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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 214 out of 8,010

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VAERS ID: 1761097 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Depressed level of consciousness, Dizziness, Hyperhidrosis, Paraesthesia, Photophobia, Pyrexia, Syncope, Throat tightness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AUPFIZER INC202101242555

Write-up: Depressed level of consciousness; Syncope; chest pain; dizziness; Hyperhidrosis; Paraesthesia; Photophobia; pyrexia; throat tightness; vomiting; This is a spontaneous report from a contactable other health professional via the Regulatory Authority. Regulatory authority report number is 622996. An 18-Year-old male patient received bnt162b2 (mRNA) (Comirnaty, Formulation: Solution for injection, Batch/Lot number: Not reported) Via an unspecified route of administration on an unspecified date as a single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. Patient experienced Chest pain; Depressed level of consciousness; Dizziness; Hyperhidrosis; Paraesthesia; Photophobia; Pyrexia; Syncope; Throat tightness and vomiting on 11Sep2021. Outcome of all the events was Recovering/Resolving. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1762422 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Delirium
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEJNJFOC20211005344

Write-up: DELIRIUM; This spontaneous report received from a consumer via a Regulatory Authority (regulatory authority, DE-PEI-202100199993) on 04-OCT-2021 and concerned a 69 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: XE395 expiry: UNKNOWN) 1 dosage forms, 1 total, administered on 05-SEP-2021 for product use for unknown indication. No concomitant medications were reported. On 11-SEP-2021, the patient experienced delirium. On an unspecified date, the patient was hospitalized. Number of days of hospitalization was not reported. It was unknown if patient was discharged. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from delirium. This report was serious (Hospitalization Caused / Prolonged, and Life Threatening).


VAERS ID: 1762544 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG4592 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Headache, Vertigo positional
SMQs:, Vestibular 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: YODOCEFOL; TRANDATE
Current Illness: Headache
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertension arterial; Pregnancy
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC202101250245

Write-up: Benign paroxysmal positional vertigo; Headache aggravated; This is a spontaneous report from a contactable consumer downloaded from the regulatory authority-WEB, regulatory authority number ES-AEMPS-1002949. An adult female patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in arm left on 10Sep2021 (Lot Number: FG4592) as DOSE 1,SINGLE for COVID-19 immunisation. Medical history included hypertension arterial from 20Sep2019 to an unknown date, "pregnancy", and ongoing headache (for clarification). The patient was not diagnosed with COVID-19 prior to vaccination. The patient was not pregnant at the time of vaccination. Concomitant medications included cyanocobalamin, folic acid, potassium iodide (YODOCEFOL) taken for pregnancy from 16Dec2019 to an unspecified stop date; labetalol hydrochloride (TRANDATE) taken for hypertension arterial from 20Sep2019 to an unspecified stop date. On 11Sep2021, the patient experienced benign paroxysmal positional vertigo (also reported on 15Sep2021; event was assessed as serious, medically significant) and headache aggravated. Therapeutic measures were taken as the result of the events which included Acetaminophen and Sulpiride 50 mg. Outcome of the events was not recovered.


VAERS ID: 1762953 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Eye irritation, Eye pain, Fatigue, Inappropriate schedule of product administration, Lacrimation increased, Ophthalmological examination, SARS-CoV-2 test, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Lacrimal disorders (narrow), Medication errors (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DULOXETINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Borderline personality
Allergies:
Diagnostic Lab Data: Test Name: Eye Test; Result Unstructured Data: Test Result:Unknown result; Test Date: 20210920; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC202101252582

Write-up: blurred vision; eyes are painful, irritated, watery; eyes are painful, irritated, watery; eyes are painful, irritated, watery; Fatigue; Sore eyes; patient received the 2nd dose of bnt162b2 on 11Sep2021 and the 1st dose on 04Jul2021; This is a spontaneous report from a contactable consumer. The consumer reported for 2 reports. This is the 1st of 2 reports. The 1st report was received from the regulatory authority. Regulatory authority report number is GB-MHRA-WEBCOVID-202109211943412980-AT8V0 and Safety Report Unique Identifier is GB-MHRA-ADR 25976729. A 21-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number: Unknown), dose 2 via an unspecified route of administration on 11Sep2021, at the age of 21 years, as dose 2, single for COVID-19 immunization. Medical history included borderline personality. Patient has not had symptoms associated with COVID-19. Patient is not pregnant; Patient is not currently breastfeeding. Concomitant medication included duloxetine taken for borderline personality from Jul2021. Historical vaccine includes dose 1 of bnt162b2 on 04Jul2021 for COVID-19 immunization and experienced eyes are painful and blurred vision. On 12Sep2021, the patient experienced fatigue and sore eyes. On an unspecified date, the patient experienced blurred vision, eyes are painful, irritated, watery. The clinical course was reported as follows: Constant fatigue. Eyes are painful, sore, irritated, watery, blurred vision and red starting after second COVID jab and getting worse. Patient has not tested positive for COVID-19 since having the vaccine. Patient is not enrolled in clinical trial. The patient underwent COVID-19 Virus Test (20Sep2021): No - Negative COVID-19 test. The patient also had eyes tests on an unspecified date (Unknown results). The case is serious (medically significant). It was also reported that the patient received the 2nd dose of bnt162b2 on 11Sep2021 and the 1st dose on 04Jul2021 which was considered inappropriate schedule of vaccine administered. The outcome for the events fatigue and sore eyes was not recovered; outcome for the events blurred vision, eyes are painful, irritated, watery was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : GB-PFIZER INC-202101258352 Same patient/drug, different dose/event


VAERS ID: 1764500 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003659 / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEMODERNATX, INC.MOD20213

Write-up: This case was received via European Medicines Agency (Reference number: BE-FAMHP-DHH-N2021-106621) on 28-Sep-2021 and was forwarded to Moderna on 28-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of MYALGIA, MALAISE, NAUSEA, HEADACHE and PYREXIA in a 12-year-old male patient who received mRNA-1273 (Spikevax) (batch no. 3003659) for COVID-19 immunisation. No Medical History information was reported. On 11-Sep-2021, the patient received second dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On 11-Sep-2021, the patient experienced MYALGIA (seriousness criterion disability), MALAISE (seriousness criterion disability), NAUSEA (seriousness criterion disability), HEADACHE (seriousness criterion disability) and PYREXIA (seriousness criterion disability). On 12-Sep-2021, MYALGIA, MALAISE, NAUSEA, HEADACHE and PYREXIA was resolving. Concomitant product use was not provided by the reporter. The patient started to feel unwell late in the afternoon. Woke up several times during the night / fever. He was doing better now, around 13:30 on 12 Sep 2021. No treatment information was provided. Company Comment - This case concerns a 12 year old male with no relevant history who experienced the serious (bt RA) events of Myalgia, Malaise, Nausea, Headache and Pyrexia starting the day of the second dose of Spikevax and ending within 24 hours. Re-challenge is unkown as no information about dose 1 is reported. Events assessed as serious by RA; however, there is no information in the source documents supporting that the events were incapacitating or met any other serious criteria. Most recent FOLLOW-UP information incorporated above includes: On 28-Sep-2021: Translation received on 30-Sep-2021 contains narrative was updated.; Sender''s Comments: This case concerns a 12 year old male with no relevant history who experienced the serious (bt RA) events of Myalgia, Malaise, Nausea, Headache and Pyrexia starting the day of the second dose of Spikevax and ending within 24 hours. Re-challenge is unkown as no information about dose 1 is reported. Events assessed as serious by RA; however, there is no information in the source documents supporting that the events were incapacitating or met any other serious criteria.


VAERS ID: 1769299 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19 pneumonia, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (narrow), 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: Test Date: 20210914; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive; Test Date: 20210920; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive; Test Date: 20210923; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive; Test Date: 20210929; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive
CDC Split Type: ESJNJFOC20211010846

Write-up: VACCINATION FAILURE; COVID-19 PNEUMONIA; This spontaneous report received from a physician via Regulatory Authority (ES-AEMPS-1018566) on 06-OCT-2021 and concerned a 71 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XD955 and expiry: unknown) 0.5 ml, 1 total, administered on 06-MAY-2021 for covid-19 vaccination. The drug start period and last period was 129 days, duration of drug was 1 day. No concomitant medications were reported. On 11-SEP-2021, the patient experienced vaccination failure and covid-19 pneumonia. On an unspecified date patient was hospitalized. Number of days hospitalized and discharge information was not reported. On 14-SEP-2021, Laboratory data included: COVID-19 polymerase chain reaction (PCR) test (NR: not provided) Positive. On 20-SEP-2021, Laboratory data included: COVID-19 PCR test (NR: not provided) Positive. On 23-SEP-2021, Laboratory data included: COVID-19 PCR test (NR: not provided) Positive. On 29-SEP-2021, Laboratory data included: COVID-19 PCR test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccination failure and covid-19 pneumonia was not reported. This report was serious (Hospitalization Caused / Prolonged). This report was associated with product quality complaint.


VAERS ID: 1771363 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-11
   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 117298PFF / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Epilepsy, Malaise, Tonic convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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: ABILIFY; LAMICTAL
Current Illness: Epilepsy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEPFIZER INC202101267686

Write-up: 1.5 hours after vaccination - tonic epileptic seizure; 1.5 hours after vaccination - tonic epileptic seizure patient has epilepsy but only has a few seizures per year striking that a severe epileptic seizure followed after vaccination; Feeling unwell; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Authority-WEB BE-FAMHP-DHH-N2021-106723. Spontaneous COVID-19 report received by the authorities on 15Sep2021. A 12-year-old female patient received first dose of the bnt162b2 (Comirnaty, formulation: solution for injection, batch/lot number:117298PFF) via unknown route of administration on 11Sep2021 as single dose for COVID-19 immunisation. The patient medical history included ongoing epilepsy. The concomitant medication included aripiprazole (ABILIFY) and lamotrigine (LAMICTAL). On 11Sep2021, after 1.5 hours after vaccination, the patient experienced tonic epilepsy attack patient had epilepsy but only has a few seizures per year striking that after vaccination also a severe epilepsy attack followed may also be a coincidence and feeling unwell. The patient did not receive treatment for events. The outcome of the events were recovered on 11Sep2021. Health Authority Comment: Treatment - No Evolution of the ADR - Recovered ADR description- 1.5 hours after vaccination - tonic epilepsy attack patient has epilepsy but only has a few seizures per year striking that after vaccination also a severe epilepsy attack followed may also be a coincidence. No follow-up attempts possible. No further information was expected.


VAERS ID: 1775788 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Influenza like illness, Lethargy, Malaise, Nasopharyngitis, Oropharyngeal pain, Pain in extremity, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta
Current Illness: No
Preexisting Conditions: Slight Asthma when she has cold or flu
Allergies: Ceclor,wheat
Diagnostic Lab Data: Rang dr at hospital and covid call centre in which we were told to take panadol
CDC Split Type:

Write-up: The same day she had vaccine she had sore arm chills, fever ,diarrhea and vomiting which still continues today on and off severe headaches ,lethargic cold and flu symptoms sore throat ,feeling unwell most of the time its knocked her about .


VAERS ID: 1777158 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, C-reactive protein, Cardiovascular disorder, Chest pain, Cough, Decubitus ulcer, Dysphagia, Echocardiogram, Electrocardiogram, Fatigue, Malaise, Nasal congestion, Pericarditis, Respiratory disorder, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210918; Test Name: Blood biology; Result Unstructured Data: Test Result:moderate inflammatory syndrome (90); Test Name: C-reactive protein; Test Result: 99 mg/dl; Test Date: 20210920; Test Name: Cardiac echo; Result Unstructured Data: Test Result:Normal; Test Date: 20210918; Test Name: ECG; Result Unstructured Data: Test Result:Normal
CDC Split Type: BEPFIZER INC202101272720

Write-up: Respiratory disorder; Swallowing difficult; Cardiovascular disorder; Nose congestion; Dry cough; Thoracic pain; Pericarditis; Polypnea; Malaise; fatigue; decubitus; This is a spontaneous report from a contactable physician downloaded from the , regulatory authority number BE-FAMHP-DHH-N2021-106898. A 13-year-old female patient received BNT162B2 (COMIRNATY; lot/batch number and expiration date not reported) via an unspecified route of administration on 11Sep2021 (at the age of 13-year-old) as dose 2, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 11Sep2021, the patient experienced pericarditis, cardiovascular disorder, thoracic pain, respiratory disorder, dry cough, polypnea, nose congestion, swallowing difficult and malaise. Symptomatology appeared on 16Sep2021 consisting of difficulty swallowing, nasal congestion, dry cough, fatigue, superficial polypnoea, chest pain increased on decubitus electrocardiography on 18Sep normal, Blood biology on 18Sep showing a moderate inflammatory syndrome (90), Cardiac echo on 20Sep normal. Confirmed diagnosis: Pericarditis. The patient was hospitalized due to the events. Reporter comment: Treatment: Aspegic 1g 3 times a day. Evolution of the ADR: In the process of improvement. Outcome of the events was recovering. Reporter comment: Treatment: Aspegic 1g 3 times a day Evolution of the ADR: In the process of improvement Examinations: Normal electrocardiogram, Blood biology: moderate inflammatory syndrome (99mg/dL C-reactive protein), Normal cardiac ultrasound. The lot number for BNT162B2, was not provided and will be requested during follow up.; Reporter''s Comments: Aspegic 1g 3 times a day Evolution of the ADR: In the process of improvement Examinations: - Normal electrocardiogram. - Blood biology: moderate inflammatory syndrome (99mg/dL C-reactive protein) - Normal cardiac ultrasound


VAERS ID: 1778336 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-06
Onset:2021-09-11
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG4493 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Maternal exposure timing unspecified, Pain, Renal colic
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: ITPFIZER INC202101279029

Write-up: Severe pains with renal colic; Severe pains with renal colic; exposure during pregnancy; This is a spontaneous report from a contactable consumer downloaded from the regulatory authority-WEB, regulatory authority number IT-MINISAL02-791059. This consumer reported information for both mother and fetus/baby. A 18-years-old pregnant female patient received second dose of BNT162B2 (COMIRNATY, solution for injection; Batch/Lot Number: FG4493; Expiration Date: 30Nov2021), via an unspecified route of administration, administered in Arm Left on 06Aug2021 11:22 as DOSE 2, SINGLE for covid-19 immunisation. Patient was pregnant at the time of vaccination. The patient medical history and concomitant medications were not reported. The patient experienced severe pains with renal colic on 11Sep2021, exposure during pregnancy on an unspecified date. The patient was hospitialised. Impact on quality of life (10/10). The clinical outcome of the events was not recovered for severe pains with renal colic and unknown for exposure during pregnancy. No follow-up attempts are possible. No further information was expected.; Reporter''s Comments:


VAERS ID: 1780327 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Blood test, Dyspnoea, Thyroid function test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No meds
Current Illness: Blocked nose, headache
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Thyroid test, blood test.
CDC Split Type:

Write-up: Shortness of breath, weakness the whole body.


VAERS ID: 1787219 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210911; Test Name: SARS-CoV-2 test; Result Unstructured Data: Positive Iu international unit(s)
CDC Split Type: PTJNJFOC20211023594

Write-up: VACCINATION FAILURE; This spontaneous report received from a consumer via a Regulatory Authority (regulatory authority, PT-INFARMED-T202109-2203) on 12-OCT-2021 and concerned a 45 year old male. The patient''s weight was 110 kilograms, and height was 195 centimeters. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number was not reported) 0.5 ml,1 total administered on 03-JUL-2021 for covid-19 immunisation. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 11-SEP-2021, the patient experienced vaccination failure. Laboratory data included: SARS-CoV-2 test (NR: not provided) Positive Iu international unit (s). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from vaccination failure. This report was serious (Other Medically Important Condition). The case is associated with Product quality complaint.


VAERS ID: 1688874 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-24
Onset:2021-09-10
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Ear discomfort, Nasal congestion, Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Ringing in ears, nasal pressure and congestion, pressure in ears


VAERS ID: 1688904 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
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: 6 weeks as of 9/10/2021
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Employee received the Pfizer vaccine dose #1 on 09/09 at the campus vaccine event. The injection was in the left upper arm in deltoid. Started have symptoms after vaccination (09/10): Sore and redness at injection site and warm to touch, half dollars size knot on arm on side of injection site. She is 6 weeks pregnant as of 09/10/2021. Advise to call back if symptoms worsen as follow up call, contact PCP/OBGYN follow up if needed. As well to put cold compress on site and take ibuprofen or Tylenol, which one she is comfortable with taking due to her pregnancy.


VAERS ID: 1688906 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (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: none
CDC Split Type:

Write-up: Zoster diagnosed in office on 09/10/2021 treated with valaycyclovir


VAERS ID: 1688923 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 3 RA / IM

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

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

Write-up: Client''s initial 2 doses in series were Moderna. Pfizer administered in error. No history of anaphylactic type reactions in the past.


VAERS ID: 1688959 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 4 AR / IM

Administered by: Public       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: UNKNOWN
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: UNKNOWN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT RECEIVED A 4TH DOSE OF PFIZER. PATIENT WAS NOT TRUTHFUL TO STAFF AND STATED HE HAD ONLY HAD ONE DOSE AND HE PRESENTED HIS VACCINATION CARD WHICH SHOWED ONLY ONE DOSE WAS GIVEN.


VAERS ID: 1688987 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Disorientation, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: PATIENT FELT LIGHTHEADED AND THEN FAINTED. WOKE UP, SEEMED DISORIENTED, CLAMMY. CALLED EMS WHO CHECKED HER BLOOD PRESSURE, BLOOD SUGAR, TEMPERATURE, AND PULSE. PATIENT REFUSED ANY OTHER SERVICE FROM EMS. LEFT AFTER ABOUT 30 MINUTES


VAERS ID: 1688989 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C1A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Needle 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: Vaccine spilled during administration. Vaccine had to be given again to patient on the same day.


VAERS ID: 1688994 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Sharp chest pains 16 hours after receiving vaccine


VAERS ID: 1689004 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: First dose Pfizer given at 0945, At 1000, starting c/o itching and rash on forearms. 25mg PO Benadryl given. Continued to be observed. At 1020 stated felt better.


VAERS ID: 1689015 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / -

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

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

Write-up: Patient was nervous about receiving vaccine due to knowing it will cause a sore arm. She wanted to use the restroom after getting the shot. She walked with mom down aisle 16 to go towards the restroom when she felt faint and mom was able to catch her. They both stated that she did not hit her head at all. Mom came and got our attention and I, pharmacist, ran to help. She was laying on the floor when I got to her and she was awake. She said she could hear and see perfectly fine. When she felt better, we got her up and walked to a chair outside of the pharmacy. We got her an orange juice to drink. She stated a few minutes later that she was feeling faint again. Mom and I got her to lay down on our bench. She was feeling better and her color returned about 10 minutes after that.


VAERS ID: 1689024 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: non
Diagnostic Lab Data: I have not seen a doctor yet and hope that that it will go away in a week or so like it did after the first dose.
CDC Split Type:

Write-up: I''m experiencing Tinnitus which I have never had before. I did not think anything of it after the first dose. Received the second dose on 9-9-21 and it has returned. It is acute in the right ear. There appears to be a correlation as I have never experienced this in my life and both bouts came on after the vaccine.


VAERS ID: 1689052 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-05
Onset:2021-09-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril one 10 MG tablet a day
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I had a rash/hive break out all over body. It started the day after second vaccination shot and continues today(5 days later) I have consulted with doctor as to what his recommendations were. I am taking antihistamines orally and applying a Benadryl cream topically. I get relief from symptoms for about 8-10 hours then it reoccurs. I have photographs if I am able to upload them to you as needed.


VAERS ID: 1689063 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Blood pressure decreased, Chest pain, Cough
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: First Moderna shot similar symptoms
Other Medications: none
Current Illness: none
Preexisting Conditions: Lyme Disease/ COVID -19 infection April 22,2020 with known antibodies by blood test
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I began having extreme shooting pain in my joints and chest to the point where I was concerned I was having a cardiac event. I could not climb my stairs without my blood pressure dropping requiring me to sit before I could even reach the top. I am in very good shape. This is my second shot and while I had similar symptoms last month, it was more profound with the second vaccine. I have been coughing ever since I got the first shot, which I was not doing prior to the shot. The coughing is so exacerbated now that I cannot even finish a simple sentence without coughing.


VAERS ID: 1689136 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Stomach pain, severe diarrhea


VAERS ID: 1689142 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / -

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

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

Write-up: first dose was moderna, second shot was pfizer


VAERS ID: 1689144 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Dyspnoea, Throat irritation, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MMR Vaccine in 2019 ER visit
Other Medications: Albuterol inhaler, MVI, Claritin
Current Illness: n/a
Preexisting Conditions: asthma
Allergies: bees, IVP dye, shellfish, tramadol, toradol
Diagnostic Lab Data:
CDC Split Type:

Write-up: wheezing, SOB, cough, scratchy throat benadryl 50 mg po at 10:28am VS obtained 10:38 am 204/130, HR 100, SpO2 98% 10:48 am 204/112, HR 86, SpO2 96% 10:55 am 170/98 and advised to go to stat care or ER for BP only. Breathing issues resolved at time of last VS obtained. Pt drove by husband.


VAERS ID: 1689164 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Hyperhidrosis, Pallor, Presyncope, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: as a child, fainted
Other Medications: NA
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: About 5 minutes after receiving the vaccine, the patient fell out of his chair in the waiting room. Vaso-vagal reaction. pt was pale, sweaty and clammy, shaking after he passed out, did not know where he was when he woke up. Was out for approximately 30 seconds. EMS arrived to check vitals which were normal and he was released.


VAERS ID: 1689176 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carafate, Macrobid, Dulera, Robaxin, Mobic, Atarax, Gabapentin, Lidex, Albuterol inhaler, Bentyl
Current Illness:
Preexisting Conditions: Allergies
Allergies: Dogs, Grass, Iodine dye, Nickel, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her first Covid Pfizer vaccine in our facility today. Due to allergy HX patient was instructed to wait for 30 mins in observation. Patient received vaccine at 10:48am at 11:18am patient complained of itchy throat and presented with a cough. Provider was notified immediately and ordered for the patient to receive 25 mg of Benadryl IM. After administration of Benadryl patient was observed for another15 mins. Patient reported feeling ok with no itchiness or cough present. Patient educated and given literature of what to expect after vaccination and instructed to call 911 or report to nearest ER immediately if any severe reactions are displayed. Patient discharged to home accompanied by her husband.


VAERS ID: 1689179 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 LA / IM

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

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

Write-up: PT WAS SUPPOSED TO RECEIVE MODERNA 3RD DOSE BUT BY ACCIDENT RECEIVED PFIZER FOR THE 3RD DOSE. NURSE PICKED UP THE WRONG BRAND OF VACCINE AS THERE WERE 2 CIRCULATING LOT NUMBERS AND VACCINE BRANDS FOR THE VACCINE CLINIC FOR THAT EVENT.


VAERS ID: 1689201 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Injection site warmth, Movement disorder, Pain in extremity
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (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: Moderna (COVID-19, mRNA, LNP-S, PF, 100 mcg/0.5 mL dose on 3/1/2021 - dose #2 LOT #016M20A
Other Medications: Ciprofloxacin HCl Solution 0.3 %;Vitamin C Tablet 250 MG (Ascorbic Acid);Magnesium Oxide Tablet 400 MG;Vitamin D3 Tablet 25 MCG (1000 UT) (Cholecalciferol);Multiple Vitamins-Minerals Tablet;Lactulose Solution 10 GM/15ML,Midodrine HCl Tablet
Current Illness: none
Preexisting Conditions: COPD, CKD stg3, Atrial Fibrillation, neuropathy, CHF, PVD
Allergies: Ceftin, Shell Fish
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Resident is weak and unable to get out of bed and resident is up everyday by 0800. Her R arm is sore and warm to touch at the injection site in comparison to the rest of her arm.


VAERS ID: 1689221 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 6 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol 108 (90 Base) MCG/ACT inhaler Inhale 2 puffs into the lungs every 4 hours as needed for Shortness of Breath or Wheezing. cetirizine (ZyrTEC Allergy) 10 MG tablet Take 1 tablet by mouth daily. tiZANidine (ZANAFLEX) 4 MG tablet Take
Current Illness: none known
Preexisting Conditions: BMI $g 40
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient c/o dizziness at 10:45 Patient was noted to be hypertensive 168/101, VS monitored for an additional 15 minutes with improvement in BP 136/84 patient without further symptom development, released to home at 11:10


VAERS ID: 1689234 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, ibuprofen, omeprazole
Current Illness:
Preexisting Conditions: ADHD, Depression
Allergies: Darvocet, Morphine, Percocet, and Vicodin all with reported anaphylaxis reactions
Diagnostic Lab Data: Urinalysis was negative
CDC Split Type:

Write-up: Patient presented to the Emergency Department at our facility with approximately 4 hours of vomiting and nausea after receiving the second vaccination for Covid yesterday. She was monitored and treated with Phenergan, Toradol, and Benadryl prior to discharge back home.


VAERS ID: 1689237 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dysphagia, Fatigue, Lip pruritus, Pruritus, Syncope, Tongue pruritus
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown - Reports taking a medication for BP but doesn''t know what the name is.
Current Illness: None
Preexisting Conditions: Unknown
Allergies: None: Reports that she had previous anaphylaxis reaction to medication in past but doesn''t know what it was.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx. 15min. after injection (08:45 am) client started complaining of trouble swallowing, tongue, lips and cheeks itching. Complained of extreme fatigue, and syncope. Approx. (9:03am) Obtained vital signs. Still complaining of worsening symptoms about 2 min. later. Called 911, administered 0.5mg Epi, IM to Rt. Deltoid, 50mg Benadryl to Rt Deltoid. Ambulance arrived approx 5 min later, client was transported to hospital via ambulance at approx. (09:16 am). She was alert and oriented, verbal when transported.


VAERS ID: 1689317 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-05
Onset:2021-09-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: swelling of the right cheek and the lips


VAERS ID: 1689336 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Paramedics reported BP 60/40, blood glucose 97.
CDC Split Type:

Write-up: About 2 minutes after vaccination, patient started feeling unwell and was given alcohol to smell. About 5 minutes after vaccination, patient fainted for about 40 seconds. She did not have any other symptoms during or after fainting. 911 was called and they took her to the hospital.


VAERS ID: 1689388 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Feeling drunk, Taste disorder
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: fish oil,multi vitamin ,vitamin D Estevan Miralax
Current Illness: no
Preexisting Conditions: no
Allergies: wheat ,whey diary, artemisinin
Diagnostic Lab Data: no
CDC Split Type:

Write-up: 15 min after shot started feeling dizzy and drunk. Blood pressure was elevated . Had to call rapid response team. Taste buds are off . Keeps tasting Tuna Fish


VAERS ID: 1689400 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Disorientation, Dizziness, Flushing, Hypoaesthesia, Pruritus, Thirst
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: When patient stood up to leave, became disoriented, dizzy, numbness in face and right arm, flushing to face. Shortly after sitting back down complained of itching to face and excessive thirst. Vitals assessed every 5 minutes. Cool compress applied to back of neck. Benedryl 50 mg PO liquid given. Patient began to feel better. Observed for 30 minutes. Patient was awake, alert and oriented x 4 upon walking out on his own without assistance. States he will follow up with a private doctor. Stated "I feel normal now" before leaving.


VAERS ID: 1689404 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 LA / IM

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

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

Write-up: Patient came in for a 2nd dose vaccination and did not have his vaccination card. He was given Pfizer for his 2nd dose and after receiving the vaccine indicated he had received Moderna for his first dose.


VAERS ID: 1689424 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA 81MG, LASIX 20MG, TOPROL XL 25MG, OXYBUTYNIN ER 5MG, PROTONIX 20MG, TOPAMAX 100MG, METFORMIN ER 500MG
Current Illness:
Preexisting Conditions: DIABETES (DIABETIC SEIZURES PER SISTER)
Allergies: NONE (PER SYSTEM)
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT HAD SEIZURE ABOUT 10MIN AFTER RECEIVING VACCINE WHILE SITTING IN THE WAITING ROOM


VAERS ID: 1689426 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: tongue numbness, treated with benadryl 50mg IM x1. Tolerated well, VSS


VAERS ID: 1689432 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Disorientation, Eye pain, Fatigue, Headache, Nausea, Visual field defect
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal 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: Protonix
Current Illness: N/A
Preexisting Conditions: GERD, Back Pain
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Severe headache, fatigue, nausea, disorientation and loss of visual field on the right side. Started the morning of September 10th, most resolved by the afternoon except for the headache and fatigue. The headache began as a severe pain behind my left eye and has since transferred to my entire head.


VAERS ID: 1689439 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

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

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

Write-up: Patient was given a Pfizer vaccine for 2nd dose when Moderna was given as first dose. As per CDC and Moderna manufacturer guidance, additional dose not indicated.


VAERS ID: 1689444 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 - / IM

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

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

Write-up: Iowa Department of Health called today 9/10 - to notify us that on March 24th, 2021 patient had received a dose of the Johnson and Johnson Covid shot.


VAERS ID: 1689470 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Blood pressure increased, Chills, Dizziness, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (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:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Developed severe headache about 5 min after administration. Then described development of dizziness and mild nausea. Given water to drink. BP taken and 106 SBP. Given ice pack for back of neck. Laid patient on exam table. BP increased to 149 SBP and patient developed shaking chills. Capillary glucose 126. Evaluated by physician at facility. No urgent need for ED evaluation. Patient continued to rest and symptoms improved; BP decreased to WNL. Mom took patient home for rest. Called mom several hours later. Patient resting comfortably. Symptoms improved.


VAERS ID: 1689471 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Hyperhidrosis, Malaise, Nausea, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Allergy to penicillin, reaction unknown. 30 minute observation. OC, NP. While resting in Obs pt c/o of nausea and feeling sick, diaphoretic and sent to med eval #2 for further evaluation. C/o of HA since this am Hx of HA. Lying down, fluids offered. Ice pack and cold water declined. Resting. Pt dry heaving and vomited his entire breakfast approx. 1liter yellow fluid. Denies any further HA or nausea, feeling much better after taking po fluids, declines electrolyte water. Pt fianc? works in mall and feels better will stop by to visit her. Discussed further symptoms persist contact PMD, rest, fluids Reviewed next dose and to have clear liquids prior to vaccine and drink plenty of water. Verbalized understanding. Discharged ambulatory at 1435.


VAERS ID: 1689480 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Public       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: None reported.
Current Illness: None reported.
Preexisting Conditions: None reported.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient denied that she had received a COVID 19 vaccination. Patient had 2 previous vaccinations with Moderna.


VAERS ID: 1689490 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Headaches and upset stomach/stomach pains.
Other Medications: Zoloft, Claritin, Allegra, Prilosec, Norethindrone Acetate. Vistiril (PRN).
Current Illness: None
Preexisting Conditions: Endometriosis
Allergies: Seasonal allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever 102, chills/shakes, nauseous stomach, headache and severe body aches. Subside with Tylenol but they come back.


VAERS ID: 1689493 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine, had flu-like symptoms, swollen kidneys. No other info available.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Light headedness


VAERS ID: 1689501 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphonia, Oropharyngeal discomfort
SMQs:, Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: approximately 15 minutes following administration of vaccine patient notice throat " feeling funny" and her voice was raspy sounding. Neither symptoms was present prior to receiving the vaccine. Patient was examined by physician, put on continuous SpO2 monitor and directly observed by an RN for 30 minutes. Patient was also given Diphenhydramine 50 mg orally. No additional symptoms developed. Patietn was bale to be discharged to home with instructions to monitor symptoms and report to clinic as needed.


VAERS ID: 1689573 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant 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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: ASTHMA
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was pale and sweating a few minutes following administration of the vaccine. After having water and staying seated for a few minutes, the symptoms reversed and patient stated feeling better.


VAERS ID: 1689577 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia oral, Swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril 20mg
Current Illness: unknown
Preexisting Conditions: n/a
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: approximately 30 min after vaccination, patient reported burning sensation down their throat with possible redness, swelling, and numbness around their mouth, benadryl was administered and patient was seen at urgent care


VAERS ID: 1689581 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private       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: ADDERALL XR, ADVAIR, ATENOLOL, CLONAZEPAM, CLONIDINE, B12, ESTRADIOL, FLUOXETINE, HYDROCODONE, LEVOTHYROXINE, LITHIUM, LURASIDONE, METOPROLOL, OMEPRAZOLE, QUETIAPINE, RESTASIS, ROPINIROLE, SPIRIVA, TOPIRAMATE, TRAMADOL
Current Illness: NONE
Preexisting Conditions: anxiety F41.9 Anxiety disorder, unspecified attention deficit hyperactivity disorder, predominantly inattentive type F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type backache M54.9 Dorsalgia, unspecified candidiasis B37.9 Candidiasis, unspecified chronic obstructive lung disease J44.9 Chronic obstructive pulmonary disease, unspecified chronic pain syndrome G89.4 Chronic pain syndrome cobalamin deficiency fever fracture of fibula headache hypertensive disorder I10 Essential (primary) hypertension hypertriglyceridemia E78.1 Pure hyperglyceridemia hypokalemia hypothyroidism E03.9 Hypothyroidism, unspecified low back pain M54.5 Low back pain nausea and vomiting obstructive sleep apnea syndrome G47.33 Obstructive sleep apnea (adult) (pediatric) pneumonia primary fibromyalgia syndrome M79.7 Fibromyalgia restless legs G25.81 Restless legs syndrome sprain of knee strain of muscle at thorax level strain of neck muscle tachycardia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: RECEIVED JANSSEN VACCINE TODAY. DURING POST ADMINISTRATION DOCUMENTATION, DETERMINED THAT PATIENT HAD PREVIOUSLY BEEN VACCINATED WITH MODERNA VACCINE- 2 DOSES, LAST IN 4/2021


VAERS ID: 1689589 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Heart rate decreased, Hyperhidrosis, Hypotension, Loss of consciousness, Pallor
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), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: had illness about a week before with similar symptoms as Covid but tested negative for covid
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Customer sat down in waiting area and then passed out and fell on the floor. He quickly regained consciousness and was pale and sweating with low blood pressure and heart rate. Paramedics evaluated him and he refused to go to the hospital. His blood pressure returned to normal.


VAERS ID: 1689596 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood glucose increased, Inappropriate schedule of product administration
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), 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: DONEPEZIL, INSULIN LISPRO, KEPPRA, LOSARTAN, MEMANTINE, MIDODRINE, METOPROLOL. NEPHROVITE, SINVASTATIN
Current Illness: ACUTE KIDNEY DISEASE, SEIZURES,
Preexisting Conditions: HYPERTENSION, HYPERLIPIDEMIA,
Allergies: ADHESIVE TAPE
Diagnostic Lab Data: INCREASED BLOOD GLUCOSE LEVELS - GAVE INSULIN - IT CAME DOWN
CDC Split Type:

Write-up: PATIENT RECEIVED FIRST DOSE ON 08-19-21 AND SECOND DOSE ON 09-09-21 (21 DAYS APART)


VAERS ID: 1689604 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FDO809 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immunodeficiency, 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: ASPIRIN 81 MG, HYDRALAZINE 25 MG, METOPROLOL 25 MG, NAPROXEN 250 MG, OMEPRAZOLE 20 MG, PRVASTATIN 40 MG, TERAZOSIN 10 MG, TERAZOSIN 10 MG
Current Illness: HTN CANCER
Preexisting Conditions: HTN CANCER
Allergies: PEANUTS
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt. was given the Pfizer vaccine as a 3rd dose booster, and his 1st two vaccines were Moderna.


VAERS ID: 1689611 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: RIGHT AFTER GIVING THE FIRST DOSE OF MODERNA (LOT 052E21A), PATIENT FELT LIGHT-HEADED AND BECOME PALE. PATIENT FAINTED AND WAS UNCONSCIOUS FOR 1 MINUTE. 9-1-1 WAS CALLED AND AMBULANCE ARRIVED. HE REGAINED CONSCIOUS AND SAID HE WAS FINE BUT STILL FEEL LIGHT-HEADED. AMBULANCE TOOK HIM TO THE HOSPITAL FOR FULL CHECK UP. PATIENT CALLED 2 HOURS LATER TO REPORT THAT HE IS DOING FINE NOW. HE DID MENTIONED THAT HE DIDN''T EAT OR DRINK ANYTHING IN THE MORNING PRIOR TO COMING FOR THE VACCINE.


VAERS ID: 1689623 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 036C21A / 1 RA / IM

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

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

Write-up: Patient had Covid vaccine this am, with no problems noted during his 15 min observation post vaccine. Patient returned to Employee Health approximately 4.5 hrs following vaccine stating he has had a "tingling feeling " in his chest for the past few hrs. Tingling has not changed in intensity. Patient does not have dyspnea or lightheadedness. Patient escorted to ED for evaluation.


VAERS ID: 1689636 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Heart rate increased, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad)

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

Write-up: Pt presented to the COVID-19 Vaccination Clinic to get the vaccine. He went to the bathroom afterwards and threw up. Then sat down and got a medics attention. He was complaining of nausea with a rapid pulse. We brought him to the ER and handed him off to the ER RN.


VAERS ID: 1689653 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Diarrhoea, Headache, Nausea, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight sore throat at the time of the vaccine. Nothing in the month leading up to vaccine.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is experiencing sore throat, cough, nausea, diarrhea, and headache. Patient will be treated with acetaminophen, ondasetron, and Imodium.


VAERS ID: 1689676 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

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

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

Write-up: Patient complained of left facial itching. Swelling and Hives noted. Patient was transferred to ICC for immediate assessment and treatment by Dr. Benadryl IM given to patient and she was discharged home accompanied by family. Patient to follow up with her MD. Patient instructed to go to the ER if condition worsens.


VAERS ID: 1689680 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / UNK - / IM

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Feeling abnormal, Injection site hypoaesthesia, Injection site paraesthesia, Pain in extremity
SMQs:, Dementia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: L Arm is numb and tingly from injection site (L deltoid) down into finger tips. Pain in elbow/hand/fingers. "Just feels weird"


VAERS ID: 1689684 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Unknown  
Location: Puerto Rico  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Female patient 66 year old refers feeling anxious before, during and after the vaccine. We take her vitals BP 170/110, P 63, SPO2 98%, Patient refers suffering form BPH and not having taken her prescribed medication for her condition. Dr. is consulted and indicates to keep patient in observation for 30 minutes and vitals reassessed. 30 min later vitals are taken BP 145/90, SPO2 99%, P 61 and patient not feeling anxious and feels better now. Patient walks away.


VAERS ID: 1689686 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Condition aggravated, Extra dose administered, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Lymphadenopathy, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (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? No
Hospitalized? No
Previous Vaccinations: As described in previous page, I had a very similar reaction on January 6th, 2021 which was one day after my second Pfizer COVID
Other Medications: Nortriptyline, Buspirone, Spironolactone, Ketoconazole (shampoo), Vyvanse, Omeprazole, Vitamins D3 and B12, Pre/probiotic (Florastor), Linzess, Botox (for migraines, once per 12 weeks), Xulane (birth control patch)
Current Illness: none
Preexisting Conditions: postural orthostatic tachycardia syndrome, androgenic alopecia, IBS
Allergies: Allergic to sulfa drugs
Diagnostic Lab Data: When I got my second dose on January 5th, 2021, I had the exact same reaction. I reported it to VAERS and the FDA tried to contact me, but they kept losing the paper packet I was sending them with all the information. In January, I had a red, swollen injection site about 1 day after the injection and then the same shooting pain that could be slightly reduced with a heating pad and Advil. However, 3 days after my injection in January, I became really sick. Looking back, I''ve talked to doctors (informally) who agree that most likely the sickness was not directly caused by the vaccine, but rather that my immune system was weakened and I caught a stomach bug that was a little worse than it would have been otherwise. Back in January, 3 days after my vaccine, I started vomiting and having diarrhea. This continued for at least 12 hours, once or twice an hour, until there was nothing left in my body to get out. I kept dry-heaving for a few hours after that. I felt really weak and could not stand or walk without feeling dangerously dizzy and lightheaded. I could not eat any food for a total of 48 hours without throwing it up or having diarrhea. I was able to keep water down in small sips to keep from getting dehydrated. After about 48 hours, I was able to keep down small bits of food and started to regain my strength. I fully recovered from that incident.
CDC Split Type:

Write-up: About 16 hours after the injection in my upper left arm, I woke up with soreness and pain at the injection site. It was not bad at first, but as the day has gone on, it has gotten worse. The injection site is now red and swollen as a bump approximately 3/4ths inch in diameter and is hot to the touch. My entire arm hurts with shooting pains from my armpit down to my fingertips. I believe my lymph nodes in my left armpit are swollen because when I put a heating pad in there, the pain lessens a bit. I also took 1 Advil when I first noticed the pain at 6 AM and 1 more Advil at 4 PM. It helped a bit with the pain this morning.


VAERS ID: 1689687 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / N/A LA / IM

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

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

Write-up: NONE


VAERS ID: 1689696 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-01
Onset:2021-09-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 UN / IM

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

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

Write-up: pew0178atient late for the second dose


VAERS ID: 1689700 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 UN / IM

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

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

Write-up: PATIENT OVER 42 DAYS FOR SECOND DOSE OF PFIZER VACCINE


VAERS ID: 1689701 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Blood glucose normal, Dizziness, Dry mouth, Muscle spasms, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Male patient, after the first dose of the pfizer vaccine reports feeling dizzy, dry mouth, tremors and cramping. Patient is anxious. Vital signs B/P 120/90, P63, Dextro 85, SPO2 99% are taken. Dr. is consulted which indicates that it is left in observation for 30 min and "gatorade" is provided. At 30 min vital B/P 120/62, SPO2 100%, P 73, PATIENT REPORTS FEELING BETTER AND NOT HAVING CRAMPS OR TREMORS. Patient proceeds to withdraw from the vaccination center under his own.


VAERS ID: 1689704 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: pt passed out after complaining of feeling vax streaming through her body. she was out for approx 15 seconds, then popped back to conciousness. paramedics responded, but patient did not go to hospital and was picked up by a friend


VAERS ID: 1689708 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 UN / IM

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

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

Write-up: OVER 42 DAYS FROM FIRST DOSE OF PFIZER COVID VACCINE


VAERS ID: 1689710 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK - / -

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

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

Write-up: lightheaded, dizzy


VAERS ID: 1689719 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-08-19
Onset:2021-09-10
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea
SMQs:, Fertility disorders (broad)

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

Write-up: Absence of menstruation


VAERS ID: 1689720 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Unknown  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

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

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

Write-up: Patient described experiencing itchiness in both forearms beginning 17 min post-vaccination (visibly red from patient scratching, no hives present); symptoms resolved after approximately 10 minutes.


VAERS ID: 1689762 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Nausea, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt reportedly received 2nd dose of Pfizer and shortly after reported diffuse itching, rash, nausea. Pt received IM epinephrine, pepcid, prednisone and Benadryl. She had improvement of symptoms after treatment and received additional dose of hydroxyzine for residual itching.


VAERS ID: 1689764 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 LA / IM

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

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

Write-up: Patient had his 2nd dose 3 days early


VAERS ID: 1689772 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Electrocardiogram, Feeling abnormal, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin-D, Voltaren, Celexa, Losartan, Ventolin, Flonase, Nicorette.
Current Illness: High serum estradiol, seasonal allergies dermatitis.
Preexisting Conditions: HTN, HLD, Tachycardia, OCD, Anxiety,
Allergies: Sulfa, PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was given second dose in COVID vaccine series, she proceeded to lab to have routine lab testing done, she was stuck twice, after second stick lab staff noted patient was pale, diaphoretic & states she "felt funny". They notified nursing staff & provider. Vitals were obtained, as well as EKG, FSBS. Pt stated she had not eaten today and it was 4pm, encouraged PO fluids. Pts initial BP 74/43, o2 Sat 100%, FSBS 108, BP after a few minutes was 102/92, EKG obtained & read by provider. patient''s color returned and she stated she felt better. Pt was observed in clinic for approx. 45minutes,pt was able to leave clinic ambulatory after event.


VAERS ID: 1689776 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 025C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None listed at this time
Current Illness: none
Preexisting Conditions: not listed
Allergies: No
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Moderna COVID Vaccine given on 8/13/2021, due to data entry error, we gave Pfizer Vaccine for second shot on 9/10/2021. Patient did not have vaccine card with her. Pharmacist reported to physician and is waiting for response. Patient noticed the discrepancy when she returned home and looked at her card. Pharmacist will follow up with patient next week. No side effects noted as of yet.


VAERS ID: 1689784 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / IM

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

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

Write-up: PATIENT RECEIVED MODERNA AT OUR FACILITY AS HER FIRST DOSE ON 8/13/21. BUT WHEN PATIENT CAME FOR HER SECOND VACCINE SHE FORGOT TO BRING HER CARD AND HAD A PICTURE ON THE PHONE OF HER VACCINATION CARD. BY MISTAKE THE PERSON WHO RECREATED HER PHYSICAL CARD WROTE PFIZER AS HER FIRST AND SECOND SHOT. THE PATIENT RECIEVED PFIZER AS HER SECOND SHOT AS A RESULT. NO COMPLICATIONS OR SIDE EFFECTS WERE OBSERVED.


VAERS ID: 1689790 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient experienced syncope about 15 minutes post vaccination no other injuries were sustained. Squad was called and they came to check out patient and bring her to hospital if needed. Patient had no other negative outcomes that were made known to pharmacy staff.


VAERS ID: 1689791 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358BA / 2 LA / IM

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

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

Write-up: The Pharmacist gave the injection then when we went to bill the vaccine we noticed that the patient should have received the vaccine on Monday, Sept 13th, not today, Sept 10th. The patient received the 1st dose on 8/23/21 and I wrote down 9/10/21 on the back of the card for the return trip. I didn''t catch it at the time of vaccination...totally my fault. The patient was notified of the error and was experiencing no symptoms when she left the store


VAERS ID: 1689793 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A201A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

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

Write-up: Anaphylaxis


VAERS ID: 1689794 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Flushing, Heart rate increased
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, B12 shots, Vit C, Stool softner/laxative, excedrin migraine
Current Illness: None
Preexisting Conditions: Fibromyalgia, Chronic fatigue syndrome, anemia
Allergies: Red dye, coconut oil
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within minute patient reports difficulty breathing, flushed, pulse rate elevated. One dose epinephrine 0.3mg given in left thigh via pen, 911 was called, nurse at next door clinic reported events to 911, while we both monitored patient . Pt was laid down and feet elevated. Breathing symptoms improved, no 2nd dose of epi was advised . Ambulance was going to be some time therefore, fire dept emt was sent. Evaluated pt and fire dept determined no other intervention needed.


VAERS ID: 1689796 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

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

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

Write-up: PT HAS HISTORY OF FAINTING AFTER RECEIVING VACCINES. HE WAS ADVISED TO WAIT FOR 30 MINUTES PRIOR TO LEAVING AFTER RECEIVING THE SHOT. ABOUT 5 MINUTES AFTER ADMINISTRATION, THE PATIENT LOST CONSCIOUSNESS. HE WAS LAID DOWN, ICE PACKS ON NECK AND HEAD AND ADVISED TO WAIT. HE RECOVERED AND HAD NO OTHER ISSUES.


VAERS ID: 1689814 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-24
Onset:2021-09-10
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized due to breakthrough COVID case


VAERS ID: 1689816 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 1808980 / UNK - / IM

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

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

Write-up: PATIENT HAD BEEN VACCINATED WITH PFIZER VACCINE IN APRIL 2021. PATIENT DID NOT DIVULGE INFORMATION AND RECEIVED JANSSEN VACCINE. WHEN ENTERING INFORMATION IN TO IT WAS SHOWN THAT SHE HAD BEEN VACCINATED WITH PFIZER. PATIENT THEN ADMITS SHE WAS VACCINATED WITH PFIZER PREVIOUSLY AND HAD WANTED JANSSEN THEREFORE SHE ASKED FOR IT. PATIENT INFORMED THIS WILL BE REPORTED FOR SAFETY PURPOSES.


VAERS ID: 1689818 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, dosage unknown Tizanidine, dosage unknown
Current Illness: None
Preexisting Conditions: Multiple Sclerosis, Hypertension
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client received the 1st COVID vaccine (Janssen, lot #206A21A and expiration 09/21/21) at 1355 in the R arm. At approximately 1430 client reported feeling slightly lightheaded to RN offered transfer to zero gravity chair but client stated he preferred to stay in his assistive chair device that allowed him to lay back. Client laid back in his chair. RN provided water and client took sips. Client''s family member provided client with personal juice. Client took sips of juice. Client was warm and dry to touch. Client reported he ate a "full lunch" approximately 30 minutes prior to receiving the vaccine. At 1440 client reported lightheadedness was resolving but stated he had "some tingling" in his left hand that "felt a little funny". Client reported he has experienced this feeling of tingling in the extremities before which has been attributed to his diagnosis of MS. Client has significant medical history of Multiple Sclerosis and Hypertension. Clients current medications include Amlodipine (dosage unknown) and Tizanidine (dosage unknown). Client has NKDA. RN took vitals at 1441 with BP 136/80 in L arm laying back in chair, HR 72, and RR 16. Client stated his vitals were within his "normal range". Client presented A&O x 4 and denied SOB, chest pain, numbness or tingling of the face, dizziness, and altered vision. At 1450 client reported he was "feeling fine". RN provided ER precautions and advised client when to f/u with PCP. Client left the facility with his family member who provided transportation at 1455.


VAERS ID: 1689819 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Dizziness, Feeling cold, Feeling hot, Head injury, Heart rate decreased, Hyperhidrosis, Mouth haemorrhage, Pallor, Skin warm, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None that we are aware of
Current Illness: None per patient
Preexisting Conditions: none per patient
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt was given covid vaccination, then moved from exam room to waiting room. Pt was sitting in waiting room chair, was leaning forwards, then leaned back. Pt then stated "Oh no" and this nurse asked if he was okay, at this time pt became unconscious et leaned to the left, fell out of the chair et hit head on floor, laid on left side. This nurse hit emergency call button, then went over to patients side, while other nurses responded. Pt was pale in color, skin temp warm et pt was diaphoretic. Pt then rolled from his side to his back, et woke up, pt was confused upon first waking, but was then able to tell us his name, et where he was and what he was doing. It was noted that pt had some blood in his mouth, from hitting floor. While pt was laying on his back, vs were taken. HR low, BP within normal range. Pt denied pain, denied SOA, but stated he was "hot, sweaty, and dizzy" pt then sat cross legged on floor. Given water to drink, noted to be shaky. Pt stated he was feeling better, but wanted to continue to sit on the floor. Pt stated when he first woke up, he was confused, because he thought he was at home sleeping. Pt was able to carry on a conversation with nurses. Pt then got up et sat in chair, stated he was cold and was shaking. Ceiling fan was turned off, et pt stated that felt better. After a while, pt walked around waiting room area before deciding he was stable enough to drive himself home.


VAERS ID: 1689822 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NO
Preexisting Conditions: NO
Allergies: nkda
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: PATIENT COMPLAINED OF CHEST PAIN VSS: 140/100 (LEFT); 140/90 (RIGHT); 142/98 (LEFT) PULSE OX: 98%; PULSE 100 REGULAR EMS CALLED AND EVALUATED; PATIENT DECLINED TRANSPORT AND STATED SHE WOULD CONTACT HEALTH PROVIDER; SHE WAS TRASPORTED HOME BY A COWOKER


VAERS ID: 1689825 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-30
Onset:2021-09-10
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder, Computerised tomogram thorax abnormal, Pulmonary embolism, Troponin increased
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, venous (narrow), 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcitriol, pantoprazole, ibuprofen, levothyroxine, terazosin
Current Illness: ankle fracture 6/12/2021
Preexisting Conditions: hypothyroidism, hypoparathryoidism,
Allergies: soma, peach
Diagnostic Lab Data: CT chest showing bilateral PE. Elevated troponin indicative of R heart strain
CDC Split Type:

Write-up: presented 10 days after vaccination with bilateral pulmonary embolism


VAERS ID: 1689831 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymph node pain, 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes in left armpit - baseball sized lump, tenderness in left armpit


VAERS ID: 1689835 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Electrocardiogram, Feeling drunk, Hyperhidrosis, Muscle twitching, Speech disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient lost consciousness a couple of minutes after receiving the vaccine, when he regained consciousness he was very sweaty, twitching, and mumbling incoherently. He said he does drink but he felt "wasted." EMS was called and checked him out on scene and stated that it was most likely anxiety related.


VAERS ID: 1689836 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Patient arrived today to receive Janssen COVID-19 vaccine. While providing the patient with education about the vaccine the patient stated "I have a history of passing out when I get IV''s and blood work done." Patient voiced that they would like to proceed with the Janssen COVID-19 vaccine today. After receiving the vaccine the patient stated that they were feeling fine, but would like to stay seated before moving to the designated waiting area. Upon observation by this nurse one minute later the patient was starting to look flushed, and the patient stated "I am starting to feel dizzy and sweaty." This nurse stayed close to patient and provided fanning. The patient stated that they would like to sit on the floor. The patient sat on the floor and then proceeded to lay down as the patient stated " laying down helps with the dizziness." This nurse obtained vital signs and ask for a co-worker to provide the patient with water. This nurse stayed with the patient and kept up a conversation while the patient waited the recommended time of 15 minutes after getting a vaccine. The patient never lost level of consciousness which was assessed by the patient kept talking with staff. Before the 15 minutes was up the patient voiced that they were feeling better. Upon assessment before leaving the patient was no longer sweating and no longer had the flushed skin appearance. The patient was able to stand and walk without assistance, and no abnormalities were observed.


VAERS ID: 1689839 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

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

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

Write-up: Initially patient denied ever receiving a covid vaccine. She then stated she did but it was 5 months ago and she received the Pfizer vaccine. She thought she needed to start the series over again because of the length of time that had gone by. Nurse informed patient she didn''t need to start series over and after this shot she would be fully vaccinated. After questioning the patient for quite some time, she stated she did have a vaccination card and handed it to the nurse. It was then realized that the patient had received Moderna for her first dose, after the nurse had already administered a dose of Pfizer for her second dose.


VAERS ID: 1689840 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT HAD A SYNCOPAL EPISODE; HE WAS NOTED TO SHAKE AND HEAD WENT BACK. HE WAS IMMEDIATELY ASSISTED TO A LYING POSITION ON THE FLOOR WITH HIS FEET ELEVATED. HE VERBALIZED THAT HE WAS DIZZY AND THAT HAPPENS SOMETIMES AFTER VACCINATIONS. PATIENT WAS GIVEN COLD PACKS AND OFFERED A SUCKER. HE WAS MONITORED FOR 30 MINUTES AFTER THE INCIDENT. HE REPORTED FEELING BETTER AND WAS DISCHARGED TO THE HEALTH SERVICES DEPARTMENT. VSS: 180/100 (RIGHT); 120/80 (LEFT); 120/76 (RIGHT); PULSE WAS REGULAR


VAERS ID: 1689841 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: none
Diagnostic Lab Data: 911 crew checked patients bp and sugar levels, patient had not eaten and did ask for some water which was provided
CDC Split Type:

Write-up: after shot was given 11:05am patient began to pass out in observation area called 911 arrived at 11;15am and released patient at 11:30am


VAERS ID: 1689847 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Hearing impairment (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: Gave a 14 year old the pfizer vaccine. Afterwards he felt dizzy and ears were ringing. Stated he had not eaten in several hours. Gave him water and a snack. He felt better about 10-15 minutes later.


VAERS ID: 1689940 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Pfizer vaccine was reconstituted with Moderna vaccine that was sitting right next to it, instead of the sodium chloride


VAERS ID: 1689951 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site pain, Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: pt reported immediate intense pain /burning on injection site and followed by tingling of tongue. she refused calling for aid or waiting around ; she said she has EpiPen on her person and husband in care that will drive her to er/urgent care.


VAERS ID: 1689956 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Feeling hot, Limb discomfort, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 100mg and Mirapex 0.25mg
Current Illness: Depression and Restless Leg Syndrome
Preexisting Conditions: Depression and Restless Leg Syndrome
Allergies: No allergies to food or medication
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Warm heavy sensation to both feet, tingling to both calves, tingling to right and left hand


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