observed for 60 minutes then discharged with instructions to apply ice x 20 min and take diphenhydramine at home, and to go to the ER if symptoms get worse.


VAERS ID: 1372110 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lethargy, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hives and rash from first dose in series
Other Medications: Singular Nexium Zinc Vitamin D Vitamin B-12 Zyrtec Vyvanse
Current Illness: See below
Preexisting Conditions: Crohn?s disease Asthma Seasonal allergies COPD Bronchaectesis
Allergies: Honey Aspartame Artificial sweeteners Stevia Allegra IV contrast dye Lortab Dilaudid Bactrim
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives, rash, lethargy. Onset less than 4 hours after injection. Hives and rash on arms, chest, back, and neck.


VAERS ID: 1372127 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Inappropriate schedule of product administration
SMQs:, Anticholinergic syndrome (broad), Vestibular 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 2nd dose 47 days after 1st dose. She felt dizzy after this dose within a couple of minutes.


VAERS ID: 1372133 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

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

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

Write-up: patient passed out for a few minutes but regain conscious quickly, patient complained of being light headed and appeared pale. Paramedics arrived to check patient''s condition. Patient blood pressure, heart rate and respiration was evaluated. Patient refused to go to the hospital and remained at our sigh for observation for 30 minutes


VAERS ID: 1372134 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

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

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

Write-up: patient fainted after getting vaccine paramedics were called and came to check patient but was not taken to hospital. per patient she was fasting


VAERS ID: 1372140 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 RA / IM

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

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

Write-up: Accidental third dose given due to facility having lost records; as of now the patient is currently doing fine. Was told the third dose still needed to be reported


VAERS ID: 1372147 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A & 00 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Fatigue, Headache, Lymph node pain, Lymphadenopathy, Malaise
SMQs:, Guillain-Barre syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swolen lymph nodes under left arm. Slightly painfull and uncomfortable,still occurring. Noticed this when I woke this morning . I also felt ill the day after the shot with painfull joints overall body weakness, headache and fatigue which lasted 24 hours and was helped by Tylenol and sleep.


VAERS ID: 1372150 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hyperhidrosis, Paraesthesia oral, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient reports none
Current Illness: patient reports none
Preexisting Conditions: patient reports none
Allergies: patient reports shellfish allergy (swelling) and radish allergy
Diagnostic Lab Data: epinephrine administered 6/3/21 at 11:54 am to right quadricep muscle blood pressure checked 6/3/21 at 12 pm 159/84 pulse 116, repeated 12:04 pm 154/77 pulse 91
CDC Split Type:

Write-up: tongue tingling, shortness of breath, excessive sweating, dizziness, shaking


VAERS ID: 1372152 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Immediate post-injection reaction, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: The patient received the first dose of the Moderna Covid-19 vaccine. The patient was administered the vaccine in the immunization booth. The PQCF was reviewed by the administering pharmacist and the patient marked no for all questions including Question 5 concerning seizure disorders. The patient remained in the immunization booth due to the immobility of the patient. The immobility of the patient was not related to the following event. The patient''s mother within 5 minutes of the vaccine being administered called that the patient was having a seizure. Code White was called to the pharmacy to support the pharmacy staff in the needs of the patient. The patient was monitored and associates were stationed near the patient as she remained seated during and after the seizure. The patient was monitored closely. The patient''s mother stated after the seizure that the patient has seizures regularly and was "due for one" meaning a seizure. The patient was continuously monitored for 20-25 minutes at which point she attempted to walk under the supervision of the pharmacy manager. The patient was able to walk under her own power and it was determined at this point she was able to leave the pharmacy area. Follow up with the patient will occur later in the evening and the next day to ensure the patient is doing well.


VAERS ID: 1372286 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM

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

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

Write-up: This pharmacy is a hybrid store that have both Pfizer and Moderna. All the paperwork was processed for Pfizer, however the pharmacist grabbed the wrong vaccine (Moderna) by mistake and administered to the patient instead of Pfizer. Moderna and Pfizer manufacturers were contacted to get further instruction. Patient was monitored for 15-20mins with no adverse reactions.


VAERS ID: 1372290 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER 8731 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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:
CDC Split Type:

Write-up: numbness in the neck on the same side as the shot within 10 minutes of administration. Kept patient for 30 minutes and pt stated


VAERS ID: 1372292 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Neck pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D Black cohosh
Current Illness: 0
Preexisting Conditions: 0
Allergies: Sulfa
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Second dose: Pain in left side of neck and chest pain on the left side. Pain started within the hour from the time of shot. It has now been 6 hours of chest pain on the left side and not letting up. Have not noticed any other symptoms such as shortness of breath or irregular heart beat.


VAERS ID: 1372299 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: has fainted from flu shots
Other Medications: Patient was taking paroxetine. reports no OTC medications
Current Illness: no reported illness
Preexisting Conditions: depression
Allergies: venlafaxine, amoxicillin, clavulanic acid are reported allergies
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: before the shot, the patient reported that he has a history of fainting. Patient fainted shortly. was given ice pack, and recovered over about 20 minutes.


VAERS ID: 1372300 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A-1 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Syringe issue, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient received partial dose of vaccine due to needle would not retract. Vaccine left in syringe.


VAERS ID: 1372301 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Odynophagia, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: UNKNOWN
Current Illness: GERD
Preexisting Conditions: GERD
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: PATIENT REPORTED THAT DURING 15 MINUTE WAITING PERIOD SHE FELT SHE HAD A LUMP IN HER THROAT. SHE ALSO REPORTED THAT THIS HAD HAPPENED DURING HER 1ST SHOT. SHE TALKED TO HER PCP LAST TIME AND THEY THINK IT MAY HAVE BEEN RELATED TO HER GERD. LAST TIME IT LASTED ABOUT 2 DAYS AND IT HURT TO SWALLOW


VAERS ID: 1372305 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started feeling hot, dizzy and lightheaded about one minute after vaccination.


VAERS ID: 1372306 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 1ST DOSE OF MODERNA VACCINE ON 5/1 FROM A DIFFERENT LOCATION. PATIENT CHECKED MODERNA ON CONSENT FORM. PFIZER WAS ADMINISTERED IN ERROR AS THE 2ND DOSE.


VAERS ID: 1372310 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Hypotonia, Loss of consciousness, Skin warm, Urinary incontinence
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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: EMS called, blood pressure taken 6/3/21, EMS took pt to ambulance for additional heart evalation.
CDC Split Type:

Write-up: Pt received janssen Covid 19 vaccine 518pm. Pt went to the waiting area chairs and within 2 minutes she was losing consciousness. Myself and another customer were able to lower patient to the floor (did not hit head). She lost all muscle tone, consciousness and bladder control (urinating on herself/floor). Sternal rub was able to get the patient to regain consciousness. Took blood pressure at 522pm and was 152/95 with pulse of 95. Arm was hot to touch and patient was sweaty. Placed a cold pack on injection site and fanned pt until EMS arrived for evaluation. EMS loaded pt on a stretcher and took to ambulance to evaluate heart rhythm.


VAERS ID: 1372312 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Approximately 10 minutes after receiving 1st covid Pfizer shot, patient reported feeling light headed and dizziness. He reported blurry vision,ringing in ears and was looking very pale. He was evaluated and monitored any other symptoms until paramedics came. Water and ice was given to patient while he waited. paramedics came and monitored patient and left


VAERS ID: 1372316 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: blood pressure was 109/79mmHg with pulse of 70bpm.
CDC Split Type:

Write-up: The patient was here for his first Moderna vaccine. He did not exhibit any agitation or nervousness. His girlfriend got her vaccine first and was talking to him as he received his. They were discussing how little it hurt when he fell out of his chair. He did not respond when we moved to him, but within five seconds he was awake and asking what happened. He was alert and sat in a chair for 30 minutes with no adverse effects from the fall. He noted he only slept 3 hours the night before the vaccine and had not eaten anything that day. The patient refused any further medical care.


VAERS ID: 1372326 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient fainted several minutes after receiving Moderna COVID vaccination and became conscious several seconds later. Sweating, loss of consciousness were the symptoms. Laid patient on the ground with feet elevated and ice pack on forehead. He received some water, juice and food and felt better within 30 minutes and was taken home by family members.


VAERS ID: 1372339 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Pt reported feeling like his throat was tight and sob. pt assessed. airway patent. o2 sat 97%. ni distress noted. pt medicated with 50 mg benadryl IM. Provider made aware. provider assessed pt with no further orders. Pt observed for 30 minutes. reported relief of symptoms. ambulated out of clinic with steady gait.


VAERS ID: 1372340 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Body temperature increased, Chills, Fatigue, Flushing, Hunger, Impaired work ability, Myalgia, Nausea, Pain in extremity, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Around 10am I became flushed and warm to the touch, started to get muscle pain and nausea. Took medicine for nausea which helped. 11am become tired and hungry. Went to lunch at Noon and ate two things and couldn''t finish. Started having chills and more muscle pain. Called off work and came home and checked my temperature at 3:30pm at it was 99.3. Took Tylenol but I''m still 99.3 range. Going to take more meds to try and break it. I do have arm soreness from last night around 8pm til currently. When wearing wired bra''s I noticed a pain in my armpit area as well.


VAERS ID: 1372352 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 RA / IM

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

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

Write-up: PATIENT GIVEN MODERNA FIRST DOSE ON 04/30/21 BY HCP ON DUTY. PATIENT CAME WITH MOM. BOTH RECEIVED MODERNA. HCP ON DUTY DID NOT NOTICE AGE UNTIL VACCINE GIVEN. CAME TO PHARMACY FOR 2ND DOSE MODERNA 06/03/21. MOM CONSENTED TO SECOND SHOT.


VAERS ID: 1372354 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / SYR

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

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

Write-up: Pt received 2nd dose, 8 days after the 1st


VAERS ID: 1372356 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: seafood, peanuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: RN vaccinated client and within 30 seconds noticed client started moving to the side. RN held client at chair, RN responded while two other RNs set up anti-gravity chair. Between all nurses, lifted client and laid in chair. PHN joined, client oriented to self and situation, pale, diaphoretic. Vitals at 1412: blood pressure 100/60 pulse 76, oxygen 97%. Client stated feeling dizzy, denied headache, blurry vision, nausea, shortness of breath, chest pain. Client given water and juice. Father present stated no reaction to first vaccine, allergies to peanuts and seafood. Vitals at 1414: blood pressure 106/70, pulse 79, oxygen 98%. Client alert and oriented x4, stated felt dizzy but did not lose consciousness. Per client same thing happened years ago when having blood drawn. Father informed we would observe for 30 mins. 1417: blood pressure 108/72, pulse 81, oxygen 98%. Client stated feeling better. Vitals at 1422: blood pressure 106/74, pulse 79, oxygen 97%. Client stated symptoms resolved. Alert and oriented x4, color normal for ethnicity. Per Father, client''s blood pressure is on the lower end. Vitals at 1427: blood pressure 100/70, pulse 85, oxygen 99%. No complaints. Vitals at 1437: blood pressure 100/70, pulse 85, oxygen 98%. Per client feeling fine, everything resolved. Client and Father given ER precautions and advised to follow up with provider. Last vitals before client leaving blood pressure 106/78, pulse 87, oxygen 97%. Client able to stand up with no complaints. Client left facility with steady gait at 1444.44.


VAERS ID: 1372358 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 - / -

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

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

Write-up: Patient was administered 1st Moderna vaccine on 5/5/2021 and 2nd Moderna vaccine on 6/3/2021. She is 16 years old and therefore outside the approved vaccination age. No symptoms during observation period.


VAERS ID: 1372540 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Chills, Deafness, Feeling cold, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: Temperature, BP, Pulse ox - all Normal
CDC Split Type:

Write-up: About 10 minutes after the vaccine, pt''s father signaled he needed help. Pt was cold and had chills. She did not speak English well, and she said she couldn''t hear. Then she stated that her throat was closing up. Then she stated she couldn''t see.


VAERS ID: 1372542 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: no
Preexisting Conditions: not known
Allergies: No
Diagnostic Lab Data: Blood pressure was monitored.
CDC Split Type:

Write-up: patient fainted a few minutes after getting pfizer covid vaccine. She felt better 5 minutes later, Her blood pressure was 113/69 pulse 73. Her blood pressure was 98/64, pulse 80 30 minutes after. But she felt perfectly fine then.


VAERS ID: 1372543 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Pharyngeal swelling, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: NONE
Preexisting Conditions: GERD, Presence of Mesh Sling, Major depressive disorder.
Allergies: NKDA
Diagnostic Lab Data: unknown.
CDC Split Type:

Write-up: within 15 minutes of receiving vaccine, PT complained of swelling of throat and something stuck in throat. PT was administered 50 mg of Benadryl, 0.3 mg of epinephrine. 911 was called and pt. transferred to ED.


VAERS ID: 1372545 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: no issues that pt has reported - 17 year old received vaccine when it is 18+


VAERS ID: 1372551 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Stated None
Current Illness: Stated None
Preexisting Conditions: Stated None
Allergies: Stated None
Diagnostic Lab Data: EKG 4 & 12 leads abnormal. Aspirin and oxygen given. EMS called.
CDC Split Type:

Write-up: Patient had a syncopal episode, pallor; VS taken- bradycardia; 4 lead and 12 leads EKG done- abnormal rhythm. ASA and oxygen given. Paramedics called.


VAERS ID: 1372559 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache
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: Back pain
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe head ache


VAERS ID: 1372562 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-13
Onset:2021-06-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

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

Write-up: Patient returned for second dose of Pfizer COVID 19 vaccine. Patient noted by immunizer for second dose to be underage per current EUA authorization. No reported adverse reactions. Second dose not administered due to age.


VAERS ID: 1372564 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fall, Photopsia
SMQs:, Accidents and injuries (narrow), Retinal disorders (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: NEXIUM
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient got up from seat to get water, begin to see lights, fell forward/ employee caught him, didn''t quite remember falling, we had patient lie on ground, elevate feet, placed cold pack on head, and cloth underneath head. Called EMS, they arrived shortly


VAERS ID: 1372567 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

Administered by: Senior Living       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: Nursing facility called us and request to provide vaccine to their residents , and I was inform only one person was getting the second dose but everyone else was getting the first dose and it Moderna. When entering the vaccine into the MCIR, I noticed the patient received Janssen and Janssen vaccine on May 17 2021. I spoke with employee and he informed Dr.and Nurse. I was told by employee the patients doing fine they will monitor him for any adverse reaction.


VAERS ID: 1372570 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none. I, the patient, have not sought medical attention. I have only researched side affects of vaccine online and discovered a small percentage of recipients also get swollen armpits.
CDC Split Type:

Write-up: Sore around injection site within four hours of recieving vaccine, dose 2, pfizer. 101 degree Fahrenheit fever developed eight hours after injection. Fever lasted 48 hours. Swollen armpit (assuming this is swollen lymph nodes) discovered in the morning of June 3, 2021 (injection received morning of June 1, 2021).


VAERS ID: 1372571 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-28
Onset:2021-06-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Lethargy, Oral herpes, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

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

Write-up: Patient only had adverse events after the second dose of covid shot on 05/28/2021. Patient starting getting fever, headache, body aches and lethargy from 5/29-6/2. He woke up this morning (6/3) with cold sores on his lip and he broke out in hives from head to toe. Patient does not come a primary care doctor. Recommended patient to be seen at an urgent care.


VAERS ID: 1372586 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head discomfort, Hyperhidrosis, Loss of consciousness, Muscle fatigue, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: Vitamin D3, Turmeric.
Current Illness: hemorrhoid, tonsillitis, varicose veins
Preexisting Conditions: hemorrhoid, tonsillitis, varicose veins
Allergies: Non as I know
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the second dose of Moderna vaccine I slept at night for about 2 hours and I was feeling muscle fatigue. When I woke up, my body temperature was 100.4 F. Around 10 am I went to the kitchen to prepare my breakfast. During this time I was feeling that my head was heavy. Then I start to feel that I cannot stay anymore and I sat down on my stool. I don''t know what happened after that because I lost my consciousness. After that I found myself lying on the back of my kitchen floor and I was completely wet. Few minutes later my body temperature was normal 97.88 F and I started to feel much better.


VAERS ID: 1372587 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Feeling hot, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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: Eliquis preservision
Current Illness: None
Preexisting Conditions: A fib mini strokes
Allergies: Pennicillin asprin sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Quiet. Not think correctly. Low Fever. Warm hands


VAERS ID: 1372589 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Dysstasia, Headache
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Moments after receiving the vaccine, while walking to the post vaccine area, patient reported right sided headache and generalized weakness. Weakness became progressively worse over 30-40 minutes, progressing to difficulty standing. Weakness generalized, not noted to be focal/unilateral. Speech slow and soft but clear. 911 called, transported to Emergency Department . Vital signs 121/76 hr 69 O2 100% rr 18. Denied pain at the time of transport.


VAERS ID: 1372595 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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:
CDC Split Type:

Write-up: Horrible tinnitus started on the second day after my 1st COVID immunization.


VAERS ID: 1372603 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Fall, Head injury, Hyperhidrosis, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hypertension (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt in for 2nd dose of COVID vaccine, negative reaction to first vaccine. Pt states he felt very dizzy after the injection. Staff (not including myself) witnessed pt have vasovagal fainting response (for about 3 seconds) and he fell straight down to ground from standing position. Paramedic(s) state they heard the pt hit the ground, and responded to the nurse stn quickly. This writer was passing out water to another pt when noticed the activity happening and was beckoned to come to the nurse''s stn. Pt alert at this time, has c/o HA, no N&V, states does feel some dizziness, v/s 144/92, O2= 98%, R=16, responds to commands but keeps asking ?What happened? ? hand strength is stable, pupils are equal and reactive to light, no bleeding of head,ears, nose,etc, noted. Ice pack applied to pt?s forehead, does have profuse sweating. No significant medical hx, no allergies. 1205pm: 133/84, p=87, O2= 98% R 16, aware of name/ place/location, but continues to ask ?what happened?, no LOC noted. Advised team to call 911, pt needs to go for further exam of head injury, though he remains stable and alert. GF of pt unable to drive pt because she doesn''t know how to drive stick shift. 1210pm: 135/86, p 94, R 16, 02 sat 98%, pt remains alert, sweating has stopped,denies dizziness at this time, does continue to say that ?back of head hurts? 1220pm paramedics have arrived, BP 128/68, p 85, R 16, 02 sat 98%. Assessment done by paramedics. Pt to go to hospital via ambulance, 1225pm pt left via gurney to ER. GF waiting for a ride for someone to come drive the car for her to meet pt at ER. Pt left alert, slowly starting to remember that he fell after injection he states.


VAERS ID: 1372753 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179-H / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: This information was reported to this writer. Immediately after receiving the second dose of the Pfizer vaccine, the patient reported a "weird sensation" in his chest. The patient became pale, and reported nausea and lightheadedness. According to the vaccinator it seemed as though the patient went into a syncopal episode. A nurse attempted to do a sternal rub to wake the patient up but was unsuccessful. The patient was then laid onto the ground and woke up; attempted to sit patient up and then went into another syncopal like episode. EMTs were notified and were on their way to attend to the patient. Patient''s feet were elevated. No history of vaccine reaction. Patient had eaten and had fluids 2 hours prior to the vaccine. Patient was sat up again with assistance but immediately felt lightheaded and had another syncopal like episode. He was again placed in a supine position with feet elevated. Immediately reported improvement of symptoms. Patient had several sips of juice and was placed on a stretcher and taken to a back room. Patient had mom and sister at his side. As the patient remained in supine position, he denied nausea and lightheadedness; no chest pain, no dizziness. Patient was alert and oriented. Remained pale in color according to his father who just arrived. Per the advice of the EMTs, patient was transferred to hospital per ambulance.


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