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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 215 out of 8,010

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VAERS ID: 1689961 (history)  
Form: Version 2.0  
Age: 12.0  
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 FC3184 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: n/a
CDC Split Type:

Write-up: Syringe-Needle malfunction when technician performing vaccination (incomplete dose). Parent wanted us to consult with patient pediatrician first to consider an additional vaccination dose. Will be discussing with DR and utilize CDC and ACIP considerations, amount of dose was hard to estimate, likely $g1/2 dose.


VAERS ID: 1689968 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
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 FC3184 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Erythema, Feeling hot, Pain in extremity
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Chest tightening and redness around arm the size of a half dollar. Very hot to touch and painful.


VAERS ID: 1689972 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient briefly fainted after vaccine


VAERS ID: 1689973 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
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 FC3184 / 2 LA / IM

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

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

Write-up: The patient came to the pharmacy to receive her second COVID vaccine (Pfizer). She did not have her card with her and she thought she was due for her second shot. We administered the vaccine. We later discovered that she was not due for her second dose until September 14th. The patient has not had any adverse effects from receiving the vaccine early.


VAERS ID: 1689974 (history)  
Form: Version 2.0  
Age: 13.0  
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 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: COVID -19 VACCINATION MODERNA WAS GIVEN TO A 13 YEAR OLD.


VAERS ID: 1689977 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-09-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neck pain
SMQs:, Arthritis (broad)

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

Write-up: patient reported sharp pain in the back of her neck that she states started with shot and has continued


VAERS ID: 1689978 (history)  
Form: Version 2.0  
Age: 34.0  
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 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (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: Generic Nexium, vitamin D, fiber gummy, Zyrtec, daily vitamin, Culterelle, vitamin B
Current Illness: None
Preexisting Conditions: Gluten sensitivity
Allergies: Penicillin, gluten, goat cheese, morphine/viocidin/codeine, Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bell''s Palsy. Also occurred with first dose but was not confirmed related to the vaccine until it happened the second time too.


VAERS ID: 1689980 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Alabama  
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: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: Patient that received the Pfizer, and it was discovered after the fact that the patient was only 10 years old. We checked in with patient multiple times while she was here to verify that she was feeling okay and explained that the vaccine is not recommended as of now for patients under 12 years old.


VAERS ID: 1689982 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-09
Onset:2021-09-10
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: There were no adverse events but the vaccine was administered to the patient after the mother gave a DOB that made the patient 12 years of age. When they came for the second dose it was discovered that the patient was only 11 years old


VAERS ID: 1689984 (history)  
Form: Version 2.0  
Age: 36.0  
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 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Epinephrine auto-injector, Albuterol
Current Illness: Sickle cell anemia, Asthma
Preexisting Conditions: Sickle cell anemia, Asthma
Allergies: Amoxicillin, sulfa drugs, pineapple, kiwi
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: RN Emergency Treatment Chief Complaint Patient presents with ? COVID-19 VACCINE BP 130/82 (BP Location: RA-RIGHT ARM, BP Patient Position: LYING, Cuff Size: Standard Adult) | Pulse 89 | Resp 20 | SpO2 100% Location of event Vaccine Center TRM Description of Event Patient came in today to receive second dose of Moderna. Patient did state she had fainted when she received her first dose at the pharmacy. As well as SOB that lasted shortly after receiving the vaccine. Patient does have allergies to amoxicillin, sulfa drugs, pineapple and kiwi. Patient does carry epi-pen for pineapple and albuterol for asthma. At 1515 patient''s dad alerted RN that patient was not feeling well. RN assessed patient, placed 6L of O2 nasal cannula. Patient stated she was having a hard time breathing, and was experiencing chest pain. RN assessed vital signs, administered epinephrine to the right vastus lateralis at 1515. Patient stated very little improvement. Patient had albuterol inhaler, and patient had 2 puffs. Patient was moved to front of hospital, with little improvement in symptoms. EMS came and assessed patient and left at around 1538. Dr. was called and updated on patient. Interventions:Patient was assessed, monitored, Medications administered: Epinephrine 0.3mg auto injector; Lot:200909X Exp. 2/2022 Response to interventions and/or medications given:Little improvement Disposition:911 and Emergency Dept


VAERS ID: 1689985 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
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 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient says he has fainted before post vaccination but did not say which ones
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt like was going to pass out after receiving the Moderna vaccine but did not actually pass out. He was very light headed and then vomited. Patient says that he had passed out previously post vaccination on two occasions. After vomiting patient felt much better . He stated he had eaten 30 minutes prior to vaccination. He was awake and alert. He stayed 30 minutes after and then left with his mother.


VAERS ID: 1689986 (history)  
Form: Version 2.0  
Age: 71.0  
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 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: Client received the COVID vaccine (Janssen, lot # 206A21A, expiration 9/22) at 1:59. At 1415, RPh observed the patient standing at her seat in the observation area and asked her if she was ok. The client complained of dizziness and was escorted to a chair by RPh and RN. At that time, the client refused vital signs, snacks, juice, Benadryl, and to be seated in the zero gravity chair. The client was observed to be clammy, with normal skin color, and complained of "the world spinning" and nausea. She denied chest pain, headache, or shortness of breath. She was offered and accepted water. The client stated she has a history of epilepsy, fatty liver, kidney disease, hypertension, and high cholesterol. She stated that she is allergic to gabapentin and that she takes losartin but isn''t sure what other medications she takes. The client appeared uncomfortable but was alert and oriented x4. At 1423, the client consented to having her vital signs assessed. At that time, her vital signs were as follows: blood pressure 130/88, heart rate 66, respiratory rate 14, O2 98%. At 1430, the client stated that her dizziness and nausea had resolved. At 1435, the client stated that her blurry vision had resolved and she no longer appeared to be clammy. At 1438, the client stood up and paced around the room. She stated that her dizziness had not resumed but that she "felt better" when standing. The client appeared to be anxious and uncomfortable but denied pain or shortness of breath. At 1443, the client complained of her nausea resuming and began to vomit in an emesis bag. After the episode of emesis, the client stated "I feel so much better now." The client denied any further nausea or dizziness. The client continued to drink water and sit comfortably in her chair. At 1445, the client''s vital signs were as follows: blood pressure 128/76, respiratory rate 16, heart rate 72, O2 97%. Education provided regarding AMS activation and primary care follow up. The client denied any further questions and was escorted to her car by her husband, who drove her home.


VAERS ID: 1689989 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: SYNCOPE (AGE UNSTATED, BUT "EVERY TIME"), POSSIBLE NAUSEA PREVIOUSLY (MOST LIKELY RELATED TO PREVIOUS SYNCOPE FROM 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 EXPERIENCED SLIGHT SYNCOPE, NAUSEA AND VOMITING AROUND 5 MINUTES AFTER INJECTION. PATIENT WAS GIVEN A WASTE BASKET, A WET PAPER TOWEL (FOR CLEANING OF THE MOUTH) AND A BOTTLE OF WATER AND WAS ASKED TO REMAIN IN THE VACCINATION BOOTH IN A CHAIR THAT HAD ARMS TO PREVENT FALLS AND POSSIBLE INJURY. PATIEN LEFT 15 MINUTES LATER UNDER OWN VOLITION WITH NO VISIBLE LASTING EFFECTS.


VAERS ID: 1690130 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Maryland  
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 EW0167 / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Chills, Migraine, Nausea, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Nothing yet
CDC Split Type:

Write-up: Extreme chills, migraine, fever,and nausea. We gave her ibuprofen and have her under a heating blanket. She is sipping water.


VAERS ID: 1690131 (history)  
Form: Version 2.0  
Age: 25.0  
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 / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Incorrect product formulation administered
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow)

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

Write-up: The event actually occurred at the mixing of the vaccine Pfizer vaccine was diluted with 1.8ml of Moderna vaccine instead of sodium chloride vaccine patient due in November


VAERS ID: 1690132 (history)  
Form: Version 2.0  
Age: 13.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

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

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

Write-up: Dizziness, blurred vision Paramedics took to ER


VAERS ID: 1690137 (history)  
Form: Version 2.0  
Age: 46.0  
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 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb discomfort, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: Patient described left arm pain, the arm that received the vaccination, and reported discomfort in the left leg as well. Routinely checked her blood pressure and it was elevated 180/118mmHg. Waited a few minutes and checked again with similar results. She denied any other symptoms. She was advised to have her blood pressure checked out. She refused the offer of EMS, and stated she would have it checked today. She left and it is unknown at this time if she was seen in the ER as advised.


VAERS ID: 1690138 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
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 - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Headache, Myalgia, Nausea, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Headache, muscle aches, nausea, back pain, sore arm, chills, fever - began approx 20 hrs after injection, persisting into evening of day two.


VAERS ID: 1690147 (history)  
Form: Version 2.0  
Age: 16.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Headache, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: peanuts only
Diagnostic Lab Data: paramedic checked he vials and they were fine.
CDC Split Type:

Write-up: patient fainted 3 minutes after the vaccine , dizzy, problem breathing, headache. heavy chest. patient was given benadryl and epipen 5 minutes after. patient improved after paramedic came, patient was able to walk out of the store with her father, father stated the will go to the hospital to further check her.


VAERS ID: 1690149 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Kentucky  
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 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site warmth
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: sulpha drugs
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Redness and warm to the touch at the vaccine site two days after the vaccine was given. The patient is using a cold compress.


VAERS ID: 1690151 (history)  
Form: Version 2.0  
Age: 20.0  
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 FC3182 / 2 LA / IM

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

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

Write-up: Patient lost consciousness and appeared to seize. He came back to in approximately 10-15 seconds. EMS came and did not think he had a full seizure.


VAERS ID: 1690154 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
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 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Musculoskeletal discomfort, Neck pain, Pain in extremity, Tenderness
SMQs:, Rhabdomyolysis/myopathy (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12, D3
Current Illness: No
Preexisting Conditions: BMI of 30
Allergies: No
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I received the injection the evening of 9/9/2021 my arm felt sore and the next day I had a headache 9/10/2021. I took 500 mg Tylenol at 12:00 p.m., at 5:30 p.m. I noticed a lump on the left side of my neck above my collarbone it is sensitive to the touch. I do not have any bump or lump on the other side opposite. This is new. My neck also feels sore going towards my shoulder on the left side same side as the injection sight.


VAERS ID: 1690157 (history)  
Form: Version 2.0  
Age: 43.0  
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 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same adverse reaction with first dose
Other Medications: moderna immunization
Current Illness: none
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness in face, pain (ache) in arms, low grade fever, nausea


VAERS ID: 1690158 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Minnesota  
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 042A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Mydriasis, Nausea, Posture abnormal, Seizure, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Shortly after receiving the vaccine, the patient reported feeling nauseous (he was sitting in the waiting area). I asked if he felt dizzy and he said no. He asked for a bag in case he threw up so I walked back into the pharmacy to get one. When I left he was leaning against the wall and when I came back he was on the ground with his eyes very dilated and a blank stare. He appeared to have slouched down the wall (didn''t fall over or hit his head). I started tapping his shoulders and loudly saying his name to try to arouse him. He then began mildly convulsing. I yelled for my technician to call ED and to get the store manager. I tried to move him into a recovery position but was unable to. I kept an eye on his breathing and pulse and after about 1 minute he came to. After the initial shock wore off of me telling him he had a seizure, he said he felt better. We waited for the paramedics to arrive, at which point they took his vitals and did a work up. They determined he did not need to go to the hospital but they were going to go wait in the ambulance with him until someone could come pick him up from the store. At that point the patient and the paramedics departed the pharmacy. As far as I know, he did not go to the doctor or hospital to be evaluated further.


VAERS ID: 1690159 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Washington  
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 - / 2 LA / SYR

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

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

Write-up: In the day after getting the shot, Headache and body ache all day. Nausea off and on. Vomiting in the evening


VAERS ID: 1690160 (history)  
Form: Version 2.0  
Age: 13.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Eye swelling, Hypersensitivity, Lip swelling, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (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? 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: allergic reaction--1 week hives, covid shot then 22 hours later developed abdominal pain, facial swelling, eye swelling, and lip swelling.


VAERS ID: 1690162 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Oregon  
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: Contusion, Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT EXPERIENCED SYNCOPE ABOUT 5 MINUTES FOLLOWING ADMINISTRATION OF THE J&J VACCINE ON 9/10/21. HE FELL FACE FORWARD ON THE FLOOR RESULTING IN A CONTUSION ABOVE HIS RIGHT EYEBROW, RIGHT CHEEK BONE AND RIGHT KNEE. PATIENT WAS PLACED IN A PRONE POSITION ON HIS BACK WITH HIS FEET LEVATED. BP WAS 117/81 PULSE 84. WOUNDS WERE BANDAGED. PATIENT WAS RESPONSIVE TO QUESTIONS AND DID NOT APPEAR TO HAVE ANY DISORIENTATION DURING CARE OF INJURIES. PATIENT WAS ABLE TO MOVE TO A SITTING POSITION AFTER 15 MINUTES AND ABLE TO STAND AND WALK AFTER 20 MINUTES


VAERS ID: 1690168 (history)  
Form: Version 2.0  
Age: 49.0  
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 - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Throat irritation
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Succinate, Metformin, Amlodipine, Vitamin D, Iron, Nexium(Generic), Losartan, Tagment(Over the counter), Atorvastatin, multi vitamin
Current Illness:
Preexisting Conditions: High blood pressure, diabetes, GERD, obesity
Allergies: Milk allergy (causes breathing problems) Lisinopril (causes cough)
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Since about 10 minutes following the shot, I began having tingling in my feet that has continued. I also have tingling in my hands. Additionally, initially, I had a scratchy throat and itched, but that lasted less than 5 minutes. However, the foot and hand tingling, which is bilateral on both but worse on the right of each, has continued and it is now about 9 hours since the vaccine shot. I did not report this to the pharmacy as I thought it would stop. I did call back a few hours later asking if I could take Benedryl in case I was having an allergic reaction. I was told I could but I have not taken anything as the tingling is not severe at this moment, just present. It was NOT present prior to getting the shot.


VAERS ID: 1690169 (history)  
Form: Version 2.0  
Age: 67.0  
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 FF2589 / UNK LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ702AB / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: penicillins, sulfa antibiotics
Diagnostic Lab Data: None at this time, patient advised to monitor for side effects.
CDC Split Type:

Write-up: On 9/10/2021 patient came to the pharmacy seeking her flu shot. Flu shot was prepared for the patient. The vaccine administrator called out a different patients name to which the patient responded and confirmed she was the other patient verbally. When asked if she was here for her second dose of pfizer covid vaccine she again responded yes. The patient received the pfizer vaccine that was intended for a different patient. The incident was discovered when the intended patient asked on the status of her vaccine.


VAERS ID: 1690172 (history)  
Form: Version 2.0  
Age: 46.0  
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 FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: benadryl, tylenol
Current Illness: Unknown
Preexisting Conditions: None
Allergies: NDKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient broke out in hives on face on forehead above eye. Extreme itching . Advised call 911 or visit ER if symptoms worsen or if new symptoms arise.


VAERS ID: 1690312 (history)  
Form: Version 2.0  
Age: 79.0  
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 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril 10 mg tablet mesalamine 1.2 GM tablet
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: No known drug allergy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The patient received her first vaccine on 08/13/21. She received the Moderna vaccine. When she returned on 09/10/21, she received the Pfizer vaccine. No adverse effects documented.


VAERS ID: 1690316 (history)  
Form: Version 2.0  
Age: 20.0  
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 (MODERNA)) / MODERNA 049E21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted after she stood up to wait for her mother to get her vaccine


VAERS ID: 1690317 (history)  
Form: Version 2.0  
Age: 14.0  
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 FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Dyspnoea, Eye movement disorder, Loss of consciousness, Musculoskeletal stiffness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (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: Fainted after Tdap.
Other Medications: information not available.
Current Illness: none according to parents.
Preexisting Conditions: none according to parents
Allergies: no known allergy.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received Pfizer covid vaccine injectioin, patient was then observed in pharmacy waiting area. after around 5 minutes, patient had nausea, then started to have something resembled seizure: loss consciousness, stiffening of body, eyes rolled backwards, lasted around 5 seconds. Then she gradually regained consciousness. She breathed heavily at first then slowly back to normal breathing. Patient was able to talk to her parents logically. Pharmacy staff called 911, paramedics arrived. Per paramedics, patient''s vital signs were normal, checked blood pressure, glucose level, pulse, heart rhythm. Patient and her family was advised to follow up with primary care provider. Family said they will bring patient to physician for evaluation.


VAERS ID: 1690528 (history)  
Form: Version 2.0  
Age: 23.0  
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 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

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

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

Write-up: Pt experienced discomfort about 2 minutes after getting Moderna Covid Vaccine. She complained of Facial swelling, throat swelling, feeling hot, and difficulty breathing. Pt was closely observed for minutes and she recovered quickly. Her pulse and blood pressure were 110/79 and 92 respectively. EMS was called but she had already recovered when they came in about 10 minutes time. No treatment was given.


VAERS ID: 1690531 (history)  
Form: Version 2.0  
Age: 53.0  
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 (JANSSEN)) / JANSSEN 204B21A / UNK RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: 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: Valsartan
Current Illness: none
Preexisting Conditions: none
Allergies: Bactirm
Diagnostic Lab Data:
CDC Split Type:

Write-up: I now have a lump (baseball sized) in my right arm pit. This is the same arm the the injection was given.


VAERS ID: 1690651 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
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 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Dizziness, Illness
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Very lightheaded since 10am on September 10th 2021. Could barely focus. Feeling as if ill.


VAERS ID: 1690654 (history)  
Form: Version 2.0  
Age: 30.0  
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 FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: Patient felt very weak and faint after receiving. She did not appear to lose consciousness as she could tell me her symptoms, but was lying in chair for a couple minutes. Had her lay on floor with feet elevated for a few minutes, then she said she felt better and wanted to sit. Had her sit on floor until no longer feeling dizzy and could move to chair. She contacted a family member to come get her and was feeling much better after 30 minutes.


VAERS ID: 1690658 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood lactic acid, Chest X-ray normal, Dizziness, Electrocardiogram normal, Fatigue, Feeling abnormal, Full blood count normal, Gait inability, Heart rate irregular, Hyperhidrosis, Lip dry, Metabolic function test, Pallor, Paraesthesia, Pulse absent, Pyrexia, Restlessness, Syncope, Troponin normal
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Akathisia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid Lexapro
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 12lead EKG, normal 9/10 Chest x-ray, normal 9/10 CBC and CMP unremarkable 9/10 Triponin and lactic acid, normal 9/10
CDC Split Type:

Write-up: Intermittently febrile early morning on second day after J&J. Afternoon became suddenly dizzy and lightheaded. Briefly passed out. Was pale, had dusky lips and sudden, perfuse sweating. I drove him immediately to the hospital. On the way there he complained of tingling in both arm and I was unable to palpate a radial pulse. Had weak carotid pulse that skipped beats for a few seconds. Duskiness worsened during this, and improved when normal bets returned. Was weak and dizzy and unable to walk to into the ER. Had elevated BP 143/92. HR 74. O2 sat 96% Resp 17. Orthostatic BP obtained, no hypotension noted. Received 1L bolus of normal saline. Discharged after testing complete and syncope resolved, roughly 2 hours later. Remains intermittently febrile, fatigued, restless and "not feeling right", thought the evening at home.


VAERS ID: 1690660 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Lymphoedema
SMQs:, Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Pt developed swelling & pain in armpit on injection side (sounds like lymphedema)


VAERS ID: 1690670 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderate rash around the neck and the lower right side of the face. Soreness and redness around the injection site. Fatigue.


VAERS ID: 1690671 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Intense ringing in both my ears about 90-120 minutes after receiving the vaccine. Called a Dr and he said that this is a rare but known side effect. He said nothing can be done except wait and see if it goes away.


VAERS ID: 1690678 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-01
Onset:2021-09-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Injection site rash
SMQs:, Peripheral neuropathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Modafinil
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Skin periodically reacts to prolonged contact with nickel
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 9/1/2021 I received my first Moderna vaccine, and on the morning of 9/10/2021 noticed a fist-sized rash at the injection site. Rash does not itch, but I do feel a burning sensation coming from it.


VAERS ID: 1690681 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-02
Onset:2021-09-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersomnia, Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (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: Wellbutrin
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Excessive sleepiness about 12 hours after injection lasting almost a day and a half. A large hard red itchy bump at injection site starting about a week and 44 minutes after injection. (I still have it and so I don''t know how long it will last so far it has been almost 14 hours)


VAERS ID: 1690683 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Paranasal sinus discomfort, Pyrexia, Rash, Rash macular
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Cough, sinus pressure, body covered in rash, fever, hard time breathing, white splotches on skin.


VAERS ID: 1690686 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms, Vaginal discharge
SMQs:, Dystonia (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: Graves Disease, PCOS, Hashimotos
Allergies: Azithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely thick vaginal discharge- like a full cup of jelly on Friday. I have never seen that before. Today it feels like I will be getting a period soon- cramping and uncomfortable.


VAERS ID: 1691017 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-29
Onset:2021-09-10
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Blood glucose decreased, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (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: Insulin, levotiroksin
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: Sugar level measured with Accu-Check machine is 47
CDC Split Type:

Write-up: Muscle ache on left arm, hypo sugar level


VAERS ID: 1692869 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

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

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

Write-up: The patient arrived to the pharmacy to receive his first dose of Shingrix (shingles) and was mistakenly administered a dose of the Pfizer COVID19 vaccine. The patient confirmed to us that he already completed doses 1 and 2 of the Moderna COVID19 vaccine series in March and April 2021, respectively. No adverse events have been reported by the patient at this time (<24 hours later).


VAERS ID: 1692873 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / IM

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

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

Write-up: Patient received the vaccine in his right arm and within a few seconds, he blanked and leaned towards the vaccinator on his right. He gained consciousness soon after and was given orange juice to drink. He recalled having a similar reaction after giving blood. He was aware of where he was and was able to carry on conversation normally. We did not call for paramedics and he remained in the pharmacy area further for observation.


VAERS ID: 1692881 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

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

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

Write-up: Patient received the vaccine and was advised to sit in the waiting area for 15 minutes for monitoring. Patient stood up a few minutes after receiving the vaccine to walk towards the pharmacy counter and passed out, falling onto the floor. 911 was called and patient was kept conscious until paramedics arrived. Patient was transferred to the hospital.


VAERS ID: 1692883 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Electrocardiogram normal, Injection site haemorrhage, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not to my knowledge
Current Illness: no
Preexisting Conditions: no
Allergies: nkda
Diagnostic Lab Data: fire rescue performed vitals and ekg 9-10-21 normal readings
CDC Split Type:

Write-up: Vaccine was administered, some blood came out of arm once needle was withdrawn. A cotton swab was used and bleeding stopped. Are was cleaned with alcohol swab and then a Band-Aid was applied. Within a couple minutes the patient looked pale and clammy. He suddenly constricted and lost consciousness. Emergency number was called , pt was laid in a supine position , one dose of an epi - pen was administered. Upon Epi-Pen administration the pt woke up within 5 seconds. Fire rescue arrived took vitals and EKG with normal results. Pt refused to go to hospital. We observed him at the Pharmacy for an additional 30 minutes and walked him into the passenger seat of his vehicle so that his wife can and did drive him home.


VAERS ID: 1692907 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth, Somnolence, Vaccination site reaction
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypoglycaemia (broad)

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

Write-up: Pregnant with 4th child, due 2/18/2022. Had extreme tiredness and difficulty staying awake the after the shot. Also had "COVID arm" the size of approximately 3 quarters, red, warm, painful, and itchy.


VAERS ID: 1692921 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-03
Onset:2021-09-10
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Zyrtec
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Latex "sensitivity"
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Large knot of swelling at injection site with itching and mild rash.


VAERS ID: 1692925 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zofran, Dicyclomine, Lisinopril, Ritalin, Methadone, Tylenol
Current Illness:
Preexisting Conditions: Chronic pain in leg & back. Migraines.
Allergies: Amoxicillin, Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches, arm sore , nauseated, migraine was worse, had fever on Friday 10th @ 8am it was 101.2, then @ 11:30am it was 101.8, then @ 4pm it was 102.3 then @ 9pm it was 102.1 I took Tylenol & Ibuprofen. When I woke up today Saturday I am feeling better and I don''t have a fever.


VAERS ID: 1692926 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient stated this is common in past due to his severe phobia of needles.
Other Medications: Irbesartan 75 mg
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient passed out a couple minutes after administration of vaccine. This was caused by his severe phobia of needles described to me before administrating vaccine. Patient stated this has happened before in the past. Patient fell to floor and regained consciousness shortly after. Stood into chair and given water. Became nervous and vomited a few times. Patient normalized after 30 minutes. Wife picked up patient and went home. Followed up with condition of patient and was feeling great and have no symptoms.


VAERS ID: 1692927 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Feeling hot, Headache, Hyperhidrosis, Nausea, Pain in extremity, Seizure, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit C, Vit D, multi-vitamin, probiotic, fish oil, magnesium glycerinate
Current Illness: None
Preexisting Conditions: None
Allergies: Hydrochloroquine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 9/10/2021: 9:40 a.m. 2nd dose of Moderna Vaccine in L arm. 4:00 p.m. L arm sore and slight headache. 6:00 p.m. chills, 11:30 p.m. woke burning hot, sweating, nauseous,, vomitting, blacked out, eyes rolled back and convulsions. 9/11/2021: 2:45 a.m. burning hot, sweating and nauseous for 15 min.


VAERS ID: 1692929 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Influenza like illness, Pain, Pain in extremity, Pain of skin, Paraesthesia, Pyrexia, Somnolence
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin methylphenidate levothyroxine raloxifene sertraline lisinopril fish oil turmeric probiotics coQ10 vitamin D calcium multivitamin senna stool softener Glucosamine chondroitin 81 mg aspirin
Current Illness:
Preexisting Conditions: High blood pressure. Narcolepsy. Neuropathy
Allergies: Gluten eggs dairy thiuram Tobramycin drops moxifloxacin drops
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu like symptoms- body aches, fever, sleepiness, weakness, dizziness, needle-like leg pain (both legs), skin on legs painful to touch.


VAERS ID: 1692930 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052EZ1A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Chest discomfort, Dizziness, Hypoaesthesia, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine; multi-vitamin.
Current Illness: None - but there is no where to mention that I have a baby that I am breastfeeding.
Preexisting Conditions: Low Thyroid; anemia
Allergies: Keflex; penicillin; IV iron infusion ; mango; eggplant;
Diagnostic Lab Data: 9/10/2021 - Vitals checked - temperature, blood pressure, heart rate. Visual check. Asked questions about how I was feeling and symptoms after vaccination. Prednisone given. I was monitored for a couple of hours. Prednisone seemed to help the symptoms subside. I was given a prescription to continue taking as needed.
CDC Split Type:

Write-up: Around 1:45 -2:00 pm 9/10 - My lips felt tingly and then my cheeks felt tingly and then both started feeling numb. My throat felt thick or swollen, but I could still swallow and breathe. I felt slightly dizzy. My heart felt fluttery on and off. My chest started having a heavy feeling. I was driving and pulled over and called my doctor. I was told to call an ambulance. I decided to go to the local urgent care. They checked vitals and after speaking to the nurse and doctor I was given prednisone. They monitored me often for a couple of hours. My symptoms subsided with the help of the prednisone. They gave me a prescription. 9/11 - My chest has continued to feel heavy and I have continued to feel dizzy but I don?t feel as though the doctors at urgent care or hospital would do anything different at this time as I am okay and not having a serious reaction that would be considered life threatening.


VAERS ID: 1692933 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 3 RA / SYR

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

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

Write-up: Fever up to 101.9 Body ache, headache Chills


VAERS ID: 1692940 (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: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GW0177 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Heart rate increased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: High fever, body aches, rapid heart rate, and chest pains still occurring the following day.


VAERS ID: 1692962 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Blood pressure systolic decreased, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: Significant drop in blood pressure. Fainting in a store 35 point systolic drop in bp


VAERS ID: 1692997 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Syncope, Tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fainting, collapsing, vomiting, tachycardia 911 call. Taken to emergency room.


VAERS ID: 1693005 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass
SMQs:

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

Write-up: Patient''s wife called and reported that patient has a lump under the armpit. Advised pt to see md if it doesn''t get better


VAERS ID: 1693011 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bronchospasm, Chest X-ray, Chills, Cough, Dyspnoea, Feeling hot, Feeling of body temperature change, Flushing, Malaise, Menstrual disorder, Myalgia, Nausea, Pain, Retching, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. However, history of episodes of a-fib and v-tach
Allergies: Erythromycin
Diagnostic Lab Data: On 09/11/2021 - physical exam - bronchospasm, rapid Covid test - negative, chest X-ray - negative
CDC Split Type:

Write-up: Received vaccine 9/10/21 and within 5 minutes I felt flush of warmth and unwell. Went home after 15 minutes, and started feeling nauseous. Then felt hot and cold with chills. Within about an hour felt like when you accidentally inhaled a sip of water coughing and dry heaving, unable to catch breath. Took Zyrtec D, unrelieved. Next day, still short of breath with face occasionally feeling warm and turning red off and on, body/muscle aches, along with unusual menstruation (since mirena IUD placed 2/5/19 usually not bleed much if at all). 9/11/21, finally went to Immediate Care Walk in and was treated for bronchospasm. Received shot of solumedrol and nebulizer in office and was sent home on titrating dose of prednisone, inhaler, and nebulizers.


VAERS ID: 1693022 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / IM

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

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

Write-up: Patient received first dose or Moderna and got second dose of Pfizer by pharmacy error


VAERS ID: 1693033 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C214 / 2 LA / SYR

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

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

Write-up: Started the next morning. A hey, very tired and fever 101.7


VAERS ID: 1693037 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / UNK - / -

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

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

Write-up: N/A


VAERS ID: 1693048 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Feeling abnormal, Hallucination, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingles #1 at age 66. In 2018. Shingrix
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After second vaccination, I experienced severe body aches, including a debilitating headache; 101 temperature with resulting hallucinations; diarrhea and extreme shivers. In short, this was so bad, I think I would rather have the Covid instead.


VAERS ID: 1693052 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-26
Onset:2021-09-10
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: No
Current Illness: No
Preexisting Conditions: Thyroid
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Trembling for 5 hours, severe shaking, bask pain


VAERS ID: 1693056 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Body temperature increased, Dizziness, Heart rate increased, Oropharyngeal discomfort, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Pt. experienced sensations of elevated temperature, "shaky vision", dizziness and "fullness" in her throat. Her pulse elevated moderately from 80 at resting to 100 during the event. She felt very anxious. She had no visible mouth or throat swelling and no difficulty breathing. All symptoms resolved except the throat "fullness" within 15-20 minutes. Continued to follow up with her intermittently for the next 6 hours and she reported all symptoms resolved except 10% of her throat sx remaining at 6 hours post vaccinations after 50mg diphenhydramine.


VAERS ID: 1693061 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Asthenia, Chest pain, Dyspnoea, Eye swelling, Influenza like illness, Malaise, Myalgia, Swelling, Swelling face
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Extreme flu-like symptos: Chest pain/swelling, difficult breathing, face and eyes swelling, muscle pain, weakness, injection site swelling, feeling unwell. Was bed-ridden for over 24hrs. Currently monitoring at home.


VAERS ID: 1693062 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram normal, Hypoaesthesia, Magnetic resonance imaging normal, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cortizone cream, vitamin C
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: MRI, CAT scan, blood work
CDC Split Type:

Write-up: Tingling and numbness in my face and my left arm and shoulder. The doctor thought is was a stroke so I went to the hospital for a CAT scan and an MRI. I did not have a stroke. The tingling and numbness lasted for about 6 hours


VAERS ID: 1693087 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Swollen area under arm. Size of baseball


VAERS ID: 1693090 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Insomnia
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: Flu vaccine, approximately 20 years ago.
Other Medications: Tramadol, Ambien, Propranolol, Hydroxyzine, Vit D (50,000 IU weekly), Iron, Bupropion
Current Illness: None
Preexisting Conditions: Anemia, Osteomalacia, Osteoarthritis, Insomnia, Anxiety / Depression. All of my medications are successful in treating conditions requiring them.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: This report is about the second vaccination I received yesterday on 9-11-2021. I had extreme insomnia. I did not sleep AT ALL, all night and have not been able to sleep at all throughout the day (no naps). I did some on-line research and found this was a (possibly rare) side-effect for quite a few people. One person said that she has not slept for 3 weeks after her second vaccine. I take pharmaceutical-strength medications for insomnia. They work perfectly well EXCEPT they didn''t work at all last night. I''m truly alarmed at this development. I would like you to add this to your symptom checklist, because it''s serious. Try working or driving on no sleep for a few days.


VAERS ID: 1693099 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308451 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Induration, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red, swollen bump, hard, painful


VAERS ID: 1693122 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Pallor, Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Attendee received second dose Pfizer vaccine at 12:35. Lot# EW0179. Attendee was directed to observation area. At 12:50 attendee attempted to stand and started to fall, someone was able to catch her and assist her back to the seated position. Attendee''s skin was cool and clammy. Attendee''s respirations were not tachypneic or dyspneic. Attendee was then assisted to the cot to lie down, with her legs elevated. HR: 83 BP: 106/80 RR: 16 O2Sat%: 97 12:55 - Attendee stated she felt better, no longer clammy or pale. Sat up in the cot. 13:10 -No voiced complaints- skin warm and dry. Took another set of vital signs before discharge without documentation. Care Practitioner educated on home discharge/adverse reaction instructions and attendee was discharged to home with her friend. Attendee did not have any reported escalation of symptoms and was able to walk out of clinic independently.


VAERS ID: 1693130 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

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

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

Write-up: Fever, chills, aches, fatigue


VAERS ID: 1693146 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 AR / IM

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

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

Write-up: Attendee received second dose Pfizer vaccine at 12:35. Lot# EW0179. Attendee was directed to observation area. At 12:50 attendee attempted to stand and started to fall, patient was able to catch her and assist her back to the seated position. Attendee''s skin was cool and clammy. Attendee''s respirations were not tachypneic or dyspneic. Attendee was then assisted to the cot to lie down, with her legs elevated. HR: 83 BP: 106/80 RR: 16 O2Sat%: 97 12:55 - Attendee stated she felt better, no longer clammy or pale. Sat up in the cot. 13:10 -No voiced complaints- skin warm and dry. Took another set of vital signs before discharge without documentation. Care Practitioner educated on home discharge/adverse reaction instructions and attendee was discharged to home with her friend. Attendee did not have any reported escalation of symptoms and was able to walk out of clinic independently.


VAERS ID: 1693147 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / UNK AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Dry skin, Pallor, Skin warm
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: Attendee received dose of Pfizer vaccine at 14:43. Lot# EW0179. Attendee was directed to observation area. At 14:45 voiced complaints of dizziness. Attendee''s skin was warm and dry. Attendee''s respirations were not tachypneic or dyspneic. Attendee assisted to the cot to lie down, legs elevated. HR: 72 BP: 98/68 RR: 19 O2Sat%: 99 14:50 - Attendee stated he felt better, no longer diaphoretic, or pale. HR: 72 BP: 104/60 RR: 19 O2Sat%: 99 15:00 - Care Practitioner educated on home discharge/adverse reaction instructions and attendee was discharged to home with his friend. Attendee did not have any reported escalation of symptoms and was able to walk out of clinic independently.


VAERS ID: 1693170 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: After getting vaccine patient felt lightheaded while sitting on chair in waiting room. Pharmacy team member called 911 and they arrived and took his vitals. Patient left with EMS.


VAERS ID: 1693175 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

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

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

Write-up: Patient (11/3/1946) received her second dose of moderna vaccine on 9/9/2021 and started experiencing rash around the injection site, fever, and trouble breathing the next day 9/10. She stated that she does have COPD and uses oxygen for respiratory issues but needed to up her oxygen that day. As of today 9/11, she is no longer experiencing any issues with her breathing nor fever, and the rash has subsided with hydrocortisone. Patient is aware to head to the emergency room if she has difficulty breathing.


VAERS ID: 1693179 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Cough, Dizziness, Dyspnoea, Hypoaesthesia, Paraesthesia, Peripheral coldness, Somnolence, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (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: Nystatin, singulair, Zyrtec, ketotifen, nac, vitamins, probiotics, citrus line, ornithine, yucca, xopenex inhaler as needed, Flovent as needed, chromodynamics sodium nebulizer as needed, black seed oil, molybdenum, PEA, ox bile, nad+.
Current Illness:
Preexisting Conditions: Asthma, allergies, eczema, possible mcas, chronic Lyme, h. Pylori
Allergies: Sulfa, erythromycin, Zithromax, legumes, dairy, wheat/gluten, hemp, pumpkin, buckwheat, cilantro
Diagnostic Lab Data: None. I self-treated and waited, nearly used epi-pen.
CDC Split Type:

Write-up: Drop in blood pressure, trouble breathing, cough, numb and tingling cold hands, headache, seeing black spots, feeling light headed. Started a few minutes after vaccination, needed to sit with feet elevated, lasted an hour and needed with falling asleep like narcoleptic.


VAERS ID: 1693185 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Throat irritation
SMQs:, 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: On 08/19/21 patient received her first dose of Pfizer vaccine. She was 52 years old. Patient said she had itchiness from the fi
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Sulfa and Latex
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Shortly after receiving the vaccine (within a few minutes) patient said she had itchiness in her throat. I gave her two diphenhydramine 25 mg capsules, which she took orally. Patient denied having any shortness of breath or any other symptoms. Patient did not want us to call EMS. Patient was monitored for at least 30 minutes. After waiting 30 minutes, patient still had itchiness in her throat and no other symptoms. It was recommended to the patient that she should stay longer to be monitored, but she made the decision to leave the pharmacy. I followed up with the patient via phone around 8:30pm, roughly 2 hours and 30 minutes after receiving the vaccine. She picked up the phone and said "hello" but then another person got on the line and was annoyed that I called stating that I woke the patient up. Patient did say "thank you" before hanging up.


VAERS ID: 1693189 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Feeling abnormal, Headache
SMQs:, Dementia (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: lisonopril
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data: None-Haven''t reported yet to pharmacy
CDC Split Type:

Write-up: Headache,warm, after walking daily 2 miles ,Friday Morning,went home ,slept from noon till 5 p.m. headache disappeared. Today,walked 2 miles daily, had burrito,water for breakfast,came home began having bowel run-off.Unusual for an afternoon of staying in


VAERS ID: 1693203 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Hyperhidrosis, Incorrect route of product administration, Injection site erythema, Injection site swelling, Injection site warmth, Nausea, Oedema peripheral, Pain, Pyrexia, Tenderness
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amitriptyline 25mg at bedtime
Current Illness: unknown
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: pt did go to urgent care on 09/11/2021
CDC Split Type:

Write-up: Patient presented on 09/11/2021 after going to urgent care with a red, warm, swollen 2 inch circular size injections site. She stated that her armpit was swollen and tender on the same arm and she had excessive sweating. She was also nauseated and had body aches and a fever of 101 to 102. It did appear that maybe her Pfizer dose was injected subcutaneously as it was a bit low on the deltoid muscle and pt is probably considered obese. Pt did go to urgent care and prescriber did prescribe Cephalexin 500mg three times a day for 7 days. I spoke with prescriber and he was a bit concerned she might have cellulitis.


VAERS ID: 1693205 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 9/9/21-5:15 pm vaccine given 9/10/21-4:00am fever, body aches, headache, exhaustion 9/11/21-fever, body aches, exhaustion, rash on neck, breasts & upper stomach


VAERS ID: 1693213 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Glipizide, Januvia, Pantoprazole, Ezetimibe. OTC - Zyrtec, Omega-3 and Citracal. My husband takes Lisinipril and Dexalant and had same side effects (both received vaccines at the same time and same lot number.
Current Illness: N/A
Preexisting Conditions: Diabetes
Allergies: Ampicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Within five (5) minutes after receiving vaccine and still in waiting area started having a strong metallic taste in my mouth. Lasted for 24 hrs and my husband a little longer (still tastes it in the roof of his mouth).


VAERS ID: 1693216 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / 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: Niacin 500mg, vitamin e, 400iu, vitamin d3, antenolol 25mg, Dexilant 60mg, lorazepam 0.5 mg , cetirizine tablet 10mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lymph nodes in right arm pit is swollen and is the size of a golf ball, it?s also painful.


VAERS ID: 1693218 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Chills, nausea, vomiting, loss of appetite, severe fatigue


VAERS ID: 1693221 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Injection site reaction, Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient had red rash at injection site. Patient described it as hot sensation and itchy.


VAERS ID: 1693236 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3901358A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal dreams, Back pain, Chills, Decreased appetite, Dizziness, Fatigue, Injection site pain, Lymphadenopathy, Migraine, Nausea, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm for 2 days sore spot at injection site for 5 days
Other Medications: Allegra 24 hour allergy over the counter medicine
Current Illness: None other than seasonal hay fever allergies.
Preexisting Conditions: Allergies and stress induced asthma, walking pneumonia 6 times
Allergies: I have allergies t Ceftin ad all it''s generics, phenylpropanolamine, grapefruit, grass, mold, strawberries, hay fever, and stress induced asthma (coughing not wheezing)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Experiencing frn36 hours now fever of 100.8 to 101.4, migraine headache, extreme fatigue, vivid dreams, arm pain at injection site, nausea, lack of appetite, swollen lymph nodes under arm and side of breast of injection side, body she''s and extreme back pain, violent bought a of chills and shaking at least 5 times for 30 to 50 minutes each time, and dizziness. None seem to be subsiding either.


VAERS ID: 1693237 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest pain, Fatigue, Haematochezia, Headache, Irritability, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Blood in stool, irritability, headache, muscle aches, chest pain, and fatigue


VAERS ID: 1693238 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: unknown
Current Illness: unknown
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT is a 14 y.o. right handed female referred for evaluation of tremor. Tremor primarily involves the right hand and right pinky. Onset of symptoms was sudden, not related to any specific activity but was noted to be 2 days after 2nd dose of pfizer covid vaccine. Never had tremor before. Denies pain, numbness, tingling, hyperesthesia. Symptoms are currently of mild to moderate severity. Tremor exacerbated by running. . Tremor is alleviated by resting extremity but it does not go away. Denies fatigue, denies anxiety or whole body jitteriness. She denies voice change, sleep disturbance, drooling during sleep (wet pillows), rigidity, postural changes, difficulty in initiating movement, difficulty with walking, difficult with posture, difficulty with swallowing and balance problems


VAERS ID: 1693258 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 8/13. See previous notes.
Other Medications: Minipress , gabapentin 600mg, Percocet PRN, ibuprofen 800 mg PRN, marijuana for pain
Current Illness: pinched nerve in neck with radiculopathy
Preexisting Conditions: pinched nerve in neck with radiculopathy
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states the day following his vaccine 8/13 and 9/10 he has had severe exacerbation of his chronic nerve pain in his hands, left arm, and neck. He had to go to the emergency room 8/13, 8/14, 8/15, and 8/16 for severe pain, numbness, and tingling in the hands and arm. He has been encouraged to go to ER for his current severe pain.


VAERS ID: 1693260 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperaesthesia teeth, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lorena, prescription vitamin D
Current Illness: Impetigo
Preexisting Conditions: NA
Allergies: Penicillin, tamiflu, monkelust
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm, sensitive teeth in multiple locations to cold drinks and air- back left top teeth and behind front teeth


VAERS ID: 1693277 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zinc, echinacea, vitamin D
Current Illness: Tested positive for Covid 19 August 20th, 2021
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The night that I got the vaccine, while I was asleep I started to develop a fever of 102.4F, chills, sweats, malaise. The symptoms persisted until I took ibuprofen and Benadryl so I could fall asleep and reduce my fever. I took ibuprofen throughout the day the next day along with DayQuil to ease my symptoms. The next night, I premedicated before bed with Theraflu and ibuprofen which allowed me to sleep. However I sweat through all my sheets and pillow. This morning I still had a fever and chills so I took more medication before I went into work and felt OK. I have now been without fever reducing medications for 16 hrs and my temperature is 99.9 F.


VAERS ID: 1693282 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Headache, Injection site erythema, Injection site pain, Joint stiffness, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol 1mg/daily; Citalopram 40mg/daily; OTC Allegra; OTC Prenatal vitamin; OTC Biotin supplement (hair, skin, nails).
Current Illness:
Preexisting Conditions: Kidney stones & UTIs
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started with a horrible headache, immediately followed by body aches with increased stiffness in joints. 24 hours later, I have chills, low-grade fever (99.2), headache, entire body aches, injection site pain and redness and some chest tightness. I basically feel like I did, when I had COVID in April.


VAERS ID: 1693288 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-01
Onset:2021-09-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Fatigue, Headache, Muscular weakness, Pain in extremity, Swollen tongue, Throat tightness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling of tongue, throat tightness, metal taste, arm pain, headache, fatigue, muscle weakness


VAERS ID: 1693294 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Peripheral swelling, Pruritus, Wheezing
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: About 30 minutes later my arm was itchy, then swollen and I felt slightly short of breath so I took 50mg of Benadryl and my symptoms went away. When I woke up today, they were back so I took another 50 mg of Benadryl. Now at 7:30 pm I am more short of breath and wheezing, and coughing so I am more concerned. I am a nurse, so I know when I would need to go to the hospital. I will take more Benadryl but I thought I should report this.


VAERS ID: 1693372 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: troponin almost 22K
CDC Split Type:

Write-up: myocarditis developed 2 days after the 2nd shot. troponin almost 22K.


VAERS ID: 1693387 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Metoprolol 25mg
Current Illness: None
Preexisting Conditions: Hypertension Tachycardia
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Headache, chills, body aches, vomiting, fever, sweating. Alternating between Tylenol and ibuprofen around the clock. Medication didn?t help much but started feeling better 9/12/21


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