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

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



Case Details (Reverse Sorted by Onset Date)

This is page 206 out of 8,010

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VAERS ID: 1760617 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-03
Onset:2021-09-12
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Colitis, Condition aggravated, Movement disorder, SARS-CoV-2 test
SMQs:, Pseudomembranous colitis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal nonspecific inflammation (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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: Medical History/Concurrent Conditions: Asthma; Eczema; Rectocolitis
Allergies:
Diagnostic Lab Data: Test Date: 20210811; Test Name: SARS-CoV-2 test; Test Result: Negative
CDC Split Type: FRPFIZER INC202101239498

Write-up: Disease aggravation; Rectocolitis; impossibility to move or to have a normal activity; This is a spontaneous report from a contactable consumer (patient) downloaded from the Agency WEB. The regulatory authority number is FR-AFSSAPS-TS20214550. A 55-year-old male patient received BNT162b2 (COMIRNATY), intramuscular on 03Sep2021 (Batch/Lot Number: Unknown) as dose 2, single for COVID-19 immunisation. Medical history included asthma, rectocolitis, and eczema. The patient''s concomitant medications were not reported. On 12Sep2021, the patient experienced disease aggravation of rectocolitis. Time interval between beginning of drug administration and start of reaction/event was 10 days (as reported). The patient underwent lab tests and procedures which included SARS-CoV-2 test: negative on 11Aug2021. The outcome of the events was recovering. Reporter''s Comments Text: Information contained in the declaration: "Disabling situations (impossibility to move or to have a normal activity) as soon as the disorders occur. In addition to the side effects indicated, I have the definite impression that the 2nd injection reactivated the symptoms of rectocolitis which had been in remission for about 2 years: intense and frequent abdominal pain, diarrhoea, false cravings, itching and ring irritation. I had to resume the treatment I was previously taking: Pentasa. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reporter''s Comments: "Disabling situations (impossibility to move or to have a normal activity) as soon as the disorders occur. In addition to the side effects indicated, I have the definite impression that the 2nd injection reactivated the symptoms of rectocolitis which had been in remission for about 2 years: intense and frequent abdominal pain, diarrhoea, false cravings, itching and ring irritation. I had to resume the treatment I was previously taking: Pentasa.


VAERS ID: 1760759 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3380 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Inappropriate schedule of product administration, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FENTANYL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic fatigue syndrome; Chronic pain; Fibromyalgia; Immunodeficiency (Has an illness or condition, not listed above, which reduces the immune response (e.g. immunodef...); Spina bifida
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC202101242791

Write-up: very large clots; Heavy periods; patient received the dose 1 on 09Jul2021 and dose 2 on 12Sep2021 (inappropriate schedule of vaccine administered); This is a spontaneous report from a contactable consumer received from the Regulatory Authority (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202109201321424960-5GJDM, Safety Report Unique Identifier GB-MHRA-ADR 25968214. A 35-year-old non-pregnant female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number: FE3380), via an unspecified route of administration, on 12Sep2021 (at the age of 35-year-old) as dose 2, single for COVID-19 immunization. Medical history included spina bifida, fibromyalgia, immunodeficiency (has an illness or condition, not listed above, which reduces the immune response (e.g., immunodef), CFS (chronic fatigue syndrome) and chronic pain-all from an unknown date. Patient has not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient was not pregnant at the time of vaccination. Patient was not currently breastfeeding. Concomitant medication included fentanyl (FENTANYL) taken for chronic pain from 2018. The patient''s historical vaccine included the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, batch/lot number was not reported), via an unspecified route of administration, on 09Jul2021, as dose 1, single for COVID-19 immunization. The patient experienced very large clots on an unspecified date; heavy periods on 18Sep2021 and patient received the dose 1 on 09Jul2021 and dose 2 on 12Sep2021 (inappropriate schedule of vaccine administered) on 12Sep2021. The patient had very large clots, plus 2inch in size, pads being changed at 3 times frequency. Patient was not enrolled in clinical trial. Patient had not tested positive for COVID-19 since having the vaccine. Outcome of the event heavy periods was not recovered and outcome of other events was unknown. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1760769 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2153 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Cough, Dysphonia, Dyspnoea, Fatigue, Oropharyngeal pain, SARS-CoV-2 test, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), COVID-19 (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: Test Date: 20200401; Test Name: COVID-19 virus test; Test Result: Positive ; Comments: Yes - Positive COVID-19 test
CDC Split Type: GBPFIZER INC202101243105

Write-up: Sputum discoloured; Chest ache; Hoarse voice; Cough; Sore throat; Tight chest; Short of breath; Fatigue; This is a spontaneous report from a contactable consumer received from the regulatory authority (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202109201431079830-MKDUI. Safety Report Unique Identifier GB-MHRA-ADR 25968607. A 55-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot Number: FF2153), first dose via an unspecified route of administration on 11Sep2021 as dose 1, single for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. Patient has not had symptoms associated with COVID-19. On 12Sep2021, the patient experienced cough, sore throat, tight chest, hoarse voice, short of breath, fatigue. The patient experienced sputum discoloured, chest ache on 16Sep2021. All events are medically significant. The patient underwent lab tests and procedures which included SARS-CoV-2 test: Positive (yes-positive COVID-19 test) on 01Apr2020. Patient has not tested positive for COVID-19 since having the vaccine. Patient was not enrolled in clinical trial. The outcome of cough, tight chest, short of breath, sputum discoloured was not recovered, while events sore throat, fatigue, hoarse voice and chest ache was recovering. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1760790 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-09
Onset:2021-09-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac flutter, Electrocardiogram, SARS-CoV-2 test
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Tachyarrhythmia terms, nonspecific (narrow), COVID-19 (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: Test Name: ECG; Result Unstructured Data: Test Result:UNKNOWN; Comments: UNKNOWN; Test Date: 20210907; Test Name: COVID-19 virus test; Test Result: Negative ; Comments: Negative
CDC Split Type: GBPFIZER INC202101242836

Write-up: Heart fluttering; This is a spontaneous report from a contactable consumer (patient) received from the regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202109201735179990-WZTWC. Safety Report Unique Identifier GB-MHRA-ADR 25969562. A 22-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number not reported and Expiry date: unknown) via an unknown route on 09Sep2021 as dose 2, single for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on an unspecified date as dose 1, single for COVID-19 immunisation. Patient has not had symptoms associated with COVID-19. Patient has not tested positive for COVID-19 since having the vaccine. Patient was not enrolled in clinical trial. The patient had his second dose and a couple of days later he started experiencing heart fluttering (12Sep2021) which lasted no longer than 15 seconds at a time and were very irregular and random. The patient underwent lab tests and procedures which included sars-cov-2 test: negative on 07Sep2021 (no, negative COVID-19 test), electrocardiogram: unknown on an unspecified date. The clinical outcome of event was recovering. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1760957 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG9019 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: C-reactive protein, Chest discomfort, Echocardiogram, Electrocardiogram PR segment depression, Electrocardiogram ST segment elevation, Electrocardiogram change, Magnetic resonance imaging, Myocarditis, Troponin T
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202109; Test Name: Echocardiogram; Result Unstructured Data: Test Result:Unknown results; Comments: Echo normal LV size and function.; Test Date: 202109; Test Name: Electrocardiogram change; Result Unstructured Data: Test Result:Unknown results; Comments: ECG changes of pericarditis with PR depression, concave up ST elevation and Spodick(s) sign.; Test Date: 202109; Test Name: Electrocardiogram PR segment depression; Result Unstructured Data: Test Result:Unknown results; Comments: ECG changes of pericarditis with PR depression, concave up ST elevation and Spodick(s) sign; Test Date: 202109; Test Name: Electrocardiogram ST segment elevation; Result Unstructured Data: Test Result:Unknown results; Comments: ECG changes of pericarditis with PR depression, concave up ST elevation and Spodick(s) sign.; Test Date: 202109; Test Name: cardiac magnetic resonance imaging; Result Unstructured Data: Test Result:Awaiting; Test Date: 202109; Test Name: Cardiac troponin T; Result Unstructured Data: Test Result:Unknown results; Comments: Cardiac Troponin T 678 (units unspecified).; Test Date: 202109; Test Name: C-reactive protein; Result Unstructured Data: Test Result:Unknown results; Comments: Elevated CRP at 69(units unspecified).
CDC Split Type: IEPFIZER INC202101239526

Write-up: Myopercarditis; severe central chest discomfort; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB. This is a report received Regulatory Authority-WEB] Regulatory authority report number [IE-HPRA-2021-084456] with Safety Report Unique Identifier [IE-HPRA-2021-084456]. A 15-years-old male patient received bnt162b2 (COMIRNATY, solution for injection, Batch/Lot number FG9019), dose 2 via an unspecified route of administration on 10Sep2021 as DOSE 2, SINGLE for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient previously took first dose of bnt162b2 (COMIRNATY, solution for injection, Batch/Lot number FE7053) as DOSE 1, SINGLE on 17Aug2021 for covid-19 immunization. On 12Sep2021, the patient experienced myopercarditis and severe central chest discomfort. The patient was hospitalized for myopercarditis (myocarditis) from 12Sep2021 to 14Sep2021. It was stated that 36 hours later on 12Sep2021, the patient experienced myopericarditis and was admitted to hospital with symptoms of severe central chest discomfort. On 14Sep2021, the patient was discharged. The patient was advised to stay off school until the following week and to avoid soccer and contact sports for 4 weeks. At the time of reporting the patient symptoms were ongoing. The event myopercarditis were serious (medically significant, hosp). The patient underwent lab tests and procedures which included c-reactive protein unknown results (Elevated CRP at 69(units unspecified)), echocardiogram unknown results (Echo normal LV size and function), electrocardiogram change unknown results (ECG changes of pericarditis with PR depression, concave up ST elevation and Spodick(s) sign), electrocardiogram pr segment depression unknown results (ECG changes of pericarditis with PR depression, concave up ST elevation and Spodick(s) sign), electrocardiogram st segment elevation unknown results (ECG changes of pericarditis with PR depression, concave up ST elevation and Spodick(s) sign), troponin t unknown results, Cardiac Troponin T 678 (units unspecified) and cardiac magnetic resonance imaging awaiting on unspecified date in Sep2021. Treatment included colchicine (brand unspecified) at a dose of 500 (units unspecified) twice daily x 3 months and ibuprofen (brand unspecified) at a dose of 600 (units unspecified) three time daily to be reduced according to C-reactive protein response over 4-6 weeks. Outcome of the event myopercarditis was not recovered. Outcome of the event severe central chest discomfort was unknown. No Follow-up attempts are possible. No further information is expected.


VAERS ID: 1761109 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-12
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain lower, Back pain, Fatigue, Mental impairment, Nausea, Taste disorder
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: AUPFIZER INC202101242887

Write-up: Mental impairment; Abdominal pain lower; Back pain; Fatigue; Nausea; Taste disorder; This is a spontaneous report from a contactable other health professional via the Regulatory Authority. Regulatory authority report number is 623830. A 57-years-old male patient received bnt162b2 (COMIRNATY, solution for injection, Lot number was not reported), via an unspecified route of administration on an unspecified date as dose number unknown, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. On 12Sep2021, the patient experienced mental impairment, abdominal pain lower, back pain, fatigue, nausea, taste disorder. Reportedly, medicine Onset Time in days for Suspect was reported as 22 days. The outcome of all the events was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1761137 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-12
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Meningitis viral
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AUPFIZER INC202101243869

Write-up: Meningitis viral; This is a spontaneous report from a contactable other health professional via the Regulatory Authority. Regulatory authority report number is 625914. A 31-year-old female patient received bnt162b2 (COMIRNATY, Formulation: Solution for injection, Lot number: not reported) via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID- 19 Immunization. Medical history and concomitant medications were not reported. It was reported that on 12Sep2021 patient experienced meningitis viral. Outcome of the event was recovering. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1762553 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-18
Onset:2021-09-12
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2832 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Abortion spontaneous complete, C-reactive protein, Coagulation test, Haematocrit, Haemodynamic test, Haemoglobin, Haemorrhage in pregnancy, Pain, Physical examination, Platelet count, SARS-CoV-2 test, Ultrasound scan, Ultrasound scan vagina, White blood cell count
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LORAZEPAM; ZOMIG; CETIRIZINE; AVAMYS; HIDROFEROL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Environmental allergy; Genital bleeding; Menstrual disorder; Non-smoker
Allergies:
Diagnostic Lab Data: Test Name: coagulation; Test Result: Negative ; Test Name: CRP; Result Unstructured Data: Test Result:0.16; Test Name: Hto; Test Result: 40.8 %; Test Name: haemodynamic; Result Unstructured Data: Test Result:stable; Test Name: hg; Result Unstructured Data: Test Result:14; Test Name: abdominal examination; Result Unstructured Data: Test Result:Soft and depressible Abdomen, not painful...; Comments: on deep palpation, without peritonism; Test Name: physical examination; Result Unstructured Data: Test Result:Good general condition; Comments: afebrile, stable haemodynamically, bloody genitalia, Transvaginal cervix formed and closed. Soft and depressible Abdomen, not painful on deep palpation, without peritonism; Test Name: platelets; Result Unstructured Data: Test Result:168; Test Name: PCR Covid-19; Test Result: Negative ; Test Name: echo; Result Unstructured Data: Test Result:Retroverted Uterus; Comments: Thickened endometrium with 12.5 x 8.6 mm intrauterine gestational sac. Embryo or vulva and vagina not observed.Left ovary with a hemorrhagic corpus luteum measuring 20.8 x 16.3 mm. Minimum left para-adnexal free fluid; Test Name: Echo transvaginal; Result Unstructured Data: Test Result:Retroverted uterus; Comments: occupied by an unstructured gestational sac of about 8x6 mm. 17 mm endometrial line. Left ovary of normal size and echostructure with image compatible with luteoma. Right ovary of normal size and echostructure. No free liquid in Douglas.; Test Name: Echo transvaginal; Result Unstructured Data: Test Result:endometrium 8.8 mm thick; Comments: without gestational sac, heterogeneous compatible with the presence of blood clots, without any hyperrefringent image that was captured by color Doppler suggestive of chorionic remains. Normal adnexa, no free fluid in the pelvis. Speculum: few hematic remains in the vagina (less than in the previous examination), but there is no active bleeding for external cervical os.; Test Name: Echo transvaginal at 18h; Result Unstructured Data: Test Result:endometrium 8.8 mm thick, without gestational; Comments: sac, heterogeneous compatible with the presence of blood clots, without any hyperrefringent image that was captured by color Doppler suggestive of chorionic debris.; Test Name: transvaginal ultrasound; Result Unstructured Data: Test Result:gestational sac TPAL: 0.0.0.0; Test Name: leukocytes; Result Unstructured Data: Test Result:8.58
CDC Split Type: ESPFIZER INC202101250512

Write-up: increased blood loss; pain; Abortion spontaneous complete; This is a spontaneous report from a contactable physician downloaded from the Regulatory Agency (RA)-WEB, regulatory authority number ES-AEMPS-1005415. This is a maternal report. Only this report is serious. A 28-year-old female patient received bnt162b2 (COMIRNATY), intramuscular on 18Aug2021 (Batch/Lot Number: FF2832) as dose 2, 0.3 mL single for covid-19 immunisation. Historical vaccine included the first dose on 28Jul2021 (lot number: FF2832), intramuscular. Family History: Father with heart disease. Paternal grandmother diabetes mellitus type 2 Personal: No interest. Environmental allergy. None known medical history. Does not smoke. Gynecological and obstetric history: TPAL: 0000. TM menstrual ataxia. Concomitant medications included lorazepam, zolmitriptan (ZOMIG), cetirizine, fluticasone furoate (AVAMYS), and calcifediol (HIDROFEROL); all taken for an unspecified indication, start and stop date were not reported. Patient was with incipient pregnancy (LMP 25Jul2021, 6.5 weeks gestation) who attended the emergency room on 06Mar2021 and 09Jun2021 due to genital bleeding. Emergency transvaginal ultrasound: gestational sac TPAL (Term infants, Premature infants, Abortions, Living Children): 0.0.0.0 ECHO: Retroverted Uterus. Thickened endometrium with 12.5 x 8.6 mm intrauterine gestational sac. Embryo or vulva and vagina not observed. Left ovary with a hemorrhagic corpus luteum measuring 20.8 x 16.3 mm. Minimum left para-adnexal free fluid. Continue resting and avoid sexual relations. New control in 1 week. Right ovary: bleeding early in pregnancy, threat of abortion.On 09Sep2021, she went to the emergency room again due to increased blood loss. Physical examination: Good general condition, afebrile, stable haemodynamically, bloody genitalia. Speculum: moderate active bleeding for external cervical os with some clot. Transvaginal cervix formed and closed. Soft and depressible abdomen, not painful on deep palpation, without peritonism. Additional tests Analytical: Hemoglobin 14; Hematocrit 40.8%; Leukocytes 8.58; Platelets 168; coagulation N; CRP 0.16. PCR Covid 19 negative. Transvaginal Ultrasound: Retroverted Uterus occupied by an unstructured gestational sac of about 8x6 mm. 17 mm endometrial line. Left ovary of normal size and echostructure with image compatible with luteoma. Right ovary of normal size and echostructure. No free liquid in Douglas. In view of pain and bleeding, treatment with vaginal misoprostol and admission for observation is offered. Intravenous analgesia with non-steroidal anti-inflammatory drugs. Transvaginal echo at 18h: endometrium 8.8 mm thick, without gestational sac, heterogeneous compatible with the presence of blood clots, without any hyperrefringent image that was captured by color Doppler suggestive of chorionic remains. Normal adnexa, no free fluid in the pelvis. Speculum: few hematic remains in the vagina (less than in the previous examination), but there is no active bleeding for external cervical os. Well controlled pain with prescribed analgesia. Reporter explained the possible options and agreed to follow-up for approximately 5 days with subsequent clinical and ultrasound evaluation. On 12Sep2021: evolution in incomplete abortion. 14Sep2021: Obstetric diagnosis of complete spontaneous abortion without complications. The mother was 5 Weeks pregnant at the onset of the event. The mother was due to deliver on 01May2022. Outcome of the event of complete spontaneous abortion was recovered on 14Sep2021, while for the remaining events was unknown.; Sender''s Comments: Linked Report(s) : ES-PFIZER INC-202101263734 same patient, different dose of the vaccine;ES-PFIZER INC-202101280322 same patient, different Pfizer product;ES-PFIZER INC-202101280321 same patient, different products


VAERS ID: 1762563 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-03
Onset:2021-09-12
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood creatinine, Blood glucose, Blood potassium, Blood pressure measurement, Blood sodium, Blood urea, Coagulation factor, Haemoglobin, Heart rate, Magnetic resonance imaging, Myocarditis, Oxygen saturation, Physical examination, Platelet count, Prohormone brain natriuretic peptide, SARS-CoV-2 test, White blood cell count
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: creatinine; Result Unstructured Data: Test Result:0.64; Test Date: 2021; Test Name: glucose; Result Unstructured Data: Test Result:76; Test Date: 2021; Test Name: potassium; Result Unstructured Data: Test Result:3.7; Test Date: 2021; Test Name: Blood pressure; Result Unstructured Data: Test Result:115/78; Test Date: 2021; Test Name: sodium; Result Unstructured Data: Test Result:135; Test Date: 2021; Test Name: urea; Result Unstructured Data: Test Result:19; Test Date: 2021; Test Name: Coagulation; Result Unstructured Data: Test Result:normal; Test Date: 2021; Test Name: hemoglobin; Result Unstructured Data: Test Result:13.2; Test Date: 2021; Test Name: Heart rate; Result Unstructured Data: Test Result:120; Comments: bpm; Test Date: 20210917; Test Name: cardiac magnetic resonance imaging; Result Unstructured Data: Test Result:Study compatible with acute myocarditis; Comments: with preserved biventricular function.**Telemetry: no incidents.; Test Date: 2021; Test Name: Oxygen saturation; Test Result: 100 %; Comments: Both alveoli (AA); Test Date: 2021; Test Name: General examination; Result Unstructured Data: Test Result:anodyne; Comments: including cardiopulmonary auscultation; Test Date: 2021; Test Name: platelets; Result Unstructured Data: Test Result:270.000; Test Name: pro-natriuretic peptide; Result Unstructured Data: Test Result:998; Comments: previous; Test Date: 2021; Test Name: pro-natriuretic peptide; Result Unstructured Data: Test Result:1042; Test Date: 2021; Test Name: SARS-CoV-2 test; Test Result: Negative ; Test Date: 2021; Test Name: leukocytes; Result Unstructured Data: Test Result:7340; Comments: with normal leukocyte formula
CDC Split Type: ESPFIZER INC202101250257

Write-up: Acute myocarditis; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB, regulatory authority number ES-AEMPS-1006301. A 15-year-old female patient received the second dose of BNT162B2 (COMIRNATY), via an unspecified route of administration on 03Sep2021 (Batch/Lot Number: Unknown) as DOSE 2, SINGLE for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously received the first dose of BNT162B2 (COMIRNATY), on unspecified date (Batch/Lot Number: Unknown) as DOSE 1, SINGLE for COVID-19 immunisation. On 12Sep2021, the patient experienced acute myocarditis. The patient was hospitalized due to the event. The clinical course was reported as follows: The patient who has been present for oppressive centrothoracic pain since last night radiated to the jaw, not accompanied by dyspnea or vegetative courtship. Yes feeling of palpitations; improvement of pain with seating and standing. Do not syncope or other accompanying clinic. No previous viriasis. The patient underwent lab tests and procedures which included SARS-CoV-2 test (also reported as rapid antigen test): negative in 2021. Blood pressure (TA) 115/78; Heart rate (HR) 120 beats per minute (bpm); Oxygen saturation (SatO2) 100% Both alveoli (AA). General anodyne examination including cardiopulmonary auscultation. General analysis: Blood count: 7340 leukocytes with normal leukocyte formula, hemoglobin (Hb) 13.2, platelets 270.000. Coagulation: normal. Biochemistry: glucose 76, urea 19, creatinine 0.64, sodium 135, potassium 3.7, pro-natriuretic peptide (proBNP) 1042, all in 2021 (previous pro-natriuretic peptide (pro BNP) 998, unspecified date). Cardiac magnetic resonance imaging (MRI): Study compatible with acute myocarditis with preserved biventricular function:.**Telemetry: no incidents on 17Sep2021. Clinical Judgment: Myocarditis without diagnostic criteria of associated Pericarditis, in possible relation to COVID-19 vaccination. - Preserved ventricular function. The outcome of the acute myocarditis was recovering. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1763150 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-12
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Cold sweat, Eye movement disorder, Feeling hot, Generalised tonic-clonic seizure, Loss of consciousness, Pallor, Pulse absent, Respiratory arrest, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Respiratory failure (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: HRJNJFOC20211002102

Write-up: NOT BREATHING; NO PULSE; ANAPHYLAXIS; COLD SWEAT; EYES ROLLING BACK; PALE; WITH 2 TONIC-CLONIC CONVULSIONS THE PATIENT REGAINS FULL CONSCIOUSNESS; COLLAPSE; VERBALIZES THE FEELING OF HEAT; LOSS OF CONSCIOUSNESS/UNCONSCIOUSNESS; This spontaneous report received from a physician via Regulatory Authority (EVHUMAN Vaccines, HR-HALMED-300050876) on 01-OCT-2021 concerned a 43 year old male of unspecified race and ethnic origin. The patient''s weight was 80 kilograms, and height was not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XE393 expiry: UNKNOWN) .5 ml, 1 total, administered on 12-SEP-2021 for covid-19 vaccination. The drug last period was 4 minutes. The duration of drug administration was 1 minute. No concomitant medications were reported. On 12-SEP-2021, the patient experienced not breathing, no pulse, anaphylaxis, cold sweat, eyes rolling back, pale, with 2 tonic-clonic convulsions the patient regains full consciousness, collapse, verbalizes the feeling of heat and loss of consciousness/unconsciousness. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from not breathing, no pulse, anaphylaxis, cold sweat, eyes rolling back, pale, with 2 tonic-clonic convulsions the patient regains full consciousness, collapse, verbalizes the feeling of heat, and loss of consciousness/unconsciousness on 12-SEP-2021. This report was serious (Other Medically Important Condition).


VAERS ID: 1763226 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG6273 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Dysentery, Incorrect route of product administration, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug abuse and dependence (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ITPFIZER INC202101239791

Write-up: dysentery; Severe nausea; chills; joint pain; fever; Route of administration was intraocular; This is a spontaneous report from a contactable consumer downloaded from the regulatory authority number IT-MINISAL02-787515. A 39-years-old female patient received first dose of BNT162B2 (COMIRNATY), intraocular administered in left arm (reported as left shoulder) on 12Sep2021 (at the age of 39-years-old) (Batch/Lot Number: FG6273) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced dysentery, severe nausea, chills, joint pain, fever, route of administration was intraocular on 12Sep2021. The outcome of the events dysentery, severe nausea, chills, joint pain, fever was not recovered. The events were reported as serious with criteria of disability. It was reported Impact on quality of life (7/10). Sender Comment: The report is classified as serious because dissentery appears in the IME list


VAERS ID: 1766587 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3620 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, CSF test, Diarrhoea, Dizziness, Dysstasia, Gait disturbance, Gait inability, Muscular weakness, Nausea, Neck pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210912; Test Name: body temperature; Result Unstructured Data: Test Result:Pyrexia of 38 degrees Centigrade; Test Date: 20210917; Test Name: spinal fluid test; Result Unstructured Data: Test Result:No protein cell dissociation
CDC Split Type: JPPFIZER INC202101262682

Write-up: diarrhoea; gait inability; unable to stand; Difficulty in walking; Difficulty in walking in standing position due to lower extremities weakness; Queasy; Giddiness; pain in the right neck; Pyrexia of 38 degrees Centigrade; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21127522. The patient was a 13-year and 5-month-old male(age at vaccination). The patient had no family history. On 11Sep2021, the patient received the first dose of bnt162b2 (COMIRNATY, Solution for injection, Lot number FF3620, Expiration date 30Nov2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 13Sep2021(2 days after the vaccination), the patient experienced Difficulty in walking in standing position due to lower extremities weakness. On 17Sep2021 (6 days after the vaccination), the patient was admitted to the hospital (and was still in hospitalization). On unspecified date, the outcome of the event was not recovered. The course of the event was as follows: Difficulty in walking in standing position due to lower extremities weakness. On 11Sep2021, the patient received the COVID-19 vaccine. On 12Sep2021, the patient had Pyrexia of 38 degrees Centigrade. On 13Sep2021, the Pyrexia was released, but the patient had Queasy, pain in the right neck, Giddiness, and lower extremities weakness and the patient became unable to stand. Therefore, the patient''s previous doctor Prescribed Nauzelin and BIOFERMIN. On 14Sep2021, the lower extremities weakness intensified, leading to gait inability. From 16Sep2021, diarrhoea appeared. On 17Sep2021, The previous doctor referred the patient to hospitalize in this reported hospital. No protein cell dissociation in spinal fluid test. There was no delay in nerve conduction velocity. There was no deep tendon reflex absent in the lower extremities, which does not correspond to guillain-Barre syndrome, but as of 22Sep2021 at the time of this report, the patient is still having difficulty in walking by himself. The reporting physician classified the event as serious (caused hospitalization from 17Sep2021 and was still in hospitalization) and assessed that the causality between the event and bnt162b2 was unassessable. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: The causal relationship with the COVID-19 vaccine was unknown, but no other cause or evidence of test abnormality was found, and the COVID-19 vaccine cannot be ruled out as a cause.


VAERS ID: 1780493 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-07
Onset:2021-09-12
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3319 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Menstruation delayed, Nausea, Pain, Pregnancy test
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Menstrual cycle abnormal
Allergies:
Diagnostic Lab Data: Test Date: 20210927; Test Name: pregnancy test; Result Unstructured Data: Test Result:Negative
CDC Split Type: GBPFIZER INC202101287327

Write-up: painful trapped wind but no bleeding; Nausea; Delayed period; This is a spontaneous report from a contactable consumer. This is a report received from the Regulatory Authority Regulatory authority report number GB-MHRA-WEBCOVID-202109281557517320-HBRRA, Safety Report Unique Identifier GB-MHRA-ADR 26005889. A 31-years-old female patient received second dose of BNT162B2 (BNT162B2, solution for injection, Batch/Lot Number: FF3319), via an unspecified route of administration on 07Aug2021 as single dose for COVID-19 immunization. The patient''s medical history included menstrual disorder from an unknown date and unknown if ongoing, menstrual cycle has been irregular in the past (early twenties) but she was now 31 and in better fitness/diet health. Patient has not had symptoms associated with COVID-19 not had a COVID-19 test. The patient''s concomitant medications were not reported. On 12Sep2021, the patient experienced delayed period. The patient underwent lab tests and procedures which included pregnancy test was negative on 27Sep2021. The clinical course was reported as follows: her period usually arrived predictably around the 12th of each month and last one was in August and was noticeably longer than usual (a few days after her second vaccine). Her expected 12th of Sept period had not arrived and as of 28Sep2021 she was experiencing nausea and painful trapped wind but no bleeding. Patient has not tested positive for COVID-19 since having the vaccine. Patient was not enrolled in clinical trial. Suspect Reactions included relevant investigations or tests conducted: Negative pregnancy test taken 27Sep21 to rule out other causes of skipped period. The outcome of event was not recovered yet and rest of both events was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1784209 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG0978 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Dyskinesia, Hypoaesthesia, Neuropathy peripheral, Tremor
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPPFIZER INC202101276343

Write-up: Peripheral nerve disorder; Movements involuntary on vaccination side/Movements involuntary of left upper arm; Tremor; numbness of left upper arm; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21127764. The patient was a 13-year and 8-month-old female. Body temperature before vaccination was not provided. On 11Sep2021 at 12:15 (the day of vaccination), the patient received the first dose of bnt162b2 (COMIRNATY, Solution for injection, Lot number FG0978, Expiration date 30Nov2021) via an unspecified route of administration on left upper arm as a single dose for COVID-19 immunization. No medical history or concomitant drugs were reported. On 12Sep2021 at 18: 00 (one day and 3 hours and 45 minutes after the vaccination), the patient experienced movements involuntary on vaccination side and peripheral nerve disorder. On 25Sep2021 (14 days after the vaccination), the outcome of the event was recovering. The course of the event was as follows: One day after the vaccination, the patient experienced movements involuntary and numbness of left upper arm (tremor) occurred. On 13Sep2021, the patient visited the vaccinating physician and was introduced to the hospital for observation. On 18Sep2021 and 25Sep2021, the patient received examination in outpatient and showed improving tendency. The reporting physician classified the events as non-serious and assessed that the causality between the events and bnt162b2 as unassessable. There was no other possible cause of the events such as any other diseases. Follow up attempts are completed, no further information is expected.


VAERS ID: 1787058 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-12
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20211025481

Write-up: COUGH; DIFFICULTY OF BREATHING; FEVER; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300109781] concerned a 44 year old male of unspecified race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A, expiry: UNKNOWN) dose was not reported, 1 total administered on 31-JUL-2021 for an unspecified indication. No concomitant medications were reported. On 12-SEP-2021, the patient experienced cough, difficulty of breathing, fever and was hospitalized (date unspecified). The number of days hospitalized was unspecified. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from cough, fever, and difficulty of breathing. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20211025481-Covid-19 vaccine ad26.cov2.s -Cough, Difficulty of breathing. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). V0: 20211025481-Covid-19 vaccine ad26.cov2.s -Fever. This event(s) is labeled per RSI and is therefore considered potentially related.


VAERS ID: 1690685 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Dizziness, Fatigue, Headache, Nausea, Paranasal sinus discomfort, Rhinorrhoea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Vomiting, nausea, chills, fatigue, headache, dizziness, coughing, runny nose, sinus pressure


VAERS ID: 1692857 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Dyspnoea, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: Trouble breathing, extreme headache, nausea & pain in abdomen.


VAERS ID: 1692884 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3183 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Dizziness, Headache, Immediate post-injection reaction, Injection site pain, Taste disorder
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC allergy medicine Non Drowsy Allergy Relief 24 hour. Took one Tylenol tablet last night for headache after shot.
Current Illness: Sinus and allergies.
Preexisting Conditions: Have been diagnosed with vertigo in the past (2007). Irregular heartbeat was detected in 1996, no medicine or monitoring needed. Was instructed to reduce stress.
Allergies: Vicodin
Diagnostic Lab Data: None at the time of this report.
CDC Split Type:

Write-up: Immediately after shot tasted a medicine like taste, felt slightly sick to my stomach, and experienced a slight pain in my right temple. About 8:00 began to feel a slight headache. Woke up feeling pain at the injection site, but nothing else. Was walking out of one room and began to feel very dizzy, steadied myself and began to walk feeling dizzy again. Had to quick episodes after that. Some stomach irritation. But went away once my dizziness stopped.


VAERS ID: 1692886 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

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

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

Write-up: I received the vaccine on 09/10/21 around 1500 and woke up around 0200 on 09/11/21 with difficulty breathing and felt like my throat was closing. I took two 25mg tablets of Equate Allergy Relief (off brand benadryl). Symptom passed and returned to bed. No other major symptom since (it is now 0930).


VAERS ID: 1692896 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Limb discomfort, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Hypertension (narrow), Lens disorders (broad), Retinal disorders (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 reported
Current Illness: None
Preexisting Conditions: None
Allergies: None reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient receives vaccine and starts to describe blurry vision. Patient closes eyes to rest a minute and then describes heavy feeling in her arms. Patient blood pressure is elevated (130/101) Patient continues to rest and then blood pressure recheck reads 191/141 EMT''s were called and Benadryl was given. EMT''s evaluated and vitals returned to normal and patient was released.


VAERS ID: 1692897 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / UNK LA / SYR

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

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

Write-up: Fever, chills, body aches, headaches, fatigue


VAERS ID: 1692932 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Eye pruritus, Fatigue, Photophobia
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (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: Metformin, 1000mg. twice a day. Januvia, 10mg. once a day. Men''s one a day multivitamin once a day. Glucosamine and Chondroitin, once a day.
Current Illness:
Preexisting Conditions: Diabetes type II
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Joint pain in my knees, sensitivity to light, itchy eyes and dizziness, fatigue.


VAERS ID: 1692943 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: Patient was advised to sit down and stay inside the store for about 15min after vaccination. Shortly after receiving the 1st dose of covid vaccine, Patient throw up in the front of pharmacy. Patient was recommended to sit a little longer for observation and make sure everything is OK before he walk out. He felt fine afterwards and agreed to follow up with his doctor if he experiences any severe side effects later.


VAERS ID: 1692952 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety
SMQs:, 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: Vistollic / Hydrocool
Current Illness:
Preexisting Conditions: Blood Cancer
Allergies: N/A
Diagnostic Lab Data: Resp : 18 , BP: 142/92
CDC Split Type:

Write-up: Anxiety - AE . Patient was monitored and released


VAERS ID: 1692954 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pro- Air HFA 108 (90 base) MCG/ACT Hydrocortisone 2.5% external cream Singular 5mg
Current Illness: None Known
Preexisting Conditions: Asthma
Allergies: Seafood
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Janssen vaccine was administered to patient under 18 years of age.


VAERS ID: 1692964 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Blindness, Feeling hot, Hyperhidrosis, Speech disorder, Tinnitus, Tunnel vision
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (narrow), Hearing impairment (narrow), Hypoglycaemia (broad)

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

Write-up: Felt sick to stomach at 7:30am, went to bathroom, sat down, started getting hot and sweaty all over my body, tunnel vision started and ears started ringing, couldn?t see or speak, came to and was covered in sweat. About 15 minutes later it happened all over again


VAERS ID: 1692976 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

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

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

Write-up: Light headed and tiredness


VAERS ID: 1692982 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

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

Write-up: Numbness and tingling on vaccinated arm.


VAERS ID: 1692995 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: N/A
CDC Split Type:

Write-up: Numbness and tingling at vaccinated arm.


VAERS ID: 1692998 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Choking, Dyskinesia, Feeling abnormal, Hyperhidrosis, Muscle twitching, Pallor, Posture abnormal, Respiration abnormal, Staring
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (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: Unknown
Current Illness:
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: The vaccine was administered into the right deltoid muscle. The patient seemed dazed and appeared pale. When asked if he was ok, he stated he had been feeling nervous. After this the patient stared blankly ahead and his breathing choked and stopped momentarily. I assumed anaphylaxis at first and prepared an Epi-Pen. Still seated, he collapsed forward. I attempted to hold him up to stop him from hitting his head on the cart in front of him. There were some slight twitching/jerking movements in his arms. The patient eventually came to and was able to sit up. He was in a sweat and stated he needed water and some air, but was well enough where he declined an ambulance. The patient was provided a bottle of water and allowed to sit in the vaccination area for about 20 minutes to recover.


VAERS ID: 1693009 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-03
Onset:2021-09-11
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Intraocular pressure increased
SMQs:, Neuroleptic malignant syndrome (broad), Glaucoma (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ATORVASTATIN 20MG
Current Illness: N/A
Preexisting Conditions:
Allergies: PENICILLIN BETA BLOCKERS ALPHA AGONISTS
Diagnostic Lab Data:
CDC Split Type:

Write-up: increased intraocular pressure and blood pressure, chronic and continuing


VAERS ID: 1693012 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

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

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

Write-up: Received a moderna vaccine and passed out about 5-10 minutes later. She was alert and talking then passed out for about a minute. I went out and she was breathing. Called 911. She woke up and vomited. Stated she felt better. Paramedics arrived and talked to her and took vitals. She opted to be taken to the hospital.


VAERS ID: 1693014 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 59676-0580-05 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Cold sweat, Dizziness, Heart rate increased, Shock symptom
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After 5 minutes felt the symptoms of shock. Rising anxiety and heart rate. Light headed and cold sweat. I felt like I would faint. I laid flat on the ground and was better in about a minute and could stand up and sit in a chair again. 15 minutes later I was relatively normal.


VAERS ID: 1693023 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Syringe issue
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: Birth control and over-the-counter vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Needle sank back into the syringe when needle touched patient skin. No vaccine was injected in patient arm. New dose was given to patient.


VAERS ID: 1693029 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right after receiving the injection she passed out for 15 seconds.


VAERS ID: 1693034 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

Write-up: Syncope episode. Vitals were taken: Temp: 97.1 B/P: 100/75 Pulse: 79 Respiration: 18 SAO2:97 Ambulance called in precaution. Vitals were checked again and patient felt good/refused transport. When conscious, stated a similar episode happened 10 years ago.


VAERS ID: 1693041 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Hyperhidrosis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient stated that he was feeling faint, I talked to him and then he became unresponsive to me. he was noticeably breathing and sweating. I had his wife come in to talk to him. It took about 20 minutes for him to completely respond to us. I called 911 for them to access his condition as well. he left feeling still a little "not quite right" and will get checked out more if he feels necessary. He did not want to go to er. It was very much like an extreme drop in sugar.


VAERS ID: 1693046 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

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

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

Write-up: syncope 10 minutes after pfizer vaccine. pt was fine after about 15 minutes. called a medic to come and evaluate patient. they determined she was fine and she went home with her parents


VAERS ID: 1693054 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Hypoaesthesia, Hypoaesthesia oral
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: chicken pox booster dose, patient stated arms swelled and stopped breathing as a child
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: latex, chicken pox booster dose
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine at approximately 12:30pm on 9/11/2021. At approximately 12:45pm patient began having trouble breathing and experienced numbness in her lips, arms , and legs. Patient was helped to lay flat on the floor where she was administered 0.3mg epinephrine autoinjector in the right upper thigh at 12:47pm. At approximately 12:49pm police arrived and took over the scene. Patient had began to breath better but still experienced numbness in her lips, arms, and legs. Police communicated with EMS and were advised not to administer any further doses of epinephrine. EMS arrived on scene at approximately 12:55pm. They assisted patient to the cot where she was set to be taken to the local emergency room for further observation.


VAERS ID: 1693063 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: the patient felt dizzy and rapid heart rate


VAERS ID: 1693064 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Electrocardiogram normal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: I got my first dose of the Pfizer shot around 4 pm and after midnight I felt a pinching in my chest which did not go away. Around 10 am I went to urgent care and was having trouble breathing (possibly a panic attack) and the chest pain is still there. They did an EKG which looked normal so I left there feeling better mentally but not feeling better from the chest pain.


VAERS ID: 1693065 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Headache, Nail discolouration
SMQs:

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

Write-up: Purple toenails and fingernails. Headache. Symptoms just started 45 minutes after 2nd vaccine.


VAERS ID: 1693066 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Pharyngeal hypoaesthesia, Throat irritation
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

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

Write-up: DIZZINESS, NUMBNESS OF ARMS AND THROAT. GAVE PATIENT BENADRYL AND THEN EPIPEN ( ONCE THE PATIENT STARTED TO HAVE THROAT IRRITATION) THEN CALLED 911


VAERS ID: 1693067 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

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

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

Write-up: pt claims to have pain in upper arm area and decreased arm motion due to vaccine. says he did not feel any effects day of vaccine, but felt severe pain and loss of motion the day after


VAERS ID: 1693068 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Condition aggravated
SMQs:, Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP 110/86 , RR 20
CDC Split Type:

Write-up: The patient has a history of anxiety attacks


VAERS ID: 1693083 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 - / SYR

Administered by: Military       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hypotension, Presyncope
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Cold sweat, dizziness and low blood pressure, almost passing out


VAERS ID: 1693084 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

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

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

Write-up: Pfizer vaccine that was provided to the patient was improperly stored in the freezer for greater than 14 days.


VAERS ID: 1693088 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pfizer vaccine that was provided to the patient was improperly stored in the freezer for greater than 14 days.


VAERS ID: 1693089 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 RA / IM

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

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

Write-up: Pt received her second moderna inj and, after completing the inj, she stood up and walked over to sit in a chair outside of the inj booth to wait for 15 minutes. She sat down, but after about 5 minutes, a customer yelled at us that someone had fainted. Upon walking out to the pt, she was laying face down on the floor, passed out. She had fainted. We helped her to sit upright, on the floor. She had fallen on floor and landed on her face. Her forehead was read, but her nose seemed ok. She was a little shaky. We gave her a bottle of water to drink and helped her into a wheel chair. Her husband came to pick her up. The tech explained to the husband that she hit her forehead on the floor and needed a ct scan to make sure she did not have a concussion. The husband only replied "ok", asked his wife if she was ready to go and wheeled her out in the wheelchair to his car.


VAERS ID: 1693092 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Vomiting
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), 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. Does not fill at this Pharmacy.
Current Illness: Broken Jaw. No other illness
Preexisting Conditions: Unknown
Allergies: NKDA
Diagnostic Lab Data: Paramedics took the patients blood pressure and appeared slightly lower than normal when they first got there, but gradually increased. They also monitored the patient''s heart, where he had normal sinus rhythm.
CDC Split Type:

Write-up: Patient came in looking for a Janssen vaccine. He came in asking if the vaccine can make him vomit because he recently broke his jaw and was worried about vomiting with his mouth wired shut. I informed the patient that it is unlikely, but a possibility and asked the patient if he still felt comfortable getting the vaccine. Because his jaw was wired shut, I asked if he''s gotten anything to eat today and described to me he had some yogurt and blend fruit, but that is it. Asked how he is feeling today and he said he "felt good" and isn''t sensitive to vaccines in the past. After Administering the J&J vaccine into his right deltoid, I asked him to sit in a chair for 15 minutes to make sure he is feeling okay. As I was helping other customers, the Patient said loudly that he wasn''t feeling good. As I walked over he repeatedly said he felt like he was going to faint. 5 seconds later he fainted in the chair. I positioned myself so he wouldnt fall out of the chair. and a technician called 911 right away. The patient was unconscious for roughly 10-15 seconds then woke up and appeared very sweaty. A technician and I stayed by the patient''s side until paramedics arrived less than 5 minutes later where the patient appeared wake and oriented to where he was. Paramedics thought the reason for the fainting after the vaccine was due to not having enough food in his system due to recently having his jaw wired shut. Pharmacy provided the patient with Gatorade, Ensure, and applesauce to help. Paramedics were here monitoring the patient for 25 minutes Patient stayed for about 1 hour until a friend came and picked him up.


VAERS ID: 1693094 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Incomplete course of vaccination
SMQs:, Medication errors (narrow)

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

Write-up: Pfizer vaccine that was provided to the patient was improperly stored in the freezer for greater than 14 days.


VAERS ID: 1693101 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / IM

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

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

Write-up: Pfizer vaccine was improperly stored in the freezer for greater than 14 days.


VAERS ID: 1693102 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

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

Write-up: Pfizer vaccine that was administered was improperly stored in the freezer for greater than 14 days.


VAERS ID: 1693103 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-28
Onset:2021-09-11
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: vaccine administration error: interval. Doses administered on 8/28/2021 and 9/11/2021. less than 17 days between doses.


VAERS ID: 1693105 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Pruritus, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: about 5-10 mins after the covid shot, patient felt dizzy, sweaty, vision blurred and itchy and hot(breathing was ok and normal) called 911 and emt came to check him out . They did not give him any treatment and told me to observe him for 30 mins and he can leave if feeling better. patient waited a few more minutes and felt better and left pharmacy


VAERS ID: 1693106 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling cold, Nerve compression, Paraesthesia, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Accidents and injuries (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prucalopride, Tylenol, ondansetron
Current Illness: gerd, acid reflux, gastroperesis
Preexisting Conditions: same as above
Allergies: metronidazole, nuts, cinnamon
Diagnostic Lab Data: only got B/P, HR tested
CDC Split Type:

Write-up: at 1015 L side of body had sharp pin pricks of pain, shortly after the pain L side from head to toe feels cold. By 1030 L side of face, neck, shoulder, arm, thigh, and ankle tingles. By 1100 L side of face, neck, shoulder feels tight (like being squeezed or scrunched without relaxing). Its now 1510 and the same reaction is still there.


VAERS ID: 1693109 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 1 LA / IM

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

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

Write-up: Redness in the shape of the bandage, minus the padding.


VAERS ID: 1693111 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 10mg Clobazam
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Whole body muscle pains, 18 hours after 2nd injection


VAERS ID: 1693112 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

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

Write-up: Patient got her first dose of Pfizer on 9/2/21 and got the second dose on 9/11/21, she got it too soon. No adverse reaction noted during post vaccination monitoring. Pt educated to go to the ER at any onset of respiratory problems or even if something don''t fell right.


VAERS ID: 1693114 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pain, Pain in extremity, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin, Lavoxyl, Zoloft
Current Illness: None
Preexisting Conditions: Diabetes 1; Hypothyroidism
Allergies: Parsnip, Seasonal Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after Shot: Complete Body Aching; Fever; Vomiting; Fatigue; Sore Arm


VAERS ID: 1693115 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pristiq, methylfolate, methylphenidate
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started vomiting at 8:00 several times. Extreme neasua following the rest of the day


VAERS ID: 1693116 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

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

Write-up: Chills, fever 102?, nausea, light headed


VAERS ID: 1693120 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Injection site warmth, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Modafinil, Sudafed, Tylenol
Current Illness: Sinus infection
Preexisting Conditions: None
Allergies: Sulfa Based Medications
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 minutes after receiving injection, felt shoulder tighten. No noticeable symptoms the same day of vaccine. The next morning when I awoke, 18 hours later, the injection site was swollen about the diameter of a mandarin orange, it is very warm to the touch, and sore. This has continued for the last 8 hours and I am now reporting the reaction.


VAERS ID: 1693123 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin c & vitamin d
Current Illness: Sinus infection
Preexisting Conditions: Anxiety
Allergies: Phenergen
Diagnostic Lab Data: Trying to see if it goes away. Need to work
CDC Split Type:

Write-up: Tingling sensations of the head. Mainly left right now.


VAERS ID: 1693124 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Headache, Pharyngeal mass
SMQs:, Oropharyngeal neoplasms (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: No
Allergies: Cephlexin, amoxacillin and Penicillin
Diagnostic Lab Data: None needed at the moment.
CDC Split Type:

Write-up: First was a lump on the throat 30 minutes after getting the shot and it has not yet went away. Not sure if that counts as shortness of breath but I was still able to breath. It is 3 hours after when the first symptom started. Also within that time, extream tiredness, severe headache and no energy. I didn''t take any medication for the side effects but did take a nap.


VAERS ID: 1693125 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-18
Onset:2021-09-11
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Other       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: I am sending this because vsafe will not let me in to report.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vsafe will not let me report


VAERS ID: 1693128 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Loss of consciousness, Pyrexia, Seizure, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: coughing, difficulty breathing, vomiting, fever, fell unconscious, seizures taken by ambulance to hospital


VAERS ID: 1693135 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Headache, Heart rate irregular, Memory impairment, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, Vitamin B-12, Vitamin D-3
Current Illness: none
Preexisting Conditions: nodules in lungs (cause never determined, possibly histoplasmosis). The nodules have been stable for several years.
Allergies: acetaminophen, pseudoephedrine, gabapentin, oseltamivir, artificial colorings, artificial preservatives
Diagnostic Lab Data: I will make an appointment with my doctor as soon as possible.
CDC Split Type: 03461

Write-up: Shortly after receiving the injection, I had a headache. Then pain in my right arm. The headache subsided in a few hours and the pain in my arm got progressively worse over the first 24 hours and then began to subside. I began to experience memory lapses after 24 hours and made many mistakes that are unusual for me. I would describe it as severe brain fog. All of that I assumed was normal. However, this afternoon (about 55 hours after injection), I had heart palpitations that were quite alarming. The initial incident lasted for a few moments (less than 5 minutes). First I felt that my heart rate was accelerated for no reason. Then it got very strong and pounded erratically. Then it got weaker but remained erratic. It alternated between these states and then returned to normal. Less than an hour later (while filling out this form), my heart became erratic again, but this time only for 10-15 seconds. It is currently back to normal, though I feel a bit funny.


VAERS ID: 1693139 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

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

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

Write-up: second dose in series was given 21 days after the first dose instead of 28 days. did not result in any adverse reactions


VAERS ID: 1693141 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Loss of consciousness, Pallor, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (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 passed out just 5-10 seconds after her vaccine was administered. Mom caught her when her knees buckled, on the ground she was shaking but I kept her sitting up. And after about 15 seconds she came to. She was dizzy and a little hot, and very pale. Mom called 911 and she was evaluated by paramedics. Her color returned and she felt much better when they left the pharmacy.


VAERS ID: 1693154 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diagnosed with Covid 08/02/2021, recovered 08/13/2021
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Running a fever, headache, nausea, sore injection site


VAERS ID: 1693157 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Deafness unilateral, Hypoaesthesia, Pain, Paraesthesia, Pyrexia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine circa 1997 I think
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling and numbness on left side of face. Throbbing pain mostly on left side of head. Blurred vision in left eye. Slight loss of hearing in left ear. Fever of 100.6. Chills. Body aches. Stabbing pain in random areas of body intermittently.


VAERS ID: 1693159 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

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

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

Write-up: None


VAERS ID: 1693162 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-11
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, zinc, iron, bcaas, preworkout, vit d, calcium
Current Illness: N/a
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itchy circular red rash


VAERS ID: 1693165 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-26
Onset:2021-09-11
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LL / IM

Administered by: Work       Purchased by: ?
Symptoms: Headache, Photopsia, Visual impairment, Vitreous detachment
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Estrogen
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: September 8th went to optical. Had pictures of the back of my eye, and an eye exam by the doctor. Scheduled for a follow up exam on 9/20/2021
CDC Split Type:

Write-up: Severe Headache for 2-3 days post vaccine. Then Seeing sharp white lightning in right eye. Went to optical to see if I had a detached Retina. It was determined I have a vitreous detachment - now I have both the white lightning and now 2 black spots in the vision in my right eye.


VAERS ID: 1693176 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: seizure meds and on meds for hashimoto''s
Current Illness: chiari malformation, epilepsy , and hashimoto''s disease
Preexisting Conditions: chiari malformation, epilepsy , and hashimoto''s disease
Allergies: clindamycin and penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Seizure: caregiver gave her ODT clonazepam- patient has epilepsy not sure if this was related to the event


VAERS ID: 1693177 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

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

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

Write-up: Patient received the wrong vaccine due to miscommunication between technician and patient. Patient was the questioned by the pharmacist and another technician prior to vaccination, but patient was not paying attention on which shot he was about to receive.


VAERS ID: 1693178 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF587 / 2 RA / IM

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

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

Write-up: This patient had an adverse event that occurred 4 and 1/2 hours after receiving his second dose of Pfizer-Biotech vaccine on 9/11/2021. His mom called the pharmacy to report her son having a mild seizure. She said he has a history of seizures but has not had one in over a year until now.


VAERS ID: 1693180 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling cold, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Approximately one minute after receiving vaccine, the patient felt like she needed to sit down. About 10 minutes later, she felt like she was going to pass out and we helped her lay on the ground. She passed out, we lifted her legs as she was lying down, and she came to. We gave her a bottle of orange juice. She continued to lay down and say she didn''t feel well. She drank a whole bottle of orange juice and still wasn''t feeling well and her husband asked for a second bottle. She said she felt cold, so we gave her a sweater. She had gotten to a sitting position at this point but then said she felt like she needed to lay down again. She started shivering, visibly shaking from being cold. We gave her another sweater to put over her legs. At this point it had been about 25 minutes since we gave the vaccine and we called the paramedics, as she wasn''t improving. They arrived, took her vitals and ended up taking her to the hospital to check everything out more in depth and monitor pregnancy stats. We called her when she got home from the hospital- they had given her fluids and she is feeling better now.


VAERS ID: 1693191 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / N/A LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ687AA / N/A RA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced nausea and lightheadedness following vaccine administration. Patient''s symptoms resolved before leaving the waiting area.


VAERS ID: 1693198 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (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 was provided second covid vaccination. After administration, patient began bleeding. Pressure was applied but blood filled the inject-safe bandage. Pharmacist was able to use cotton to absorb blood and re-bandaged injection site. Before re-applying a bandage, the bleeding had stopped. Parent was instructed to use cool compress if swelling occurred. After 15 minutes, patient was fine.


VAERS ID: 1693199 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Extra dose administered, Fatigue, Injection site pain, Pyrexia, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Fatigue, severe lack of energy, loss of appetite, moderate pain at injection site, chills, feverish skin, increased thirst


VAERS ID: 1693201 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Headache, Pain, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sudafed for seasonal allergies and a daily multivitamin.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, horrible body aches, headache, chills, brain fog and fatigue.


VAERS ID: 1693207 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Within 5 minutes of receiving his first dose of the Pfizer COVID vaccine, patient was feeling lightheaded, sweating, and began vomiting in a waste basket. He never fainted, but was looking pale. I had him remain seated and gave him a cold bottle of water and cool damp paper towel to put on his forehead. After vomiting a few times and waiting for a period of time, the patient said he was feeling better and not lightheaded any longer and wanted to leave. His girlfriend was with him and she went to get the car. The patient said he just wanted to sit in front of the air conditioning of the car as he felt the bright lights and heat of the store were not helping. He was able to walk out on his own.


VAERS ID: 1693208 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None


VAERS ID: 1693217 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BUSPIRONE
Current Illness: ANXIETY- VERY ANXIOUS AND CRYING ABOUT EVENTS OTHER THAN GETTING A VACCINE AT THE TIME SHE GOT HER VACCINE
Preexisting Conditions: DENIES
Allergies: SULFA ALLERGY
Diagnostic Lab Data: PULSE 89 SPO2 99
CDC Split Type:

Write-up: PATIENT WAS GIVEN HER FIRST PFIZER COVID VACCINE AT 12:38 PM. SHE WAS VERY EMOTIONAL AT THAT TIME AND STATES NOT ABOUT THE VACCINE ALTHOUGH SHE SAID SHE WAS NERVOUS. SHE WAS CRYING AND ASKED ABOUT IF I KNEW OF A GOOD COUNSELOR. I TOLDER HER A PLACE AND SHE SAID SHE ALREADY HAD AN APPT SCHEDULED WITH THEM. SHE TALKED HOW SHE JUST RECENTLY WAS DIAGNOSED WITH ANXIETY AND PUT ON BUSPIRONE ABOUT A MONTH AGO BUT SHE NEED THE THERAPY SIDE OF IT ALSO. I TOLD PATIENT AFTER THE VACCINE SHOT TO WAIT IN THE CLINIC FOR 15 MINUTES IN CASE OF AN ALLERGIC REACTION. 6 MIN LATER I AM CALLED OUT IN STORE CLINIC WHERE SHE HAD PASSED OUT. WE GOT HER BACK TO THE EXAM ROOM AND GOT HER SOME WATER AND CALLED 911 BECAUSE WHEN SHE WOKE UP SHE SAID SHE BUMPED HER HEAD ON SOMETHING. SHE SAID THAT SHE WENT TO GET SOME GROCERIES AND THAT WHILE IN THE CHECKOUT LINE SHE FELT FAINT AND TRIED TO MAKE IT BACK TO THE CLINIC AND PASSED OUT. EMS ARRIVED AT 1250 FOR EVALUATION AND AT 1:02 PM SHE WAS TAKEN BY EMS TO HOSPITAL


VAERS ID: 1693220 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Nausea, Pallor, Vomiting
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), 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: passed out about 10 minutes after receiving first dose-came to immediately after; pale; nauseous; vomited once; BP 99/51. gave water, had her rest.


VAERS ID: 1693227 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Cough, Dysphagia, Headache, Retching, Throat clearing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

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: Was given COVID-Pfizer, Hep B, Tdap, Polio, Meningococcal, and Adenovirus all on the same day on 30Jul21. She developed a sensat
Other Medications: Prenatal vitamin Loratadin Indomethacin
Current Illness:
Preexisting Conditions:
Allergies: Penicillin Possible vaccine reaction in the past
Diagnostic Lab Data:
CDC Split Type:

Write-up: 18 y/o F that presented for COVID-19 Vaccination. She provided a history or allergic reaction to vaccines after receiving a plethora of vaccinations on 30Jul21. At that time she was given benadryl but no epinephrine. She had been evaluated by an ER provider who did not feel that the patient had anaphylaxis. I reviewed the patient''s medical record and determined that the patient was a candidate for vaccination. The medical box with epinephrine and benadryl was opened and set in the observation area in preparation for possible reaction. The patient was vaccinated with Pfizer 0.3mL. She was brought over to the 30-minute observation area in good condition. Approx. 5 minutes after vaccination she began complaining of difficulty swallowing and complained of a bad headache but endorsed breathing well and not having any abdominal pain or itching. There were no rashes. Her HR was in the 60''s and her RR was 14. She did not feel cold or clammy. No diaphoresis and was answering questions appropriately. At this time IM Benadryl was prepared but NOT given because at approximately 10 minutes after vaccination, she developed more severe symptoms and began coughing and throat clearing with gagging. She was immediately placed in the supine position. EMS was called while simultaneously giving IM epinephrine (@1717, left lateral thigh). The patient had immediate improvement in symptoms. Patient began speaking again clearly and answered questions appropriately and no longer complained of such severe difficulty swallowing. No additional epinephrine was administered. EMS arrived at approx 1722 and care of the patient was handed off at that time. At no time did patient have AMS or hives. No pruritus. I was present for the entire event and presided over the care of the patient and administration of epinephrine. - Dr. In the ER the patient was reportedly well appearing and doing quite well without additional symptoms.


VAERS ID: 1693228 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-10
Onset:2021-09-11
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer on 4/19 and 5/10. Positive on 9/11


VAERS ID: 1693231 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Vasovagal syncope


VAERS ID: 1693233 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Headache, Immediate post-injection reaction, Tinnitus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: TYPE 1 DIABETES, KIDNEY DISEASE, ANXIETY, PSYCHOSIS
Preexisting Conditions: TYPE 1 DIABETES, KIDNEY DISEASE, ANXIETY, PSYCHOSIS
Allergies: PENICILLIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT IMMEDIATELY EXPERIENCED TIGHTNESS ON CHEST, HEAVY HEADACHE, DIZZINESS AND RINGING IN EARS AFTER RECEIVED VACCINE AT 10:56AM . PATIENT WAS LAYED DOWN ON THE FLOOR AND 911 WAS CALLED. EMT ARRIVED AFTER 5 MINUTES AND PATIENT WAS TAKEN TO HOSPITAL.


VAERS ID: 1693241 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Pt here for Johnson and Johnson vaccine, c/o ?faintness? at approximately 1520, a few minutes after vaccination, presented with pallor. No LOC noted. PT denies s/s beyond feeling of faintness. At 1520, BP sitting was 88/60, HR was 88, RR was 18, SPO2 was 99% on RA. PT accepted juice, water, transferred herself to cot requiring minimal assistance and laid with feet elevated. PT reports that she ?feels better? laying. Pt reports a history of similar responses after blood draws. VS at 1530: BP 100/60 laying, HR 60, SPO2 98% RA. At 1532, PT sat at edge of cot without difficulty, pallor greatly improved. VS at 1532 were: 102/68 sitting, HR 62, Spo2 99% RA. PT reports she fee?s ?97% better?. At 1537, PT is able to stand without difficulty, transfers from cot to chair without requiring assistance. PT reports that her baseline BP is typically ?low?. PT educated on vasovagal responses, verbalized understanding. At 1544, BP is 104/70 standing, HR 58, SPO2 99% RA, PT is able to stand and says she feels ?normalish?. At 1549, PT is walking without difficulty, reports she is at baseline, and that she feels ready to exit. VS at 1549: BP 104/62 standing, HR 56, SPO2 99%RA. Color is improved and PT denies further concerns. PT exited facility accompanied by friend at 1553.


VAERS ID: 1693244 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Pallor, Retching, Vomiting
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), 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: UNKNOWN
Preexisting Conditions: NONE, JUST HEADACHE BEFORE VACCINATION
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENTS'' MOM SHOUTED OUT THAT SHE HAD PASSED OUT, 911 WAS CALLED. I RAN OUT AND FOUND THAT SHE WAS CONSCIOUS AND LOOK VERY PALE AND DRY HEAVING , PATIENT STARTED FEELING DIZZINESS AND VOMITED ABOUT 10 MINUTES AFTER VACCINATION , TREATED WITH BOTTLE OF WATER TO DRINK AND COLD PACK TO PUT ON NECK, OUTCOME WAS THAT SHE FELT FINE AFTER ABOUT 20 MINUTES AFTER EMERGENCY CREW ARRIVED, PATIENT WAS ABLE TO GO HOME WITHOUT AMBULANCE


VAERS ID: 1693249 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3014SBA / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Lip discolouration
SMQs:, Glaucoma (broad), Optic nerve disorders (broad), Retinal 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: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately after 15-20 minutes of injection of covid vaccine, my daughter lost her vision. All she could see is a bright white light for approximately 2-3 minutes. In addition, her lips became white in color.


VAERS ID: 1693250 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event, Wrong product administered
SMQs:, Medication errors (narrow)

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

Write-up: The patient came into the Pharmacy to inquire about getting herself an influenza vaccine and her son a J/J vaccine. They decided to obtain the services of the pharmacy and receive their specific vaccines. I, as the pharmacist, drew up the J/J vaccine and attached a needle to the influenza pre-filled syringe. I also obtained all necessary supplies and brought them into the vaccination room. I ushered in Pt and her son and had the mother sit down to receive her vaccine first. After walking through my standard processes of informing the patients and verifying all vaccines, I mistakenly acquired the wrong vaccine and administered it to the mother. The mother was to receive the influenza vaccine, but instead she received the J/J vaccine. She informed me that she had received the J/J vaccine at least 6 months ago meaning that she has now received a 2nd J/J dose. She opted out of receiving the influenza vaccine, which I also concurred. She remained around the pharmacy and in the store for at least 15 minutes and showed no type of reaction. She received no interventions from myself except informationally. I reported the event in our Costco system. Costco is taking steps to modify factors that may have contributed to this event. At this time, Pt, nor anyone else, has reported any adverse reaction(s). This reporting is to document that an accident in administration has occurred and whether an adverse event is to arise there is a record of reporting. At this time, there has been no adverse reaction reported to me.


VAERS ID: 1693252 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / UNK LA / IM

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

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

Write-up: HEADACHE, NAUSEA


VAERS ID: 1693253 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: None known


VAERS ID: 1693255 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-04
Onset:2021-09-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Pain in extremity, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore arm, 9/4 and 9/5 Fatigue, 9/5 Started bleeding vaginally on 9/11 at 6:15pm. I?ve been breastfeeding and have not ovulated or had a period for the last 7 months since giving birth.


VAERS ID: 1693262 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 LA / IM

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

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

Write-up: No side effects reported per patient. Patient should have received Pfizer instead of Moderna.


VAERS ID: 1693268 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a different vaccine as the second dose.


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