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

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



Case Details (Reverse Sorted by Onset Date)

This is page 21 out of 8,010

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VAERS ID: 1768483 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-14
Onset:2021-10-07
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 AR / 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? 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: None
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient 16 years old at time of vaccine which Jansen Covid vaccine to be given to 18 years and older. Patient''s date of birth on the covid card is incorrect.


VAERS ID: 1768548 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-14
Onset:2021-10-07
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chromaturia, Myalgia, Pyrexia, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Headache, tingling and numbness in arms and head, slight nausea - 4 hours Muscle ache and diarrhea - diminished but continued since first shot (full body muscle aches and fever following second shot) Cola colored urine - 12 hours Sudden onset Tinnitus in left ear - continued since shortly after first shot (can wake me up at night)


VAERS ID: 1768571 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JANSSEN COVID 1 / 1 LA / IM

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

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

Write-up: Administered a vaccine after it expired. Was opened at 9:00 am 10/6 and administered at 12:30 on 10/7.


VAERS ID: 1768586 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Norvasc, cranberry concentrate, aspirin, TUMS, Vit D3, cinnamon, ibuprofen, lisinpril, lysine, mag-ox, melatonin, metformin, omeprazole, miralax, K+, pravastatin, senokot, torsemide, tramadol
Current Illness: NA
Preexisting Conditions: DM type 2, HTN, aortic valve disorder, aortic stenosis, osteoporosis, hypercholesterolemia
Allergies: Sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient already received her 3rd (booster) dose on 9/30/21 at the facility she resides in- this was not know at the time of her appointment today or did the patient tell us she just received her boost dose. A 4th dose was given today, not knowing she just got it a week ago, it did not come up on our immunization history.


VAERS ID: 1768601 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Blood fibrinogen, Blood lactate dehydrogenase, Blood urine, Computerised tomogram head, Extra dose administered, Full blood count, Haematochezia, Haptoglobin, Headache, Metabolic function test, Oral mucosal blistering, Petechiae, Prothrombin level, Serum ferritin, Stomatitis, Troponin, Urine analysis
SMQs:, Severe cutaneous adverse reactions (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Ischaemic colitis (broad), Hypersensitivity (broad), Medication errors (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 325mg QD; diltiazem ER 240mg QD; atorvastatin, 10mg; telmesartan 40mg QD; multivitamin; probiotic; Spiriva 18 mcg;; zantac 300mg; caltrate 300mg BIDi
Current Illness: none
Preexisting Conditions: hypertension history of lung cancer COPD hyperlipidemia
Allergies: Floxin, Biaxin, doxycycline, penicillin, PC Tar
Diagnostic Lab Data: Head CT CBC CMP ferritin fibrinogen haptoglobin LDH UA troponin PTT prothrombin
CDC Split Type:

Write-up: Patient got the Moderna vaccine 2 days ago this was her third shot. Last night after eating she noticed some sores in her mouth and this morning they got larger and were blisters. She also states she noticed some blood in both her urine and in her stool. Otherwise patient states she has been feeling well has no fevers. She had a mild headache this morning that has since resolved. No other new medications that she started recently no recent travel or tick bites. On examination patient has a sending petechiae to both legs extending up to her thighs. She states that these were not there when she put her socks on this morning at 9 AM.


VAERS ID: 1768658 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-10-07
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

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

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

Write-up: Breakthrough case. PCR test for covid on 10/7/2021 was positive


VAERS ID: 1768693 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / UNK UN / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, 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: OxyContin, Oxycodone, bupropion, astravatin , vitamin D3 4000u
Current Illness: Ulcerative Colitus (remission)
Preexisting Conditions: Ulcerative/chrones disease
Allergies: Sulfa, kflex, gabapentin, lrica
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever Aches and Pain. Entire body, fatigue, injection site (left arm) very sore


VAERS ID: 1768719 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-24
Onset:2021-10-07
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sofia Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient was vaccinated on 2/3/21 and 2/24/21, so was fully vaccinated when testing positive for COVID-19 on 10/7/21.


VAERS ID: 1768738 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Lip pruritus, Paraesthesia, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine daily; INFLUENZA
Current Illness:
Preexisting Conditions: Asthma, Anemia, hx of thyroid cancer, PID, peptic ulceration, headaches, Bipolar disorder, Depression
Allergies: Penicillins- hives and itching Vicodin -headache, body aches
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient states that her mother started noticing red, blotchy areas on the right side of her face. Patient states that her face, upper lip and bilateral upper extremities started itching, she also started having a tingling sensation to her fingers and red, blotchy areas to her hands. Patient started having symptoms 45min after immunization. Patient was given Benadryl 25mg, her symptoms improved and she went back home.


VAERS ID: 1768744 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-17
Onset:2021-10-07
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-CoV-2 NP PCR positive 10/7 x 2
CDC Split Type:

Write-up: Breakthrough symptomatic COVID-19 infection, positive PCR 10/7/21.


VAERS ID: 1768748 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3524 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Fatigue, Injection site pain, Lymphadenopathy
SMQs:, 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: Isotretinoin; Sertraline hydrochloride; Desogestrel
Current Illness:
Preexisting Conditions:
Allergies: Shrimp
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at the application site on the day 06/10/21. Left axillary lymph adenomegaly on 10/07/21. Left axillary pain on 10/07/21 without improvement with analgesic. Fatigue on 10/07/21 improved with analgesic.


VAERS ID: 1768766 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Gaze palsy, Hyperhidrosis, Muscle contracture, Pallor, Seizure like phenomena
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Physical exam by nurse practitioner within ~20 minutes of event.
CDC Split Type:

Write-up: Patient received vaccine as part of on campus clinic. Shortly after he received the vaccine, he had seizure like activity. Upper extremity muscles contracted. Distant gaze. Did not lose consciousness. Resolved quickly - was A and O x3, and then had diaphoresis, pallor, and lightheadedness. These sx resolved quickly as well without treatment. Once patient seemed back to baseline patient taken to campus health center for evaluation.


VAERS ID: 1768777 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK RA / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Lethargy, Pyrexia, Sensitive skin
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, high temperature 101+, lethargic, skin is hyper sensitive.


VAERS ID: 1768783 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30148BA / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pain, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertaline, enalapril, gabapentin, levothyroxine, simvastain, estradiol, progesterone
Current Illness: None
Preexisting Conditions: Thyroid
Allergies: Sulfa and penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Very red, swollen, painful, hot and itches. The swollen area is 4 inches long oval shape.


VAERS ID: 1768785 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased, Nerve injury
SMQs:, Accidents and injuries (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received dose on right arm . Patient had limited mobility on right arm so he went to hospital. Hospital determined the vaccine administer hit a nerve near the shoulder.


VAERS ID: 1768789 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Hyperhidrosis, Pallor, Presyncope, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Unknown Which, but Patient stated a similar event has happened previously after this event.
Other Medications: Unknown
Current Illness: None Reported
Preexisting Conditions: None Reported
Allergies: None Reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient experienced a near syncopal event after administration of vaccine. It was reported afterwards that patient had not eaten anything since the previous day, patient was anxious about receiving vaccination, and patient had experienced a previous reaction to another vaccine in this same manner. Patient appeared anxious, pale, and slightly diaphoretic. Patient was on his back on the floor, legs elevated, vital signs obtained. Vital Signs WDL, pulse slightly tachycardic. After a period of time, patient''s BP was WDL and pulse was WDL at which time patient was assisted to a sitting position. Patient ambulated out of department and no other interventions


VAERS ID: 1768798 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Mydriasis, Skin warm
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: During administration, patient jumped away from the needle, she felt like fainting. Proceeded to black out. Patient was warm to touch, sweating, eyes dilated. After about 30 minutes of laying on her side on the floor she started to feel better. She was capable of walking out to the car by herself.


VAERS ID: 1768801 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Headache, Influenza like illness, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetnus
Other Medications: Lamictal Ibuprofen
Current Illness: None
Preexisting Conditions: Slight asthma Arthritis Bi polar
Allergies: Red dye Ingredient in tetanus shot
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu like symptoms; Arm hurts going up into shoulders; Headache; weak; Dizzy.


VAERS ID: 1768807 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: October 7, 2021 ; 39 year old male patient received his second Covid 19 vaccine, Pfizer. Pt states he started having symptoms of nausea, and dizziness, after 10 minutes of receiving the vaccine. Pt states he felt nauseas during his 1st dose for the first two hours but it went away afterwards.. Pt''s vitals were: 109/74 ; 62 Hr ; 16 RR ; 97 SPO2 at 1538 and another set of VS were taken at 1553 with results of 117/81 ; 63 HR ; 99 SP02. Pt refused ER transport. Pt did not receive EPI


VAERS ID: 1768813 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Administered incorrect quantity of vaccine (only 0.3 mL). Called Pfizer to advise. Suggest to administer full amount of vaccine in opposite arm.


VAERS ID: 1768828 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Flushing, General physical condition abnormal, Heart rate increased, Hyperhidrosis, Loss of consciousness, Pallor, Seizure, Syncope, Yellow skin
SMQs:, Torsade de pointes/QT prolongation (broad), Cholestasis and jaundice of hepatic origin (broad), Anaphylactic reaction (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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: N/A
Preexisting Conditions: Patient mentioned having Atrial Fibrillation and High Blood Pressure when paramedics arrived.
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: After patient received his Janssen (J&J) vaccine, he was directed to sit for 15 minutes in front of our pharmacy area. Within the first minute of sitting down, another patient of the pharmacy who was standing by saw him and said he "didn''t look good" and grabbed my attention. He fainted while in the chair for a few seconds, then regained consciousness. When I was next to the patient, I asked if he could hear me and feel my touch when I grabbed his hand, and he said yes. He began (and continued) sweating profusely. He said he had chills but was able to breathe normally. He began to turn a pale yellow/white in color. He lost consciousness a second time and began seizing for roughly 10 seconds. After regaining consciousness again, he was very flushed in the face with a faster pulse. He asked if he could lay down. I gave him ice for his neck to cool him down and had him lay down on the floor until paramedics arrived (verified this was okay with operator on the phone). He said that made him feel a lot better. I was informed he was not allowed to eat or drink anything per operator. Paramedics arrived and took him to the nearest hospital. Time course of roughly 30 minutes or less.


VAERS ID: 1768833 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 RA / IM

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

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

Write-up: Initial 1st and 2nd dose were Moderna, 3rd dose given was Pfizer


VAERS ID: 1768843 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: PT WAS REQUESTING FLU SHOT, BUT LVN-OUTSIDE CONTRACTOR MISTAKENLY GIVEN PFIZER COVID SHOT INSTEAD. PT ENDED UP GETTING BOTH FLU SHOT (AND PFIZER ON THE SAME ARM-PREFERRED BY PT). PT FIRST 2 SHOTS RECEIVED MODERNA (2ND SHOT ON 3/8/21).


VAERS ID: 1768846 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Dry mouth, Dysarthria, Dyspnoea, Headache, Hypoaesthesia, Hypoaesthesia oral, Lethargy, Nausea, Paraesthesia, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: neuropathy, cancer
Allergies: lasix, zithromycin, bacitracin.
Diagnostic Lab Data: HR: 130, R 20, BP 130/80 , SAT 99%
CDC Split Type:

Write-up: Patient complained of numbness and tingling bilateral lower extremities, dry mouth, lethargic, headache, shortness of breath, numbness of lower lips, light headed. patient presented with clammy skin, slurred speech, dry mouth, tachycardia, n/v x2.


VAERS ID: 1768847 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Initial 2 doses were Moderna, 3rd dose given was Pfizer.


VAERS ID: 1768851 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: osteoarthritis of cervical spine, osteopenia of multiple sites, osteoarthritis of hands, joint swelling, primary biliary cirrhosis
Allergies: Ceftin, Sulfa, Clindamycin, Erythromycin, Hydrocodone-acetaminophen, Tramadol, Prednisone, Cefuroxime Axetil, Penicillin G,
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was inadvertently given 0.3mL of Pfizer COVID undiluted


VAERS ID: 1768854 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

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

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

Write-up: PFIZER BOOSTER GIVEN AS 3RD SHOT. PATIENT HAD MODERNA FOR PREVIOUS 2 VACCINE.


VAERS ID: 1768855 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Ear pain, Headache, Nasal discomfort, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Headache Nose felt funny Left ear was hurting top throat itchy then bottom of throat was itchy 08:40 Inserted 24 gauge IV in Left AC Space 08:43 - Epi 0.5mg IM Left thigh 08:44 - Benadryl 50 mg administered via IV ear/nose/throat s/s improved Developed chest tightness, moved to floor elevated feet. EMS called. Transported via ambulance to ED.


VAERS ID: 1768860 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carvedilol 6.25 mg po daily HCTZ 25 mg PO take 1/2 tab daily Tramadol 50 mg 2 tabs every 8 hours PRN pain Plaquenil 200 mg PO 2 tabs every M W F and one tab T Th Sa Su Amlodipine 5 mg PO daily ASA 81 mg PO daily Caltrate 600 with Vita
Current Illness: UNSTEADINESS ON FEET CHRONIC FATIGUE, UNSPECIFIED OTHER IRON DEFICIENCY ANEMIAS OTHER MALAISE ESSENTIAL (PRIMARY) HYPERTENSION ACQUIRED ABSENCE OF BOTH CERVIX AND UTERUS ACQUIRED ABSENCE OF OTHER SPECIFIED PARTS OF DIGESTIVE TRACT ACUTE APPENDICITIS WITH PERFORATION AND LOCALIZED PERITONITIS, WITH ABSCESS UNSPECIFIED CATARACT LOBULAR CARCINOMA IN SITU OF LEFT BREAST OTHER GIANT CELL ARTERITIS RHEUMATOID ARTHRITIS, UNSPECIFIED PAIN IN UNSPECIFIED JOINT HISTORY OF FALLING
Preexisting Conditions: see above
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Resident previously received the Moderna series (2 vaccinations). She was given the Pfizer booster on 10/7/21 with no adverse reactions thus far. MD notified, family notified. Pharmacist administered the vaccine.


VAERS ID: 1768869 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye swelling, Hypoaesthesia oral, Lip pruritus, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Dexilant, Trazodone, lisinopril, venlafaxin, synthroid, gabapentin, prednisone, Vitamin D w/vitamin K, asprin
Current Illness: Non
Preexisting Conditions: LCV, hypoactive thyroid, Acid reflux, Vit. D deficiency
Allergies: Morphine, codeine, diazipan
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I waited the required 15 minutes and felt fine. At approximately 30 minutes post injection I started to itch. I realized I had hives on my legs. My lip was itchy, numb and my eyes felt swollen. I drove myself to the ER. There I received IV medications solumedraol, Pepcid, and Benadryl. After approx. 20 minutes the itching stopped. After approx. 40 minutes the hives had all dissapeared.


VAERS ID: 1768874 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Sexual dysfunction (broad)

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

Write-up: Vomiting, numbness and tingling of face.


VAERS ID: 1768875 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2689 / 3 RA / IM

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

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

Write-up: PATIENT RECEIVED PFIZER FOR 3RD VACCINE WHEN PREVIOUS TWO VACCINES WERE MODERNA


VAERS ID: 1768881 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Sexual dysfunction (broad)

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

Write-up: reported left lateral knee was tingling & numb, itchy & tightness in throat, able to swallow offered oral Benadryl, he declined, immediately sent for check up at Urgent Care.


VAERS ID: 1768883 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: asthma, CAD, cardiomyopathy, COVID 19,
Allergies: albuterol
Diagnostic Lab Data: pulse ox 99% on room air
CDC Split Type:

Write-up: developed throat tightness with coughing


VAERS ID: 1768891 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR

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: RA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I went in because I am immune compromised to get a 3rd moderna vaccine recommended by my doctor. I filled out a form online stated I had to moderna shots, I filled a form and hand delivered it that started I?d had 2 moderna vaccines. I also gave them my vaccine card with moderna written on it. They proceeded and gave me a Pfizer vaccine.


VAERS ID: 1768896 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 - / IM

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

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

Write-up: Patient received 2nd dose of Pfizer today. He did not disclose his Janssen COVID vaccine administration from earlier this year until after receiving his 2nd dose of Pfizer. Patient should not have received his 1st or 2nd dose of Pfizer with this clinic due to his previous COVID vaccination status.


VAERS ID: 1768903 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

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

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

Write-up: Patient came wanted a Pfizer vaccine and did not have CDC card. Patient reported he already have two injections of Pfizer vaccine. Gave pzifzer vaccination injections. After logging patient information on the website it was discovered patient had one time dose of Moderna vaccine. Wife went home to search for CDC card and it was discovered he had Moderna injections twice . Patient had mix doses of Moderna and Pfizer. He did not complain of pain and no distress noted. No adverse effects noted. Patient was encouraged to see his healthcare provider in case of an adverse reaction.


VAERS ID: 1768907 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Right arm numb & lips numb


VAERS ID: 1768925 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient used fake names and received full series of all approved vaccines. It was not caught until he received his final dose of Moderna


VAERS ID: 1768947 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-03
Onset:2021-10-07
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 RA / 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: N/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/.a
Diagnostic Lab Data: no adverse events
CDC Split Type:

Write-up: Patient was only 16 years old when she received Moderna vaccine


VAERS ID: 1768961 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flomax, Amlodipine, Furosemide
Current Illness: urinary incontinence, hypertension
Preexisting Conditions: no
Allergies: No known allergy
Diagnostic Lab Data: Patient was given Pfizer vaccine for 3rd dose even though he had Moderna for 1st and 2nd dosages. Patient waited for 30minutes and had no adverse reactions at time of injection.
CDC Split Type:

Write-up: Patient was given Pfizer vaccine for 3rd dose even though he had Moderna for 1st and 2nd dosages. Patient waited for 30minutes and had no adverse reactions at time of injection. Patient was given Pfizer vaccine for 3rd dose even though he had Moderna for 1st and 2nd dosages.


VAERS ID: 1768969 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

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

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

Write-up: None.


VAERS ID: 1768977 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-10-07
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

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

Write-up: Miscarriage at 10 weeks


VAERS ID: 1768979 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

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

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

Write-up: None


VAERS ID: 1768983 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B212A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Diarrhoea, Epistaxis, Muscle spasms
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: can''t take flu vaccine. Knocked her out for 14 days.
Other Medications: Medication: Diabetes medication- Lorcardin, Gabapetin, Osteoprine, Singular, also taking insulin Multivitamins. Doesn''t know the dosage.
Current Illness: None
Preexisting Conditions: Diabetes- since October 2014
Allergies: Lisinopril, Albuterol,Marijuana, and latex. No food allergies.
Diagnostic Lab Data: No test performed
CDC Split Type: vsafe

Write-up: 4/7/2021 Diarrhea, cramping, upset stomach, bloody nose occurred around September 27th ,2021


VAERS ID: 1768985 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 3 LA / IM

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

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

Write-up: None


VAERS ID: 1768988 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carvedilol 12.5mg Losartan 100mg Atorvastatin 20mg
Current Illness: None
Preexisting Conditions: Bypass heart surgery 08/2014 Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Joint pain, muscle ache, weakness within 24 hrs


VAERS ID: 1768991 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Hypotension, Paraesthesia, Paraesthesia oral, Presyncope
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: states she has "passed out" from flu vaccine in the 90''s
Other Medications: Unknown
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient returned to clinic after approx 10minutes after leaving. Just prior to entering the building, she vasovagaled. She was immediately placed in a wheelchair and taken to a stretcher. BP was low 88/54 and diaphoretic. Stated she started to feel better once lay down. After approx 10min of stretcher, pt began to get the chills and stated she had tingling in her mouth and left side of face and neck. Transferred patient to ED for further evaluation.


VAERS ID: 1768992 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 3 LA / IM

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

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

Write-up: None


VAERS ID: 1769032 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 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: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Pfizer Covid vaccination, then his wife came back and told us he has already gotten the 2 dose series of Moderna Covid vaccine. This would be considered a booster, but with a different manufacturer.


VAERS ID: 1769036 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt was administered .25 mg diphenhydramine @ 1155.
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: PCN, Amoxicillin, class drugs.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Pt received 1st dose @1100. waited in clinic for 15 minutes. Pt left. 30 minutes later Pt started to feel per Pt "like my throat was closing". when PT returned to clinic seen by Provider and administered .25 mg of diphenhydramine @ 1155 IM. Vitals signs taken and where as follows. B/P 124/87, HR 82, O2, 100 n RA.


VAERS ID: 1769055 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall Aldactone
Current Illness: None
Preexisting Conditions: None
Allergies: Ceclor
Diagnostic Lab Data: Primary Health should have both vaccines documented. I went to the same clinic for both.
CDC Split Type:

Write-up: I was given the wrong vaccine by a nurse. I verified with the front desk beforehand that I was supposed to get my 2nd Moderna, not Pfizer. The nurse failed to check my record, or my vaccination card, and gave me the Pfizer vaccine instead.


VAERS ID: 1769061 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Baseball size lump in armpit lymph node of left vaccination arm.


VAERS ID: 1769062 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / IM

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

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

Write-up: patient fainted, then regained consciousness, sweaty palms, palms turned bright red then pale white


VAERS ID: 1769067 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Crying, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)

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

Write-up: A 61-year-old female patient received her 2nd dose of Pfizer COVID-19 vaccine. Within 15 minutes of administration, patient reported severe body weakness, dizziness and experienced uncontrollable tears. Pharmacy called code white and patient refused 911 and asked pharmacy to monitor until her co-worker arrived. Patient requested pharmacy to call her work and inform them about the reaction. Her vitals were normal with BP of 135/80 HR of 85 at the time of the reaction. Normal breathing. No signs or symptoms of allergic reaction. Pharmacy provided food and water. Pharmacy continued to monitor the patient until her co-worker arrived.


VAERS ID: 1769069 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-21
Onset:2021-10-07
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Hypoaesthesia, Pain, Pain in extremity, Pyrexia, SARS-CoV-2 test positive
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 10mg, Adderall 10mg
Current Illness:
Preexisting Conditions: Pituitary tumor
Allergies:
Diagnostic Lab Data: Positive COVID test 9/30/21
CDC Split Type:

Write-up: I had Numbness in right side of body setting in an hour after inoculation that lasted 24 hrs, headache lasting from inoculation to present, fatigue, pain in lower legs. I contracted COVID-19 with fever of 103.5, 8 days after inoculation and continue to suffer from fatigue/exhaustion, back/body aches,.


VAERS ID: 1769082 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient received 2nd dose of Pfizer COVID Vaccine. Did not declared that he had received 2 Moderna doses in March 2021.
Current Illness: Mental Health Disorder, Venous Insufficiency, Smoker, Benign Prostatic Hyperplasia.
Preexisting Conditions: Mental Health Disorder, Venous Insufficiency, Smoker, Benign Prostatic Hyperplasia.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 2nd dose of Pfizer COVID-19 vaccine was given to patient after he got 2 Moderna COVID-19 vaccine doses in March 2021. Patient did not disclosed that he received 2 other previous COVID-19 vaccines.


VAERS ID: 1769084 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphonia, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
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: Approximately 10 minutes after administration patient reported her throat felt slightly swollen or tight. She stated it was not enough to cause any difficulty breathing and that it wasn''t itchy. She took 25mg of liquid benadryl at this time. She reported no other symptoms but could still feel swelling (not improving and not getting worse) and her voice was slightly hoarse. She did not want us to administer EpiPen and she did not want us to call EMS as she stated the swelling was not getting worse. She was able to speak, drink water and swallow. We continued to monitor. She took another 25mg of benadryl and reported no changes. She was feeling well enough to leave with her husband at 55 minutes after administration and we advised her to follow up with a visit to urgent care if no improvement. She did follow up with a visit to the local urgent care where she states she was given IV medrol and more benadryl.


VAERS ID: 1769085 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 3 LA / IM

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

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

Write-up: The patient made an appointment for her 1st dose Moderna shot. She checked in with the pharmacy technician to confirm her first dose. She confirm it is the first Moderna dose with the pharmacist. After 15 minutes from receiving her vaccination. She brings out her COVID-19 vaccination card to show the pharmacist she is getting her 3rd dose of Moderna. She received the 3rd doses of Moderna without being moderately to severely immunocompromised,


VAERS ID: 1769086 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: dizziness, feeling of passing out.
Other Medications: zoloft 10 mg , birth control
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness, sweating, clamy skin and feeling of passing out.


VAERS ID: 1769237 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-04
Onset:2021-10-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood urine present, Chills, Fatigue, Haematochezia, Haemoptysis, Oral blood blister, Petechiae, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Systemic lupus erythematosus (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: After the first two shots, the pt noticed HA and chills. After this third booster shot, pt also noticed fatigue and some chills
Other Medications: famotidine 20 mg oral tablet: Hx, 1 tab(s) orally 2 times a day losartan 50 mg oral tablet: Hx, 1 tab(s) orally once a day Spiriva 18 mcg inhalation capsule: Hx, 1 cap(s) inhaled once a day aspirin 325 mg oral tablet: Hx, 1 tab(s) orally
Current Illness:
Preexisting Conditions: COPD, HTN, HLD, and lung cancer s/p rt lower lobectomy
Allergies: Biaxin, doxycyclinem floxin, PC tar, Penicillin
Diagnostic Lab Data: the ER she was found to have platelet level < 2.
CDC Split Type:

Write-up: 3 days post vaccine patient presents to ED with blood blisters in mouth and blood in urine/stool for the last day. Pt noticed that there were a couple blood blisters in her mouth yesterday night. This morning the blisters has increased in size and new ones had started to form and they began to bleed. Pt received 2 moderna COVID shots earlier this year and went to pharmacy for a booster. After the first two shots, the pt noticed HA and chills. After this third booster shot, pt also noticed fatigue and some chills that resolved spontaneously. Pt also received a flu shot about 2 weeks ago. Pt also noticed petechiae in her LE while at the hospital today going up to her mid thigh. She also states that she had some hemoptysis but was unsure if it was just blood from her oral blisters. She also endorses blood in urine and blood in stool but both are only present when she wipes. She did not noticed a change in stool color or overt hematuria. She denies any changes in her medications, no recent illnesses, no new medications other than her vaccine history.


VAERS ID: 1769247 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Loss of consciousness, Pain, Pyrexia
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), 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: First dose of child?s vaccines when I was a baby, paralyzed me from the mid chest down for 3 months. Parents never gave me anoth
Other Medications: Fish Oil capsule, vitamin D3, mens multiviamin, omeprazole 20 mg (once per day), Lisinopril and Hydrochlorothiazide 20/25 mg once per day, allopurinol 300mg once per day,
Current Illness: None
Preexisting Conditions: Gout and High Blood Pressure
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Extreme joint pain, massive headaches, fever of 103, neck pain, back pain, knee pain, ankle pain, elbow and shoulder pain, light headed, passed out,


VAERS ID: 1769248 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, Paraesthesia oral, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Pt c/o dizziness, high heart rate, blurred vision, tingling to lips


VAERS ID: 1769249 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Pallor
SMQs:, Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: bleeding disorder
Allergies: nkda
Diagnostic Lab Data: Initial vital signs: BP 100/60; pulse 55; resp 18 Repeat vital signs: BP 120/72; pulse 58; resp 16
CDC Split Type:

Write-up: Patient received his vaccine and went outside to the waiting area for his 15 min observation. While outside he became weak, pale and clammy. The medical team was alerted and we went outside and patient laid on the ground. His vital signs were obtained. He stated he has passed out before. He is diabetic and had not eaten today. Patient was given water, candy and a nutrigrain bar. He stated he felt better after he ate. His skin color, condition and vital signs improved. Patient stated he felt fine and could ride his bike home.


VAERS ID: 1769277 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pain, redness and swelling at injection site; swollen lymph nodes under arm


VAERS ID: 1769280 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Fall, Head injury, Vertigo, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: no know health condition
Preexisting Conditions: no known health condition
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: VERTIGO, DIZZINESS, BLURRY VISION, LIGHTHEADED, FELL DUE TO IMBALANCE. PT WAS WELL RESPOND AFTER HE FELL. PT HIT IS HEAD REAL HARD ON THE FLORE DUE TO IMBALANCE BUT NEVER LOST THE CONCIOUSNESS.


VAERS ID: 1769290 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Eye pain, Head discomfort, Headache, Injection site swelling, Myalgia, Pain in extremity, Pyrexia, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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: None
Current Illness: None
Preexisting Conditions: Chronic, acute DVT
Allergies: Heparin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, runny nose, sore arm and swelling/bump (injection site), dizziness, muscle aches, joint pain, chills, left eye pain on occasion, low grade fever 99.8? My head feels very heavy; too heavy for my shoulders to carry.


VAERS ID: 1769295 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Hypoaesthesia oral, Migraine
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient reported feeling dizzy, lightheaded, and numbness in the mouth and arm after receiving the first dose of COVID vaccine(9
Other Medications: Metoprolol, methimazole, and vitamins
Current Illness:
Preexisting Conditions: Graves disease and hypertension
Allergies: Aspirin, and azithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported feeling dizzy, lightheaded, migraine like headache, numbness on the left side of the mouth, and mental fog, 10 min after receiving the vaccine. BP 145/100. Monitored patient for another 10min. Patient reported that the symptoms subsided prior to leaving. Patient was taken home by spouse. Advised patient to report any other symptoms to primary health provider or report to ER if experienced any life-threatening symptoms.


VAERS ID: 1769296 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: The vaccine was given post-expiration date. no adverse reaction


VAERS ID: 1769472 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, 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: Omega 3, lemon balm, magnesium, vitamin d
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, joint pain, muscle pain, fever


VAERS ID: 1769477 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Read swelling at the injection site and around, very itchy
CDC Split Type:

Write-up: Read swelling at the injection site and around, very itchy


VAERS ID: 1769479 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Haematochezia, Heart rate increased, Lymphadenopathy, Neck pain, Pain in extremity, Peripheral swelling, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aMILoride-hydrochlorothiazide (5-50 mg tablet) amLODIPine (10 mg tablet) Potassium Gluconate (550 mg) Low Dose Aspirin (81 mg)
Current Illness:
Preexisting Conditions: Hypertension Heart murmur/leaky valve Spine deformity
Allergies: Lactose Intolerance
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fast heart beat - 10 minutes after vaccine (10/6/21) Sore and swollen arm (10/6/21) Vomiting and diarrhea, with loose, watery, mucus and bloody stools (10/7/21) Sore neck on right side, swollen lymph nodes (10/7/21)


VAERS ID: 1769480 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

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

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

Write-up: Pfizer dose was given after patient had gotten Moderna vaccination series. Moderna vaccine was given on 2/9/21 and 3/9. He did not have any adverse event at the time of vaccination. However, he was not indicated for a dose of Pfizer vaccination.


VAERS ID: 1769484 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Feeling hot
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: chest pain an hour after the vaccine that is still persisting and associated with sensation of radiating heat from the chest


VAERS ID: 1769489 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (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: Synthroid 50mcg daily; triamcinolone acetonide ointment on hands/feet; zinc gluconate lozenges PRN (used one lozenge two days ago and one lozenge today)
Current Illness: Skin infection on hands and feet (unsure if fungal infection/athlete?s foot or other dermatitis)
Preexisting Conditions: Chronic nerve pain (mild) from fractured C5
Allergies: Mild allergy to cherries and other pitted fruits No known drug allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within 5 minutes of receiving my vaccine, I got a strong metallic taste in my mouth. My vaccine was less than an hour ago, but I still have the metallic taste.


VAERS ID: 1769496 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Patient stated that she was allergic to Flu vaccine, Sulfa antibiotics and Morphine.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received the Pfizer Covid 19 vaccine. She was hesitant to receive it because she said she had an adverse reaction to flu vaccine. She had an anaphylactic reaction in the past. She is also prone to allergic reactions to various antibiotics. She said she was only getting the vaccine because of the state mandate. She received her vaccine at around 1:20 pm and almost immediately had an allergic reaction. She said her throat was swelling up and she had a hard time breathing. Code white was called. Offered Epi-pen, but the patient already had one and she said she did not want to inject it because that would mean a trip to the hospital. Her husband was a paramedic and he had the epi-pen handy in case she stopped breathing. She insisted on benadryl. She was given 6 capsules of benadryl. Patient insisted on taking 6 capsules. She has had similar reactions and she said she always takes 6 capsules. After a few minutes, patient insisted on going home. She left with her husband.


VAERS ID: 1769501 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 RA / IM

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

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

Write-up: Patient received second vaccine outside the recommended window of 28-42 days from the first vaccine. 1st: 8/7/21 2nd: 10/7/21


VAERS ID: 1769503 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

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

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

Write-up: Patient received second vaccine outside the recommended window of 21-42 days from the first vaccine. 1st: 4/11/21 2nd: 10/7/21


VAERS ID: 1769505 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 22 yr old petite, slender built female with history of fainting after needles (told to staff AFTER the event), did just that. However her boyfriend caught her and placed on the floor without continued ALOC or hypotonia. Resolved with rest and leg elevation, ice on her face. Departed after education and without incident.


VAERS ID: 1769669 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-02
Onset:2021-10-07
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 LA / IM

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

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

Write-up: pt''s arm is a little swollen and hot to the touch. she said the redness is growing about 3 inches


VAERS ID: 1769677 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Dyspnoea, Feeling abnormal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrocodone/APAP, levothyroxine, gabapentin, atorvastatin, meloxicam, amlodipine, duloxetine, losartan, and quetiapine.
Current Illness: No acute illnesses mentioned.
Preexisting Conditions: High cholesterol and blood pressure. Chronic pain. Depression. Low thyroid.
Allergies: Chlorzoxazone, Crestor, and sulfa antibiotics.
Diagnostic Lab Data: Unsure what the ER tested.
CDC Split Type:

Write-up: About 10 minutes after getting her immunization the patient returned to pharmacy saying she didn''t feel good. Chief complaint was trouble breathing. Patient looked like she was going to pass out so we help her to the floor. Patients legs were elevated and she was given and ice pack. Over the course of 10 minutes her breathing seemed to normalize. Patient also complained of feeling spacey and light headed. EMSA did transport because of elevated blood pressure. When I checked on patient later that day she was at home and doing well.


VAERS ID: 1769678 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Lip swelling, Malaise, Oropharyngeal discomfort, Paraesthesia oral, Pruritus, Rash
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: per pt- two other times she has had reactions to a FLU shot
Other Medications:
Current Illness: recent flu vaccine with anaphylaxis
Preexisting Conditions:
Allergies: Patient stated allergic to Compazine and had recently had an allergic reaction to her FLU vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient began to complain of "itching all over" about 20 minutes after receiving her vaccination. Shortly after that, she complained of feeling unwell. BP was 152/100. Patient began to complain of tingling around her mouth. Rph observed mild swelling on bottom edge of lower lip. Pt began to cough and kept trying to clear her throat. EPI 0.3 was administered. Paramedics arrived 4 minutes and 30 seconds afterward. Patient had developed a pink rash on arms that was noted by EMS and Rph.. Patient taken to ER.


VAERS ID: 1769687 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: not known
Preexisting Conditions: not known
Allergies: none listed
Diagnostic Lab Data: none
CDC Split Type:

Write-up: approximately 3-5 minutes after receiving 2nd pfizer covid vaccine, patient lost consciousness. He quickly regained consciousness after putting patient on his back, elevating his feet, and placing an ice pack on his forehead. EMS was called and patient was evaluated and released.


VAERS ID: 1769695 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site haemorrhage, Injury associated with device, Product dose omission in error
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: Pharmacist accidentally punctured patient''s right arm with empty syringe. Patient had mild bleeding from injection needle. Upon discovery of event, pharmacist administered new syringe and needle with Pfizer COVID-19 vaccine into patient''s right arm.


VAERS ID: 1769865 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK - / -

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

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

Write-up: pfizer vaccine administered instead of j&j


VAERS ID: 1769868 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

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

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

Write-up: Patient was accompanied by her son for translation, who also completed her paperwork for the Pfizer booster. Pharmacist asked patient''s son for the patient''s vaccination card, to which the patient''s son replied that his father was carrying the card and would return to the pharmacist after using the restroom. Patient''s son assured the pharmacist that the patient had last received their Pfizer second dose at least 6 months prior. Patient''s Eligiblity Attestation Form was also completed with a checkmark stating so. Pharmacist proceeded with giving the patient the shot while waiting for her husband to arrive with the vaccination card so that pharmacist could fill it out. When patient''s husband arrived, he handed over her vaccination card, which stated that the second Pfizer dose had been given on 4/13/21. Pharmacist realized that the patient had received her booster shot a few days early (180 days, or 6 months, from 4/13/21 would be 10/10/2021).


VAERS ID: 1769872 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 - / -

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

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

Write-up: At 1736 RN signaled that client was not feeling well. Client leaned forward and gave emesis bag. Client had 1 vomit episode. Client was already sitting on anti-gravity chair due to history of syncope with vaccinations. RN stated client first complained of headache and dizziness within a minute of vaccination. Vitals at 1738 by RN: blood pressure 101/65, pulse 58. Client appeared pale, alert and oriented x4. RN gave client water. Per client phobia of medical procedures and did not want blood pressure to be taken and it made her symptoms worse. Client reported no other medical history, no medications and no allergies. Client reported feeling "headache, dizziness and nausea ." Client denied blurry vision, chest pain or shortness of breath. At 1743 client asked to eat her chocolate, per client it helps her. Pulse 57 at 1749. Client reported all symptoms had resolved. Client''s boyfriend present and stated he would drive her home. asked client if we could recheck blood pressure and client accepted. At 1558 vitals: pulse 77, oxygen sat 100%, blood pressure 138/94. RN reviewed with client ER precautions. Last vitals at 1806: blood pressure 132/87, pulse 71. Client stood up at 1807 and walked a few steps without any complaints. Client left facility at 1807 with steady gait.


VAERS ID: 1769876 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036D21A / 1 RA / IM

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

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

Write-up: NUMBNESS, TINGLING AND COLDNESS IN ARMS AND FINGERS


VAERS ID: 1769996 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-26
Onset:2021-10-07
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

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

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

Write-up: Pt admit to hospital 10/7/21, COVID positive - s/p 2 doses of Pfizer (last dose 2/26/21)


VAERS ID: 1770001 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-10-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: it hurt like if I had gotten hit, then it started itching,


VAERS ID: 1770006 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysgeusia, Headache, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Headache, nausea, dizzy, metallic taste in mouth, pain at injection site


VAERS ID: 1770008 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3A9ZG / N/A RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Axillary pain, Chills, Lymphadenopathy, Tenderness
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Intermittent chills, left axillary pain, tenderness and lymphadenopathy


VAERS ID: 1770013 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LD1146 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Genital herpes
SMQs:, Opportunistic infections (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: Reactivation of genital herpes following 2nd dose of Pfizer-BioNTech Covid vaccine (Lot EN 6204) on 03/10/2021, age 69
Other Medications: Keflex 250mg daily Levothyroxine 50mcg daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Reactivation of genital herpes; also occurred 2 days following 2nd dose of Pfizer-BioNTech Covid vaccine


VAERS ID: 1771135 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-04
Onset:2021-10-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Gait disturbance, Hot flush, Hypersomnia, Lymph node pain, Oral herpes, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lexapro (5 mg)
Current Illness: none
Preexisting Conditions: Guillain Barre Syndrome in 2013
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Sore lymph nodes in underarm area still on day 5, slept for 11 hours, cold/hot flashes, cold sore emerged in center left of lower lip. Haven''t had a gold sore in over 25 years. Left foot is tender so a bit wobbly walking wise. No treatment for lymph nodes or tiredness. Just rest. Will pick up abreva for cold sore. possibly physical therapy for foot to be discussed with doctor.


VAERS ID: 1771138 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1771140 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline, 25mg, PO qam
Current Illness: Nome
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 99.7 F, chills, muscle pain, fatigue, malaise, headache, GI disturbance


VAERS ID: 1771169 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Product preparation 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1771172 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Flushing, Hyperhidrosis, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Medium


VAERS ID: 1771173 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1771174 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Throat irritation
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (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: Pfizer 1, given 9/2/2021
Other Medications: Symbicort, Albuterol
Current Illness: Asthma
Preexisting Conditions: Asthma
Allergies: Peanuts, coconuts, eggs, mangoes, wheat, pineapples
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Complained of throat itching and dizziness


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