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

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



Case Details (Reverse Sorted by Onset Date)

This is page 208 out of 4,799

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VAERS ID: 1415645 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET8885 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Maternal exposure during pregnancy, Myalgia, Pyrexia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: ASPIRIN; BISOPROLOL; FOLIC ACID
Current Illness: Pregnancy
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased; Comments: Patient has not had symptoms associated with COVID-19 Patient is not enrolled in clinical trial Patient is not currently breastfeeding
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: Body temperature; Result Unstructured Data: Test Result:37-37.3 Centigrade; Comments: 10:50 low grade fever; Test Date: 202106; Test Name: Body temperature; Result Unstructured Data: Test Result:38.6 Centigrade; Comments: kept increasing to a max of 38.6; Test Date: 202106; Test Name: Body temperature; Result Unstructured Data: Test Result:37.5 Centigrade; Comments: decreased to 37.5 after taking paracetamol; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021657425

Write-up: Low grade fever 37-37.3/kept increasing to a max of 38.6 and then decreased to 37.5 after taking paracetamol; shivers; Maternal exposure during pregnancy; muscle pain/Muscle ache; This is a spontaneous report from a contactable consumer received from a regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202106041133163330-EXVSN. A 28-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 03Jun2021 (Batch/Lot Number: ET8885) as single dose for COVID-19 immunization. Medical history included suppressed lactation from an unknown date and unknown if ongoing, ongoing pregnancy. Concomitant medications included aspirin taken for pregnancy from Feb2021 to an unspecified date; bisoprolol from Sep2020 to an unspecified date; folic acid taken for vitamin supplementation. The patient experienced maternal exposure during pregnancy on 03Jun2021 with outcome of unknown, muscle pain on 03Jun2021 with outcome of recovering, muscle ache on 04Jun2021 with outcome of recovering, fever on an unspecified date in Jun2021 with outcome of recovering, low grade fever on 03Jun2021 10:50 with outcome of recovering, high temperature on 04Jun2021 with outcome of recovering, shivers on 03Jun2021 with outcome of recovering, chills on 04Jun2021 with outcome of recovering, shivering on 04Jun2021 with outcome of recovering, all reported as medically significant. Clinical course reported as follow: About 12 hours after having the vaccine (10:50 on 03Jun2021) patient experienced low grade fever 37-37.3 which presented with shivers, muscle pain and chills. Her temperature kept increasing to a max of 38.6 and then decreased to 37.5 after taking paracetamol. The low grade fever of 37-37.3 remains still along with muscle aches and chills. Patient was exposed to the medicine third-trimester (29-40 weeks). Patient has not tested positive for COVID-19 since having the vaccine. The patient underwent lab tests and procedures which included COVID-19 virus test: No - Negative COVID-19 test. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1418258 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Dizziness, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Neuropathy (Cause of neuropathy unknown); Whiplash injury (Chronic whiplash)
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 202106; Test Name: CT scan; Result Unstructured Data: Normal; Test Date: 202106; Test Name: Blood test; Result Unstructured Data: Normal
CDC Split Type: DKJNJFOC20210637605

Write-up: DIZZINESS WITH A SWAYING FEELING; LOW FEVER; MUSCLE PAIN; HEADACHE; This spontaneous report received from a consumer via a Regulatory Authority [EMEA EVHUMAN NLP, DK-DKMA-WBS-0070952] concerned a 36 year old female of unknown race and ethnic origin. The patient''s weight was 49 kilograms, and height was 172 centimeters. The patient''s concurrent conditions included whiplash injury, and neuropathy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: XD975 and expiry: UNKNOWN) 1 dosage forms, 1 total, administered on 03-JUN-2021 for covid-19 immunisation. No concomitant medications were reported. On an unspecified date in JUN-2021, Laboratory data included: Blood test Normal, and Computerised tomogram Normal. On 03-JUN-2021, the patient experienced dizziness with a swaying feeling, low fever, muscle pain, and headache, and was hospitalized (date unspecified). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from low fever, muscle pain, headache, and dizziness with a swaying feeling. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: 20210637605-covid-19 vaccine ad26.cov2.s-dizziness with a swaying feeling. 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). 20210637605-covid-19 vaccine ad26.cov2.s-low fever, muscle pain, headache. This event(s) is labeled and is therefore considered potentially related.


VAERS ID: 1422651 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA2453 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Dyspnoea, Headache, Hyperventilation, Hypoaesthesia, Tachypnoea, Tension
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: body temperature; Result Unstructured Data: Test Result:36.9 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC2021672529

Write-up: Headache; Dyspnoea; Numbness of limbs; Tachypnea; Hyperventilation syndrome; mental tension; This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is v21112221. The patient was an 18-year and 8-month-old female. Body temperature before vaccination was 36.9 degrees Centigrade (on 03Jun2021). The patient had no medical history. On 03Jun2021 at 15:00 (the day of vaccination) (18-year-old at vaccination), the patient received the first dose of BNT162B2 (COMIRNATY, solution for injection, lot number FA2453, expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunization. Concomitant medications were not reported. On 03Jun2021 at 15:08 (8 minutes after the vaccination), the patient experienced headache, dyspnoea, and numbness of limbs. On 03Jun2021 (the same day of the vaccination), the outcome of the event was recovered. The course of the event was as follows: About eight minutes after the vaccination, the patient experienced headache, dyspnoea, and numbness of limbs. Oxygen administration, adrenaline 0.3mg intramuscular, securing vascular access was carried out. The patient was experiencing tachypnea. Auscultation was performed but no wheeze was observed. With the Breathing rate became normal, headache and numbness of limbs disappeared. About two hours later, symptoms totally disappeared. There was absolutely no blood pressure low and oxygen saturation low during observation. The reporting physician classified the event as non-serious and assessed that the causality between the event and BNT162B2 as unassessable. Other possible cause(s) of the event such as any other diseases was Hyperventilation syndrome. The reporting physician commented as follows: Judged by symptoms happened during observation, the physician guessed that hyperventilation syndrome was caused by mental tension. The physician thought that no anaphylaxis, no adrenaline administration was needed (as reported). The outcome of all events was resolved on 03Jun2021 at 17:08.


VAERS ID: 1424956 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC1526 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Feeling hot, Hyperhidrosis, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergic bronchospasm; Allergic rhinoconjunctivitis; Food allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: Blood pressure; Result Unstructured Data: Test Result:80/60 mmHg
CDC Split Type: ITPFIZER INC2021674442

Write-up: After a few minutes from the administration of the vaccine, profuse sweating, syncope, tremors in the limbs. Spontaneous recovery. Patient reports feeling of heat.; After a few minutes from the administration of the vaccine, profuse sweating, syncope, tremors in the limbs. Spontaneous recovery. patient reports feeling of heat.; After a few minutes from the administration of the vaccine, profuse sweating, syncope, tremors in the limbs. Spontaneous recovery. Patient reports feeling of heat.; After a few minutes from the administration of the vaccine, profuse sweating, syncope, tremors in the limbs. Spontaneous recovery. Patient reports feeling of heat.; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number IT-MINISAL02-739547. A 17-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in Arm Left (reported as left shoulder) on 03Jun2021 (Lot Number: FC1526; Expiration Date: 30Sep2021) as 0.3 ML SINGLE (at the age of 17-years-old) for COVID-19 immunization. Medical history included Allergic bronchospasm and Allergic rhinoconjunctivitis both from an unknown date and unknown if ongoing, and food allergy. There were no concomitant medications. The patient experienced after a few minutes from the administration of the vaccine, profuse sweating, syncope, tremors in the limbs. Spontaneous recovery. Patient reports feeling of heat, all on 03Jun2021. The patient was hospitalized for the events. Actions taken (Administration of intravenosus= i.v. physiological solution). The patient underwent lab tests and procedures which included blood pressure measurement: 80/60 mmHg on 03Jun2021. The outcome of the events was recovered on 04Jun2021. Reporter comment: Blood pressure= PA detected 80/60 mmHg. Polyallergic patient to inhalants (rhinoconjunctivitis and episodic bronchospasm). Previous food allergy. No known drug allergies. No concomitant medication intake. No follow-up attempts are possible. No further information is expected.; Reporter''s Comments: PA detected 80/60 mmHg. Polyallergic patient to inhalants (rhinoconjunctivitis and episodic bronchospasm). Previous food allergy. No known drug allergies. No concomitant medication intake.


VAERS ID: 1438593 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Malaise, Maternal exposure during breast feeding, Maternal exposure during pregnancy, Migraine, Off label use, Product use issue, SARS-CoV-2 test, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Neonatal exposures via breast milk (narrow), Medication errors (broad), Hypoglycaemia (broad), COVID-19 (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: PARACETAMOL
Current Illness: Breast feeding
Preexisting Conditions: Medical History/Concurrent Conditions: Pain relief; Pregnancy (Patient no longer pregnant at the time of reporting.)
Allergies:
Diagnostic Lab Data: Test Date: 20210602; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021710064

Write-up: blurred vision; feeling or being sick; Maternal exposure during breast feeding; Maternal exposure during breast feeding; Maternal exposure during breast feeding; Headache; Migraine; Maternal exposure during pregnancy; This is a spontaneous report from a contactable consumer received from the Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202106141146254060-KCJ5X, Safety Report Unique Identifier: GB-MHRA-ADR 25469510. This is maternal report. A 34-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 03Jun2021 (lot number: not known) at dose 1, single for COVID-19 immunisation. Medical history included pregnancy (patient no longer pregnant at the time of reporting), ongoing breast feeding, and pain relief. Unsure if patient has had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. Concomitant medication included paracetamol taken for pain relief from 03Jun2021. The patient experienced maternal exposure during pregnancy (on 03Jun2021), maternal exposure during breast feeding on an unspecified date; and headache and migraine on 04Jun2021. Clinical course reported: constant headache from last 10 days after getting vaccine. A severe headache that was not relieved with painkillers or was getting worse and felt worse when lie down or bend over a headache, that''s unusual and occurred with blurred vision, feeling or being sick. The medicine did not have an adverse effect on any aspect of the pregnancy. Relevant investigations or tests conducted: "NA". Patient has not tested positive for COVID-19 since having the vaccine. The patient underwent lab tests and procedures which included COVID-19 virus test: no - negative COVID-19 test on 02Jun2021. The outcome of the events headache and migraine was not recovered; and for other events was unknown. Regulatory authority assessed the events as serious: disability and medically significant. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1448794 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW2245 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Maternal exposure during pregnancy, Pain in extremity, SARS-CoV-2 test, Scan
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID
Current Illness: Pregnancy (Estimated due date: 14Oct2021.)
Preexisting Conditions: Medical History/Concurrent Conditions: Folic acid supplementation
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test; Test Name: scan; Result Unstructured Data: Test Result:Normal
CDC Split Type: GBPFIZER INC2021736326

Write-up: Hand pain; Maternal exposure during pregnancy; This is a solicited report from a regulatory authority from a contactable consumer. This is a report from received from a regulatory authority (RA). The regulatory authority report number is GB-MHRA-YCVM-202106031438033550-DC2QL, Safety Report Unique Identifier GB-MHRA-ADR 25494183. A 33-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 03Jun2021 (Lot Number: EW2245) at the age of 33-year-old as single dose for COVID-19 vaccination. Medical history included ongoing pregnancy (estimated due date: 14Oct2021), and folic acid supplementation. Patient was exposed to the vaccine second-trimester (13-28 weeks). Patient had not had symptoms associated with COVID-19. Patient was not enrolled in clinical trial. Patient was not currently breastfeeding. Concomitant medication included folic acid taken for folic acid supplementation, start and stop date were not reported. The patient experienced maternal exposure during pregnancy on 03Jun2021 with outcome of unknown, hand pain on 04Jun2021 with outcome of recovered on 05Jun2021. The event hand pain was reported as serious (medically significant). Patient did not think vaccination had an adverse effect on any aspect of the pregnancy. The patient underwent lab tests and procedures on an unspecified date which included covid-19 virus test: no - negative covid-19 test; scans: normal. Patient had not tested positive for COVID-19 since having the vaccine. The reporter''s assessment of the causal relationship of the hand pain with the bnt162b2 was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment.~ No follow-up attempts are possible. No further information is expected.; Sender''s Comments: A causal association between BNT162B2 and the reported events cannot be excluded based on temporal relationship. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RAs, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1366589 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Feeling cold, Feeling hot, Headache, Nausea, Pain, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Prenatal vitamin, Tylenol
Current Illness: Sinus infection few weeks ago
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cold chills , then warm , shaking , achy , some nausea and headache


VAERS ID: 1366597 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-29
Onset:2021-06-02
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Arthralgia, Blood test, Dry eye, Dry mouth, Dry skin, Fatigue, Immune system disorder, Myalgia, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, Synthroid, Atorvastatin, Sertraline, Duloxetine, Buspar, Oxybutynin, Fentanyl patch
Current Illness: None
Preexisting Conditions: Degenerative disc disease, osteoarthritis, chronic pain,
Allergies: Lactose intolerant
Diagnostic Lab Data: Blood tests, urine sample
CDC Split Type:

Write-up: No taste, no smell, fatigue, dry eyes, no saliva, extra dry skin, sore joints and muscles. Immune system attacking


VAERS ID: 1366856 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hives after IM flu vaccine. PT stated it happened over a decade ago
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Provider ordered a CBC
CDC Split Type:

Write-up: PT reported to the Clinic around 1500. PT stated she received the second dose of the Moderna Vaccine around 1330. PT stated she started to break out in pin point hives on both arms around 1450. PT stated she has had hives after a flu vaccine before. PT states it was over a decade ago. PT denies any difficulty breathing or any other symptoms. I called the on call provider and the PT was seen in clinic at 1536.


VAERS ID: 1366857 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-29
Onset:2021-06-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got period 2 weeks early days after vaccine that?s heavier than normal


VAERS ID: 1367463 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dehydration, Full blood count, Laboratory test, Nausea, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

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

Write-up: body aches, nausea,, subjective fever/chills, near syncope.


VAERS ID: 1367694 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 LA / IM

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

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

Write-up: Employee, Medical assistant took Moderna from freezer and without waiting the 2.5 hours, he drew vaccine and injected into patients arm. I I have spoke with the patient today after she left to make sure she was not feeling any unusual side effects. I am not sure of what the proper protocol is for this error is. I called the Moderna hotline and they really could not assist me in this matter.


VAERS ID: 1367696 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Injection site haemorrhage, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown/not reported
Allergies: denies
Diagnostic Lab Data: na
CDC Split Type:

Write-up: near immediate lump at injection site. minimal bleeding when withdrawing needed. lump measured at injection site 18 mm x 13 mm. no active bleeding, no erythema or bruising. Spoke to patient for 8 minutes during which time no additional signs or symptoms were noted. Discussed next steps. Will call to check on status in 4-5 hours and again in 20-24 hours. Advised to contact our clinic or PCP with any additional questions or concerns. Has appt with PCP 6/3/21 for annual PE. Advised to monitor site periodically.


VAERS ID: 1367706 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Needle issue, Underdose
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: albuterol, zyrtec
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: When going to inject vaccine, needle was inserted into arm and when the syringe was depressed the needle retracted immediately, sending most of the vaccine down the patients arm and leaving some in the barrel, it is believed to be less than half the dose administered therefore a second full dose of vaccine was administered in the opposite arm.


VAERS ID: 1367713 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Dizziness, Nervousness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: After giving vaccine, patient was in observation area and stated he felt light headed. He was nervous about the vaccine and feeling anxious. After speaking with him, he calmed down and stated he normally gets anxious regarding immunizations. He sat for 20 minutes and felt fine enough to go home.


VAERS ID: 1367729 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Penile pain
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in my penis.


VAERS ID: 1367750 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

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

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

Write-up: 17 year old given 2nd dose of Moderna COVID-19 vaccine. No physical adverse event.


VAERS ID: 1367753 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline Ibuprofen Vitamin D3 Vitamin B12
Current Illness: MS
Preexisting Conditions: MS
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose of Pfizer vaccine and waited 30 minutes after. About 28 minutes later developed itching to forearms and swelling in hands. EMT gave IV Benadryl and patient became dizzy- transported to ED


VAERS ID: 1367756 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall, Hyperhidrosis, Pallor, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (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: Dizziness-Fell from chair to floor. Pale, diaphoretic-vasovagal. Moved from floor to stretcher by EMS, brought to med screening for evaluation. B.P :103/60 Rechecked 116/74. Left in stable condition at 12:53 . Recorded by RN and Medic.


VAERS ID: 1367770 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: OCP Ariprozole 20 mg qd, Pantropozole20 mg qd, Sertraline 200 mg qd, Prazosin 1 mg qpm Trazadone 50 mg qpm
Current Illness: none
Preexisting Conditions: Depression and anxiety
Allergies: Celery, Mustard
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt c/o tongue swelling without difficulty breathing, EMS called . Epinephrine 0.3mg administered. EMS arrived,swelling less . After discussion with EMS and mother pt agreed to transport to Hospital.


VAERS ID: 1367772 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Public       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 mixed series. Initially got Moderna, came in and was given Pfizer for a second dose. Client counseled and doing well after injection wait time.


VAERS ID: 1367783 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal tenderness, Burning sensation, Chills, Cough, Dry skin, Erythema, Injection site erythema, Injection site pain, Injection site swelling, Lipase increased, Lymphadenopathy, Pancreatitis acute, Productive cough, Pyrexia, Rash, Rash erythematous, Respiratory tract irritation, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), 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), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Past Medical History: Diagnosis Date ? Allergic rhinitis ? Asthma ? Asthma ? Chronic neck pain ? Duodenitis ? Gastroparesis ? GERD (gastroesophageal reflux disease) ? Herniated disc, cervical ? Hiatal hernia ? Obesity ? Renal stones ? Stomach ulcer ? Stress incontinence ? Uterine fibroid
Allergies: Amlodipine Not Specified Unknown Reaction Chicken Allergy Not Specified Unknown Reaction Chicken and turkey Ciprocinonide [fluocinolone] Not Specified Hives Ciprofloxacin Hcl Not Specified Unknown Reaction Codeine Not Specified GI Reaction Doxycycline Not Specified Unknown Reaction Environmental Not Specified Unknown Reaction Flovent Hfa [fluticasone] Not Specified Unknown Reaction Latex Not Specified Unknown Reaction Morphine Not Specified GI Reaction Percocet [oxycodone-acetaminophen] Not Specified Unknown Reaction Prednisone Not Specified Unknown Reaction Vicodin [hydrocodone-acetaminophen] Not Specified GI Reaction Whey Protein [cardiowhey] Not Specified GI Reaction Wool Alcohol [anhydrous Lanolin]
Diagnostic Lab Data: 6/2/21 lipase 997 U/L
CDC Split Type:

Write-up: Patient is a 56-y.o. female with PMH of GERD who states that since receiving a COVID-19 vaccination 2 days ago has had progressive swelling, aching and redness in her left arm where she received the vaccination. Complains of associated lymph node swelling under her left arm and into her neck. Also complained of onset of phlegmy cough and some burning in her lungs associated with her asthma. Additionally complained of burning discomfort in her upper abdomen. Denied associated nausea, vomiting or diarrhea. States she has had some low-grade fever and chills. Musculoskeletal: General: Swelling ( Left arm with mild swelling, erythema and tenderness) present. No deformity. Normal range of motion. Cervical back: Normal range of motion and neck supple. Lymphadenopathy: Cervical: Cervical adenopathy present. Left cervical: Superficial cervical adenopathy present. Upper Body: Left upper body: Axillary adenopathy present. Skin: General: Skin is warm and dry. Findings: Rash ( Burning red rash on the outside aspect of both feet) present. No erythema. 56-y.o. yr old patient with PMH of hypertension and asthma presenting with adverse reaction to COVID-19 vaccination including acute pancreatitis. Lab work showed elevated lipase of 1000, and on examination she had epigastric tenderness: Admitted with acute pancreatitis, and was started on IV fluids


VAERS ID: 1367836 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (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: Zoloft, Olanzapine, Aurovela
Current Illness:
Preexisting Conditions: Functional Neurologic Disorder, Pseudoseizures
Allergies: Amoxacillin- hives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seizure activity noted within 30 minutes of vaccination. Pt known to have functional neurologic disorder and pseudoseizures daily (sometimes back-to-back). Pt alert and orientedx4. Pt dizzy and states she did not eat lunch today. Provided with water and granola bar. Second seizure noted 20 minutes later. Pt stayed for observation for additinal 40 minutes following second seizure. Client refused transportation to hospital and clients brother came to pick her up.


VAERS ID: 1367909 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / SC

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Hyperhidrosis, Injection site pain, Oropharyngeal pain, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (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: Serouill , valium, Zoloft,singular,advair,combivent respimat,
Current Illness: Asthma with complications
Preexisting Conditions: Asthma with complications lung disease mental illness
Allergies: Bees
Diagnostic Lab Data: None have not contacted doctor yet
CDC Split Type:

Write-up: severe fatigue with wide spread pain, sore throat , arm pain at injection site, chills,sweating


VAERS ID: 1367938 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002187 / 1 LA / IM

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

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

Write-up: The day after my arm was significantly swollen and painful but it wasn''t too bad. Today I woke up with a red circular rash around the vaccine site that''s approximately 3 inches in diameter. It''s red, hot and itchy.


VAERS ID: 1367946 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204AA21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Dorozolamide eye drops for glaucoma
Current Illness: n/a
Preexisting Conditions: glaucoma & over weight
Allergies: shell fish , sulphur drugs & dust , pollen etc
Diagnostic Lab Data: have not went to doctors yet just discovered
CDC Split Type:

Write-up: Noticing a small lump under skin on right collar bone by feeling or touch


VAERS ID: 1367973 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Discomfort, Headache, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: N/A
Current Illness: Covid 19
Preexisting Conditions: Irritable bowel syndrome
Allergies: Skin allergies to bleach , latex , and adhesive.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Severe diarrhea , nausea , severe pain and soreness in left arm , discomfort and headache.


VAERS ID: 1367987 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006021A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Musculoskeletal stiffness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: sore arm and shoulder 1st injection
Other Medications: none
Current Illness: None
Preexisting Conditions: Seasonal Allergies
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Stiff arm, current low grade fever 99.7


VAERS ID: 1367991 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Scale of 1-10. 10 being severe. 1:30 am joint pain, 5; site tenderness, 4; nausea, 3. Joint pain lessened by 12 pm on 06/02. Nausea worsened all day on 06/02. Loose stools 11 times that same day.


VAERS ID: 1367994 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Dyspnoea, Headache, Heart rate increased, Neck pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (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: lisinopril 20 mg daily diclofenac sodium 75mg daily Levothyroxine 0.75mcg daily
Current Illness: none
Preexisting Conditions: hypertension thyroid problems
Allergies: codeine PCN
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 11:55am-10 minutes after receiving the vaccine patient complained of "heart beating a little fast, SOB and feeling woozy". Ambulance was called. BP-115/72, pulse 88, pulse ox 99%, resp 14. 11:59am- LPN administered one 81 mg chewable aspirin per Dr''s request. BP 124/72, pulse 83, pulse ox 99%, resp 14. 11:58am-IV started with NS at KVO per RN. O2 per NC at 2L. Patient c/o neck, left shoulder and head pain. 12:10pm-81 mg chewable aspirin given per Dr''s orders. Ambulance arrived and patient transported to Hospital. Husband notified to meet patient at hospital.


VAERS ID: 1368000 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Dizziness, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Felt dizzy immediately post first dose covid 19 vaccine (Pfizer) on May 12, 2021
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pulse 86 Respirations 18 SPO2 100% BP 118/72 Exam was normal
CDC Split Type:

Write-up: Felt dizzy immediately post vaccination (same thing happened after the first dose) Patient stated she felt anxious about vaccine, felt dizzy and wanted blood pressure checked. Patient was given water, symptoms resolved within several minutes Discharged to home with son


VAERS ID: 1368005 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

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

Write-up: Patient was given 0.5mL of Janssen vaccine IM into her right deltoid muscle. Post vaccine patient, fainted during the 15 minute wait period. She was promptly attended to, and did not exhibit signs of anaphylaxis. EMS came to assess patient even though she felt "completely normal" after she fainted.


VAERS ID: 1368007 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Patient slumped over in waiting chair shortly after vaccination. Felt like he was going to pass out he said, he got really sweaty and a little shaky. He slumped over twice for about 3 seconds each time, but he was easily woken up and was able to tell me his name. His symptoms lasted about 15 minutes after his vaccination. He drank some water and had some candy. He felt much improved.


VAERS ID: 1368014 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline, probiotic, vitamin D, Vitamin B supplement, Neuroflam supplement. l-theanine, Claritin nystatin 21 day course she completed on 5/29/21 Azithromycin was completed 10 days before vaccine.
Current Illness: Took antibiotics recently because it had dental work and doctor had advised it as a precaution. Took Nystatin because had fungal infection after antibiotic. She had a cold (negative Covid test) about 2 wks ago. Cold was resolved last week, she had a fever with this, and that was 13 days prior to the vaccine.
Preexisting Conditions: PANDAs
Allergies: PCN- rash and joint inflammation. Dust mites, mold, mild to pet dander.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Rash on torso and legs


VAERS ID: 1368015 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Blood pressure increased, Chest pain, Dizziness, Presyncope, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient reports sharp pain in left upper chest area and into the under arm area and reports she may pass out. Patient had a vasovagal syncope episode followed by vomiting. After 30 mins of resting, she reports she was no longer lightheaded or nauseous. Chest pain resolved. Patient does report headache at departure. 12:53 - BP 152/82, P-73, R-20, Pulse Ox-97%. 13:00 - BP 140/80, P-87, R-20, Pulse Ox-100%. 13:10 - 122/78.


VAERS ID: 1368027 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / SYR

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

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

Write-up: 100.2 fever, body aches, sore injection site.


VAERS ID: 1368033 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Flushing, Hyperhidrosis, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Mild


VAERS ID: 1368039 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Nausea, Syncope, Tinnitus, Unresponsive to stimuli, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Mild, Systemic: Tinnitus-Mild, Systemic: Visual Changes/Disturbances-Mild, Additional Details: Patient recovered and mom says she was taking him to the doctors office for follow-up


VAERS ID: 1368045 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Got lightheaded,nauseated and pale after standing after vaccination. Remained alert and oriented after falling. Her father caught her before she hit the floor. Vomited a small amount after sitting up. Remained a&O x4. b/p 110/62 pso2 99% heart rate 70. Monitored then released with her father@1320. Informed to seek medical attention for any further problems.


VAERS ID: 1368050 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

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

Write-up: Systemic: Chills-Mild, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Shakiness-Mild, Systemic: Weakness-Medium, Additional Details: EMT and paramedics came


VAERS ID: 1368053 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anosmia, Dyspnoea, Headache, Nausea, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Abilify, Topamax, Adderall, Spironolactone, Cymbalta, Levothyroxine, multivitamin.
Current Illness: UTI currently being treated.
Preexisting Conditions: Fibromyalgia, migraines, narcolepsy, sleep apnea, Hashimoto''s thyroid disease, ADHD, bipolar, depression, panic anxiety, PTSD.
Allergies: Depakote, Penicillin, Erythromycin, Clindamycin, Avilamycin, Gabapentin.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, had no reaction at all. Starting today she lost her sense of smell, also having a headache. She also has a runny nose, shortness of breath and nausea. She has not taken anything for these symptoms. She called her PCP and they have called her in a prescription for Phenergan.


VAERS ID: 1368068 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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

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

Write-up: Patient was given the second dose of Pfizer Covid 19 vaccine on 6/2/21 at 12:29pm and was asked to wait for 15 minutes to watch how the patient reacts with the vaccine. He didn''t have any side effect on his first dose. After 3 minutes of getting the vaccine, his wife notified me that she needs assistance. He was sweating profusely and was about to lose consciousness. His wife and I kept saying his name to check his response. He could not response or was about to faint. His pulse is slow, and his face is red. Since there was other customers waiting for shots in the clinic, I asked the technician to ask for pharmacy manager assistance. He came in the clinic, and checked patient''s pulse and blood pressure. The blood pressure was high (170/89). We checked his blood pressure again, and it was lower after couple minutes. Patient started to have consciousness and understand what we are talking. He told us that he always had the same reaction after getting his blood drawn. We asked him to sit down and was monitored by us in the clinic. After 30 minutes, he said that he was feeling fine without any problems and decided to leave. He can breathe ok and didn''t have any adverse reactions such as swelling of throat and lip or hives. His wife and he didn''t eat anything before getting the vaccine. I checked his blood pressure again, and it was 130/80. Will follow up on him this evening and tomorrow.


VAERS ID: 1368070 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 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? 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: Faint, vaers reaction. BP: 118/72 PR: 68 SPO2:98% Room air Recorded by RN & Medic.


VAERS ID: 1368082 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

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

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

Write-up: Patient was light headed and sweaty after 10 minutes getting the shot. I was talking to him the whole time to make sure he is conscious. It seemed he lost consciousness twice but came back very quickly. Patient said he had lack of sleep the night before so we do not know for sure if the reaction was just because of vaccine or there are other reasons behind his reaction. By the time 911 came patient was ok and could talk and communicate well. they took him to ER for more exams.


VAERS ID: 1368085 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Flushing, Palpitations
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (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: "Heart racing", flush-Repeated no s/s of first injection. C/O feeling dizziness PR:85 SPO2:99% Room Air B/P: 170/90


VAERS ID: 1368088 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Write-up: Patient was sitting for 15 minute observation period when he started convulsing and fainted. He again started convulsing and then he came to, was nauseas and dizzy and pale.


VAERS ID: 1368094 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Tested positive for COVID on 5/21
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, stomach ache, fever (101) and vomiting


VAERS ID: 1368101 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-21
Onset:2021-06-02
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

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

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

Write-up: Moderna vaccine was given at the age of 17 years old.


VAERS ID: 1368102 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lipoma
SMQs:, Lipodystrophy (broad)

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

Write-up: Woke up this morning with swollen, painful nodule on left-side of collarbone.


VAERS ID: 1368120 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 - / IM

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

Write-up: This dose is one week early was due to be given 6/9 dose one Pfizer EW0179 5/19/21 at RCSJ Mega Site only sending this report for documentation at this time.


VAERS ID: 1368126 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Hyperhidrosis, Impaired driving ability, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OCPs
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt had received her first vaccine and was in the observation area. She was seen to have slumped in her chair, preceding a syncopal episode. The patient remained in her chair during the episode. Pt informed us after the syncopal episode that she had felt as if she fell asleep. She has no medical history of seizures or syncope in the past. She did have limb movement during the period of syncope. The episode seemed to last no more than 15 seconds. The patient quickly woke and began speaking to us. She was clammy and sweaty, vitals were completely normal as taken by the RNs. She was observed in the private area for $g 15 minutes, given drink and crackers, tolerated well. She ambulated well and had her fianc? pick her up. She will follow up with her PCP this week. vitals: BP: 120/80, P 72, O2 98%


VAERS ID: 1368147 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (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: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports having chest discomfort about 5-10 minutes after getting vaccination. Vitals stable, she was observed for 30 minutes and patient notes symptoms have improved.


VAERS ID: 1368169 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Lethargy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Weakness/ Lethargic Seen by EMS on site PR 52 SPO2 100% BP 88/35 BP at 10:20am 101/57


VAERS ID: 1368188 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Guest had near syncopal episode, Guest also described feeling nausea


VAERS ID: 1368205 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid Propranolol Aspirin
Current Illness: No
Preexisting Conditions: Hashimoto?s Thyroiditis Cardiac micro vascular disease
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up in the middle of the night with chills. Feeling feverish but no fever present. Muscle and joint pain along with severe headache and fatigue.


VAERS ID: 1368209 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Panic reaction
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Unknown
Preexisting Conditions: unknown
Allergies: NKDA
Diagnostic Lab Data: none- pt refused to go to hospital with EMTs.
CDC Split Type:

Write-up: Pt received vaccine, about 5 mins later he stated he was not feeling well, but could not articulate symptoms. He was breathing ok, but was in a state of panic. He requested we call 911, which we did immediately, and gave him an ice pack. EMTs arrived and he refused transport. He called his mother, who came and got him. EMTs waited with him until she arrived.


VAERS ID: 1368224 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Device connection issue, Incorrect dose administered, Syringe issue
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: Medication Error: Syringe and needle was not well tighened. Patient was injected but vaccine spilled out . Both vaccinator and patient were certain patient did not receive full dose (0.3 ) of vaccine. Clinical head was informed. A second shot was given in same arm per patient''s preference. No adverse effects noted at this time. Patient was advised by clinical head. She was instructed to vsafe. A pfizer fact sheet was given. She was educated on what to expect after a covid-19 vaccine and observed for 30 min.


VAERS ID: 1368243 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 OT / IM

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

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

Write-up: Difficulty breathing, dizziness. Evaluated by EMS-Cleared


VAERS ID: 1368267 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Patient was sweating, had headache, dizziness, blurred vision.


VAERS ID: 1368276 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient''s father stated patient was over the age of 12. When we tried submitting to insurance DOB written on consent for, was denied due to incorrect DOB. Father spoke and wrote incorrect DOB. According to insurance DOB is exact date.


VAERS ID: 1368320 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received dose from refrigerated vial of vaccine 16 hours after initial puncture to vial. Vial punctured on 6/1/2021 2:20 pm; dose drawn and given 6/2/2021 9:14am; Vaccine Exp date: 6/23/2021. No known adverse reaction to the patient.


VAERS ID: 1368321 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient is under the age of 12. Father stated on form 12 years of age with DOB incorrect. Once we billed insurance they denied claim. Insurance states patient''s DOB in system is exact date.


VAERS ID: 1368333 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysstasia, Eye movement disorder, Hypotension, Loss of consciousness, Malaise, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient received vaccine at approximately 3:10PM. After receiving she seemed fine and was able to walk to the waiting area. After approximately 1-2 minutes she reported to her boyfriend that she did not feel well and "needed some water." Immediately following she began to lose consciousness and went completely limp with her eyes rolled back, according to her boyfriend who caught her and placed her on the ground. The boyfriend also reported some muscle tremors occurring during this. After another minute the patient regained consciousness and was awake and oriented to person and place but not time. She was able to see properly and was vocalizing effectively. 911 was called immediately following initial loss of consciousness and EMS arrived to collect vitals. Patient was given a few sips of water. No medications were given. Following EMS assessment, patient was hypotensive and unable to stand on their own; EMS transported the patient to the emergency department.


VAERS ID: 1368339 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-06-02
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neurological symptom
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ASPIRIN 81MG DAILY, CEPHALEXIN 500MG TWICE A DAY
Current Illness:
Preexisting Conditions: HISTORY OF CVA IN 2000, HISTORY OF DVT
Allergies: BACTRIM
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to this hospital ER with symptoms of stroke. Neurologist asked that we report to VAERS due to proximity to his vaccination timeline.


VAERS ID: 1368344 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Vital signs measurement
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Feeling faint 180/90 85 98% on R/A


VAERS ID: 1368363 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: Patient received refrigerated vial of vaccine 16 hours after first puncture. Vial punctured 6/1/2021 at 2:20pm; drawn and administered 6/2/2021 at 9:25am Exp date of vaccine: 6/23/2021


VAERS ID: 1368369 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Facial paresis, Muscle tightness
SMQs:, Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She had her vaccine and within 5 minutes her face became really tight, she cannot smile. Then she is forgetting things as well, taking her a long time to process thoughts. As time goes on the situation seems to be getting worse. Her muscles seem to be weak in her face. She has not called her doctor yet.


VAERS ID: 1368376 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Pt didn''t disclose previously vaccinated on 1/15/21 and 2/10/21 with Moderna COVID vaccine.


VAERS ID: 1368378 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Pt reported "difficulty swallowing" and feeling of "tightness in throat" Was taken to Med Obs 1 for further assessment and monitoring. VS Stable and pt reported symptoms resolving by reporting "better" at 0804 and completely resolved by 0814. VS WNL and no objective s/s distress noted at any time. Vital Signs: Sitting 0802 BP 147/79 HR 57 RR 16 SpO2 100% RA Standing 0805 BP 147/89 HR 59 RR 16 SpO2 100% RA Sitting (prior to release) 0814 BP 126/82 HR 47 RR 16 SpO2 99% RA


VAERS ID: 1368380 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Asthenia, Blood pressure increased, Cardiac monitoring abnormal, Dizziness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad)

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

Write-up: Dizzy/weakness Pulse Rate: 83 SPO2: 100% Room air B/P:161/114 @10:30 AM. @10:34 B.P.:158/110 Increase Blood pressure and heart. Arrhythmia per cardiac monitor/EMT Given ASA 81 mg x4 =324 mg Pt. was taken to the emergency room at 10:40 AM.


VAERS ID: 1368387 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-28
Onset:2021-06-02
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Hospitalized.
CDC Split Type:

Write-up: Two blood clots.


VAERS ID: 1368393 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-13
Onset:2021-06-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Patient received the vaccine even though he was under age (16 years old at the time of vaccination). No adverse event with the patient. Reporting due to age limitations.


VAERS ID: 1368395 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received the first dose Moderna she was a little scared but she was ok. She got her shot and was told to stay around for 15 minutes, she starting walking with her mom, when she told her mom she felt dizzy, then she passed out unto her mom''s arms, her mom put her on the floor, did not heart her head. Mom helped her to get up and came back to the pharmacy, sat her down again. We called 911 for help, patient asked for water, while her mom went to get her some water, pharmacist was watching her when she had a short convulsion for about 2 to 3 seconds, she stretched her body to the back. When 911 came, she had already recovered her color, her vitals where ok, she was breathing normal. Patient refused to get on the ambulance, signed her release and left. Emergency personel advised her to follow up with her doctor.


VAERS ID: 1368396 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain, Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, tizanidine, estradiol tab, trulicity, clonazepam
Current Illness: NA
Preexisting Conditions: Hypothyroidism, menopause, arthritis, diabetes, anxiety
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: tingling of feet- patient said it felt like bees were stinging her, swelling of fingers, fatigue, body aches, headache


VAERS ID: 1368404 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Fatigue, Gait disturbance, Headache, Injection site hypersensitivity, Injection site pain, Injection site rash, Mobility decreased, Muscle spasms, Myalgia, Pain, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cefalexin.
Current Illness: Unknown issue with ear. Redness and pain on upper cartilage going on 5 months. Doctor put me on antibiotic as a last stitch effort.
Preexisting Conditions: Migraines, cyclic vomiting syndrome (under control with diet currently. No flares in over a year). Anxiety.
Allergies: Sulfa and mushrooms
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large raise bump at injection site; about the size of my palm. I have a sleeve tattoo so I can?t t lol if it?s red. Doesn?t feel warm. Area is hyper sensitive. Even a shirt touching it is quite painful. Can?t lift right arm to even put deodorant on. Sever muscle and joint pains. Charlie horses up and down legs. It hurts to lay down or put my back on anything. Walking is shaky because of the pain in my legs. Headache. 101-102 fever without medication. Ibuprofen lowers the fever but does not touch the pain. Severe chills/can?t get warm. Exhausted and can barely get out of bed because of it and the pain.


VAERS ID: 1368405 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None to medication, unknown to food or other products
Diagnostic Lab Data: None include
CDC Split Type:

Write-up: Patient was admin less then recommended dose of moderna vaccine today secondary to syringe malfunction , we consulted CDC website and the guidance instructed not re-administer second dose since patient receive more that half of the recommended dose originally .


VAERS ID: 1368409 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

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

Write-up: Approximately 60 to 90 seconds after administering vaccine to patient, the patient experienced a vasovagal syncope episode. The patient briefly lost consciousness. The pharmacist was able to catch the patient as he lost consciousness and prevent him from falling and further injuring himself. The patient was then moved to a mat on the floor to rest and recover. The patient regained consciousness as he was being moved to a mat on the floor. The patient then maintained consciousness and recovered fully from the event after approximately 20 minutes. The patient was monitored for 30 minutes prior to leaving the pharmacy. He also had a family member (his father) who accompanied him to the appointment and was the patient''s driver to and from the pharmacy for his vaccination.


VAERS ID: 1368410 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Dyspnoea, Flushing, Peripheral swelling, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (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: COVID shot flu vaccine and hepatic vaccine.
Other Medications: Multivitamin
Current Illness:
Preexisting Conditions: Psoriatic arthritis and psoriasis
Allergies: Flu vaccine hepatitis a and b vac , penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flushed; breathing issues; swelling of my arm; rash; diarrhea.


VAERS ID: 1368412 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Vasovagal syncope immediately after IM injection. Lowered pt to floor and elevated LE on chair. Pt responsive and AOx4. Taken to Med Obs 1 for VS, assessment and further observation. VS WNL and no reported or objective s/s distress noted during assessment. Pt reported symptoms resolved and escorted to doors from Med Obs 1 at approx 0848 VS Sitting 0832 BP 108/67 HR 83 RR 16 SpO2 98% RA Sitting 0845 BP 113/58 HR 76 RR 16 SpO2 98% RA Standing 0846 BP 1108/62 HR 74 RR 16 SpO2 100% RA


VAERS ID: 1368477 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Headache
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache and weakness


VAERS ID: 1368502 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-29
Onset:2021-06-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Epistaxis, Nasal congestion, Productive cough
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad)

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

Write-up: Sudden, pouring nosebleed, both nostrils. 20 minutes of pressure stemmed most of the bleeding. Major difficulty breathing through nose after clotting occurred. 1 hr after initial nosebleed/partial clotting, pressure on back right nostril was relieved when I snorted and coughed up a dollar coin amount of mucus and blood. Left nostril still "stuffy and till some spotty bleeding 2 hours later. No prev history of nosebleeds.


VAERS ID: 1368508 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: dizzine post 1st moderna vaccine
Other Medications: unknown
Current Illness: none
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pharmacist discussed dizziness with patient before receiving 2nd dose of Moderna. Received vaccine at 1:23pm. Patient sat after receiving vaccine with pharmacist. Patient felt fine and said she would be ok to sit in post vaccination area. Patient seemed hot and asked to remove her mask. Had patient return to room where vaccine was given because the temperature was cooler. Sat with her in room for a few minutes and she felt better to go back into post vaccination area. About twenty minutes later, patient was still feeling dizzy. Asked patient if she wanted lie down. Patient moved back into immunization room and did not want lie down. Gave her a cold pack and checked her blood pressure, 140/104. Patient took meclizine 25mg. Patient was talking and said her mouth felt funny. Offered her benadryl and checked for other symptoms. Patient refused Benadryl. Sat with her awhile longer and patient said she felt ok to leave. Her Mother drove her home. Patient was here about an hour post vaccination.


VAERS ID: 1368510 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: none
CDC Split Type:

Write-up: Patient was sitting in the observation area after his vaccine and his companion alerted us that he had fainted. He slumped to the side for a few seconds, we held him up and he came to rather quickly. He said he had felt dizzy. He had some water and sat for about 20 more minutes until he felt back to normal.


VAERS ID: 1368520 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Diaphoretic History related to shots PR: 77 SPO2:96 B/P 124/82 Brought via wheelchair to med. screening room for evaluation by medic. Recorded by RN


VAERS ID: 1368524 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Patient started feeling dizzy and fainted. Paramedics came and took her.


VAERS ID: 1368542 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Patient complained about back pain, and look pale in the face. Insisted on recieving the vaccine
Preexisting Conditions: N/A
Allergies: None listed at pharmacy
Diagnostic Lab Data: Patient''s blood pressure was take, as well as oxygen levels.
CDC Split Type:

Write-up: Patient passed out, after vaccine. Patient complained about sever back pain before vaccine, but insisted on recieving the vaccine on 6/2/21. Patient was transferred to clinic, and placed under care and then transported by ambulance from pharmacy.


VAERS ID: 1368552 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-07
Onset:2021-06-02
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Hypoacusis
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unisom
Current Illness: Had covid between my first and second dose. Tested positive 1 week after first dose.
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: Went to walk in care. Ear looks healthy, no blockage or wax, no irritation. PA couldn''t figure out the issue, suggested psuedoephedrine for 5-7 days to see if it would help.
CDC Split Type:

Write-up: Hearing issues in right ear. Pressure around ear (feels like it needs to pop). No congestion or sickness.


VAERS ID: 1368554 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 had syncopal episode, Hit head on counter upon collapse


VAERS ID: 1368558 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, flonase, omeprazole, mirena
Current Illness: none known
Preexisting Conditions: HTN, GERD
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pharmacy provides the vaccine and vaccine supplies to me for this weekly clinic. Today they supplied me with Coviden Magellan 3mL syringe with hypodermic safety needle 25g 1". I personally drew up the vaccines myself without any issues. When I injected this patient however, the syringe immediately came off of the needle when I started to push the vaccine. The needle was in the patient''s deltoid, the vaccine liquid ran down her arm, and I was left holding an empty syringe in my hand. I immediately contacted our hospital''s Infectious Disease physician who oversees the vaccination program to see what was recommended regarding re-administering or waiting to re-administer. Because I was very confident that the patient received little to no vaccine, he advised me to re-administer the vaccine today. assistant vice president of pharmacy services for clinic recommended that I complete the VAERS form in the event that the patient suffers any adverse event from re-administering the vaccine. As of right now, there are no reported consequences or unexpected outcomes as a result of this.


VAERS ID: 1368566 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: minutes after receiving the 2nd dose, patient felt dizzy and passed out on the floor. she regained consciousness within a few seconds, and was responsive, she waited about 20 minutes before leaving the store, EMS was not called, she reported no other adverse effects


VAERS ID: 1368570 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 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: none of mention
Current Illness: none of mention
Preexisting Conditions: enlarged lymphnode on a single lung
Allergies: none of mention
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient signed up and intended to receive Johnson and Johnsen but mistakenly was administered Pfizer. No symptoms of note. just wrong intended vaccination. Patient states most likely will fulfill the series in 3 weeks.


VAERS ID: 1368588 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Hypertension, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aimovig, baclofen, fluoxetine, symbicort, modafinil, naratriptan, spiriva, pantoprazole, albuterol hfa inhaler
Current Illness: n/a
Preexisting Conditions: Chronic migraine, possible fibromyalgia, TBI, seizures, asthma
Allergies: Keflex, Penicillin, clonazepam
Diagnostic Lab Data: Unsure of exact values
CDC Split Type:

Write-up: Patient experienced facial numness/tingling, chest tightness, possible throat swelling, and shortness of breath about 10 minutes after administering Moderna Covid vaccine dose 1. Instructed patient to stay in consultation room for observation. I stayed with the patient and called 911. EMS arrived on scene about 5-10 minutes later. Took vitals, oxygen saturation within normal limits, elevated bp, normal heart rate. EMS monitored patient for about 15 minutes after which patient was still conscious and alert. EMS advised patient to go to hospital for further evaluation and patient accepted. EMS took patient to hospital. Patient generally seemed fine when he left the pharmacy which was about 30 minutes after receiving the vaccine.


VAERS ID: 1368596 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Eye pruritus, Ocular hyperaemia, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil, glucosamine, vitamin b-12
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe itching and redness in both eyes. Slight swelling in upper lids.


VAERS ID: 1368599 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

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

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

Write-up: Patient was administered Pfizer vaccine as second dose rather than Moderna (Moderna administered as first vaccination).


VAERS ID: 1368607 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / IM

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

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

Write-up: 1400: Pt recd. Vaccine and immediately loss conciousness for 20-30 seconds, Pt regained conciousness , was diaphoretic and anxious. Pt VS noted BP 96/60, HR 73, SPO2 100% on RA, RR 22. Pt escorted via wheelchair to ER for further evaluation. Husband notified.


VAERS ID: 1368610 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

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

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

Write-up: Patient given Pfizer vaccine for 2nd dose in series rather than Moderna. Moderna was administered 1st dose


VAERS ID: 1368618 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling abnormal
SMQs:, Dementia (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: Pulse 89 Respiration 18 SPO2 100% BP 126/78 Exam normal
CDC Split Type:

Write-up: Felt "spacey" Patient was given water and was observed, symptoms resolved Discharged to home


VAERS ID: 1368620 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1073 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Dizziness, Headache, Immediate post-injection reaction, Odynophagia, Pleuritic pain, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Seasonal allergies
Preexisting Conditions: N/A
Allergies: Seasonal Allergies, NO history of anaphylaxis
Diagnostic Lab Data: 1145 118/70 104bpm 18 99%
CDC Split Type:

Write-up: HPI: Patient is a * year old * who presents following administration of the first dose of Pfizer COVID19 vaccine in the left deltoid. She states that immediately following administration of the vaccine, she started to feel lightheaded with ?fuzzy vision,? and pain with swallowing. She denies a history of anaphylaxis. She affirms seasonal allergies and confirms that she was feeling ?stuffy? this morning. She affirms that she ate and drank this morning without odynophagia. She relates that there was a big family argument that is causing her to feel stressed at this time as well. She affirms pleuritic chest pain, odynophagia, epigastric abdominal pain, headache, lightheadedness, and blurry vision. She denies chest pain, difficulty breathing, swelling of the face/lips/tongue/throat, skin rash/itching, cramping abdominal pain, nausea, and vomiting. Exam: GEN: Alert and oriented x 4, NAD. Patient appears to have a developmental delay secondary to eye contact avoidance, slow to respond, and speech impediment. HEAD: NCAT EYES: PERRL, EOMI ENT: Ears normal, Nose normal, OP normal, no evidence of angioedema NECK: Supple, without LAD. CV: RRR, no m/r/g PULM: Shallow, guarded breathing at rest, but clear to auscultation bilaterally with deep inspiration, no accessory muscle use ABD: Soft, no tenderness. SKIN: No rashes, skin warm and dry. No erythema or edema of the injection site. MSK: FROM, MS 5/5 NEURO: Alert and oriented x 4, CN 2-12 grossly intact, no ataxia, gait steady Clinical Impression/Field Tx: Vital signs stable and physical exam within normal limits, however, patient continued to report odynophagia, pleuritic chest pain, abdominal pain, lightheadedness, and blurry vision, even after giving patient snack/drink and reclining her with lower extremities above the level of heart and head. EMS called to the scene for further evaluation. Instructed patient and parent to consult their PCP regarding the post-vaccination reaction. Patient and parent instructed to go to emergency department should she develop chest pain, difficulty breathing, swelling of the face/lips/mouth/tongue/throat, or cramping abdominal pain with nausea/vomiting. Patient and parent demonstrated understanding of post-vaccination instructions. Medications administered: None Disposition: EMS contacted due to patient not improving. Care transferred to EMS . No workup was performed by EMS and they instructed the parent of the patient to take the patient to ER via private car for further evaluation. Father was amenable to plan and signed form.


VAERS ID: 1368628 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 LA / IM

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

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

Write-up: patient received second dose on Moderna at approximately 1:45 pm. Around 1:55 patient started feeling nauseous and dizzy. Blood pressure was checked at that time, 107/75. Patient reported hadn''t eaten lunch but had breakfast. Gave client some orange juice and continued to monitor. Patient reported feeling some better, rechecked blood pressure at 2:05 pm, 97/65. Reported feeling more dizzy, nauseous, requesting to lay down. Nurse helped patient to wheelchair and wheeled patient next door to Health Department, to Hospital at 2:10 pm. Gave report to clerical staff and pushed patient to ER lobby. 2:20 patient started vomiting. ER nurse came to get patient, gave ER nurse report.


VAERS ID: 1368630 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Dizziness, Feeling hot, Nausea, Pallor, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Patient reports no illnesses
Preexisting Conditions: Patient reports no chronic health conditions
Allergies: Patient reports no allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given has second dose of Pfizer. He did not have any reactions with his first dose. He felt dizzy, nauseous and had a stomachache. He was also feeling hot and complained of feeling a tingling sensation in his fingers. This was a few minutes after the vaccine was given and he was sitting at the post-immunization area. We directed him to sit on the floor and gave him 2 cold packs to put on his neck. Patient looked pale and weak so we also gave him some cold water. After a few minutes of sitting, he asked for us to call 911. We called 911 and alerted management. After paramedics came, patient was taken away. Patient seemed to be doing fine as he was leaving. He regained color in his lips, but was still feeling the other symptoms.


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