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

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



Case Details (Reverse Sorted by Onset Date)

This is page 217 out of 4,799

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VAERS ID: 1364574 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

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

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

Write-up: Patient under 18 was accidently given the Moderna Dose instead of the Pfizer one indicated


VAERS ID: 1364601 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product administration error, Syringe issue, Underdose
SMQs:, Medication errors (narrow)

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

Write-up: NEEDLE FAILURE, VACCINE WAS LEAKED OUT ; ONLY LESS THAN 20% VOLUME WAS ADMINISTERED ON LEFT ARM. OUTCOME : 1) IMMEDIATELY INFORMED PATIENT OF THE VACCINE ADMINISTRATION ERROR 2) ADMINISTER 0.5 ML MODERNA VACCINE IN THE OPPOSITE ARM ( RIGHT ARM) IMMEDIATELY . 3) PATIENT HAS NO SYMPTOMS .


VAERS ID: 1364611 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Cough
SMQs:, Anaphylactic reaction (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: Influenza Vaccine
Other Medications: Losartan 50 mg, Norco, Flexeril, Phenergan, Hydroxyzine, Ventolin/Duoneb, Singular, Motrin, Hydrochlorothiazide, Benadryl, Lasix, Protonix, Famotidine, Symbicort, Levothyroxine, Spironolactone, Liothyronine, Senna-Docusate, Incruse ellipta
Current Illness:
Preexisting Conditions: Undifferentiated autoimmune disorder, lumbar pain, asthma, COPD, hypertension, hypothyroidism, PCOS, Reactive airway, Hashimoto''s disease
Allergies: Purrell, isopropyl alcohol, latex, sulfa, penicilline, EES, Zithromax, Keflex Biaxin, Clindamycin, tetracycline, Cymbalta, oxycodone, diltiazem, Amlodipine, Neurontin, Bactrim, Lyrica, Elavil, Celebrex silvadine ,Levaquin, lidocaine, Mobic mepivacaine, Doxycycline, aztreonam, chloride/bleach cleaning products chlorohexydine, tegretol, Effexor
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient in observation approximately 20 minutes after receiving the 1st dose of Pfizer presents with c/o chest tightness and dry cough. Patient has a history of anaphylaxis to multiple causes and was advised to stay in observation for 45 minutes. Patient was given oral fluids and evaluated by EMS. Patient requested to be transported to Hospital. Patient was alert and oriented x 4, denies difficulty breathing, shortness of breath, wheezing. Clear Lung sounds. Patient was started on Duo nebulizer at 09:05AM and transported to RGH 09:08AM. Initial Vitals (08:53AM): 130/88, HR 118, O2 Sat 93%, RR 20; Discharge Vitals (09:08AM): 127/83 HR 111 O2 Sat 100% RR 20.


VAERS ID: 1364636 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis
SMQs:, Neuroleptic malignant 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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. received shot at 7:42 am. At 7:49 am pt. reported that he had a headache, sweats and chills. Monitored pt. He reported no difficulty breathing, no itching. BP at 8:02 am was 115/89 pulse 108 and pt. reported that chills and sweats were gone. At 8:12 am pt said he felt fine except a mild headache on the left side of his head. Pt. left pharmacy at that time. Advised pt. not to get 2nd dose of Moderna vaccine and to consult physician if any other symptoms develop throughout the day.


VAERS ID: 1364652 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Member in observation approx 10 mins after receiving vaccine became diaphoretic with complaints of nausea,. Member then began to vomit x 2.


VAERS ID: 1364654 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WE0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pallor, 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: No information
Current Illness: Unknown
Preexisting Conditions: No
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Syncope. Her face was pale. Within 10 mins she was normal after we apply cold compress.


VAERS ID: 1364672 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: After receiving a Jansen vaccine, pt got up to leave and started to complain that she was dizzy. Then, she slowly lost consciousness in this RN?s arms. Pt was lowered to the floor with her feet elevated in a chair. Pt regained her consciousness quickly and sat up for a while to make sure that pt was not dizzy any longer. After 15 minutes, pt went home with her mother.


VAERS ID: 1364675 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypertension, Oedema peripheral, Palpitations, Refusal of treatment by patient, Tachycardia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (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: Albuterol Montelukast
Current Illness: Denies
Preexisting Conditions: Asthma
Allergies: Denies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 57 y/o female with past medical history of Asthma who presents with palpitations post vaccination administration. Patient states that this is her second dose in the two-dose series. Patient denies previous reaction with first dose. Patient states that received todays vaccination to the R arm. Patient states that she was nervous prior to receiving todays injection and that she suffers from anxiety (undiagnosed). Patient also states that she takes Albuterol daily and Montelukast. This NP explained to patient that Albuterol is a rescue medication and not a controller, that she is taking the medication incorrectly. I advised the patient to follow up with her primary physician to discuss a controller such as Pulmicort instead of using a rescue drug as maintenance. NP, CNO and Paramedics at patient side. Patient with noted peripheral edema. Patient initial vitals showed tachycardia and hypertension. Patient initial vitals (153/88 BP, 127 HR, 98% RA, Resp 16 and EKG Sinus Tachy). Patient states that her palpitations come and go. Patient denies sore throat, difficulty swallowing, chest pain or difficulty breathing. Patient monitored for 30 mins with no improvement of symptoms (Patient remained Hypertensive (171/88, 172/87, 174/94) and Tachycardia (105-127) and it was determined to call Fire Rescue. Fire Rescue assessed patient and advised to seek further medical attention but patient refuses. Patient signed AMA with rescue and patient was provided with the AshBritt Logistics and IEM Health AMA form, patient signed and ambulated off site without difficulty.


VAERS ID: 1364710 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Fatigue, Pharyngeal erythema, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: None
Current Illness: Post nasal drip and seasonal allergies
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt states that prior to receiving vaccine he was having PND and rhinorrhea in the morning which had resolved before he arrived to the vax site. After receiving shot at 1023 pt states he started feeling fatigued, he had intermittent CP located at center of chest, non-radiating that lasted about 10 minutes, he also had a scratchy throat. Pt was given a benadryl PO at 1045. On PE, pt mild pharyngeal erythema, CTAB, RRR, CP had resolved and was non-reproducible, VSS, spO2 98, HR 81. Pt was advised to go to ED or urgent care for further evaluation, by 1100 pt stated he felt fatigued, but had no other symptoms. Pt was walked outside the vaccine facility where he had said his wife would we waiting, wife was not found. Pt was advised to drive himself to the ED/UC and f/u with his PCM the tomorrow morning 02JUN20201, pt verbalized understanding.


VAERS ID: 1364765 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Cough, Dyspnoea, Feeling hot, Flushing, Hypersensitivity, Injection site pain, Nausea, Retching, Sputum increased
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Annual flu vaccines. I have been advised not to obtain annual flu vaccines. Physician advised to get COVID-19 infection if I co
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: several allergies to antibiotics (penicillin), codeine derivatives, citrus products, and prior flu vaccines (protein-based vaccines)
Diagnostic Lab Data: CVS provided diphenhydramine (Benadryl, 25 mg tablets). Recovery from adverse event ongoing; now 90 minutes after vaccine injection
CDC Split Type:

Write-up: 15 minutes after injection started to feel facial flush, heat, nausea, followed in next 10 minutes by difficulty breathing, heavy chest, excessive mucus production, cough, gag on mucus. I have had multiple allergic responses. Controlled full allergic response with 2 diphenhydramine (25 mg each). Met with my personal care physician before COVID-19 vaccination to evaluate risks of vaccination. Doctor advised to proceed to obtain vaccination. Scheduled vaccination on date my husband was available in case of adverse response. 2 hours after injection arm started to hurt similar to what family members have reported as common responses to vaccine.


VAERS ID: 1364803 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-29
Onset:2021-06-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Electrocardiogram ST segment elevation, Myocarditis, Troponin T increased, 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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Allergies: Peanuts, Pollen, Soy
Diagnostic Lab Data: hsTNT 203 then 300. EKG with diffuse ST elevation
CDC Split Type:

Write-up: Myocarditis


VAERS ID: 1364844 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

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

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

Write-up: Fainted, excessive sweating


VAERS ID: 1364847 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine 10mg Omeprazole 20mg
Current Illness: None
Preexisting Conditions: acid reflux. depression
Allergies: NKA
Diagnostic Lab Data: none at this facility
CDC Split Type:

Write-up: fainted. light headedness. vomiting. dizziness


VAERS ID: 1364848 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pharyngeal swelling, Rash, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: PCN Sulfa
Diagnostic Lab Data: Epi 0.3mg given and 25mg Benadryl IM
CDC Split Type:

Write-up: Itchy throat that advanced to swelling, rash both upper arms


VAERS ID: 1364849 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Pt given Vax at 11:11am, about 11:23am pt started feeling dizzy and nauseous. Pt laid on the floor and put feet on the chair. Ice pack provided to forehead at 11:28am, BP 11:31am 97/61 P53. Pt is talking, awake. said she moved her arm and was an influx of pain and that''s what made her dizzy. 11:40am- BP 107/67 P55. pt more awake and feeling better, 11:43am BP 102/74 P68. Pt sat up on her own, ate a few pieces of chocolate. feeling much better 11:52am BP 109/73 P 66 pt was able to stand up and feeling ok


VAERS ID: 1364859 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

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

Write-up: None 2 hours post vaccine


VAERS ID: 1364862 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer dose 1, tachycardia and high blood pressure with mild dizziness and headache
Other Medications: medroxyprogesterone, darbepotein alfa, PRN benadryl, PRN epi, PRN hydrocoritsone
Current Illness: none
Preexisting Conditions: complex medical history including POTS, "gut failure" followed by GI transplant team on TPN, mast cell activation syndrome with multiple allergies, prolonged QTc
Allergies: latex, peanuts, tree nuts, ativan, zosyn, betadine, clonazepam, ketamine, klonopin, ondansetron, tegaderm, cortisporin, vancomycin
Diagnostic Lab Data: none- just did three sets of vitals, all showing only mild tachycardia 100-110 (including her baseline set of vitals prior to vaccine)
CDC Split Type:

Write-up: developed headache and slight dizziness within minutes of vaccine administration.


VAERS ID: 1364873 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Dizziness, Lethargy, Loss of consciousness, Pallor, Unresponsive to stimuli, Vision blurred, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: approximately two minutes after administration of vaccination patient had sat down in waiting area and became lethargic/dizzy/blurred vision. She had passed out with face pale and lips turning blue, minimally responsive. Called 911 and while awaiting for ambulance patient had recovered from all symptoms with the exception of "spotted visions." Observed patient for over an hour while a family member came and upon the time of departure there was resolution of all adverse events.


VAERS ID: 1364880 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 LA / IM

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

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

Write-up: Second dose was unknowingly given 2 weeks apart, not 4. Patient has tolerated well, waited 15 minutes in clinic with no issues


VAERS ID: 1364883 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / UNK RA / 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? 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 dizzy after getting the pfizer covid shot , she mentioned she didn''t eat before she comes in, and kept watching her , making sure she is hydrating , patient said she feels much better, and good to go


VAERS ID: 1364890 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Tunnel vision
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Optic nerve disorders (broad), Retinal disorders (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: felt lightheaded, tunneling of vision, sweating, no LOC--started to feel better after 5-10 minutes vitals stable juice given


VAERS ID: 1364894 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness transient, Malaise, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was told to have a seat in the waiting room for 15 minutes after vaccination. Against medical advice, he left immediately. Employee called the pharmacy and informed us patient was in the bathroom feeling like he was going to throw up, his vision was going black and he was tingling. Our pharmacist brought an epi-pen to the bathroom immediately, however, patient had left the building before pharmacist could evaluate him.


VAERS ID: 1364900 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Patient seemed fine after dose then complained of feeling dizzy. She passed out after sitting down.


VAERS ID: 1364901 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

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

Write-up: Diaphoresis with light-headness and fainting


VAERS ID: 1364905 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-07
Onset:2021-06-01
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Blood test, Limb discomfort, Muscle disorder, Pain in extremity, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Visited clinic,Wednesday 5/19/21 after no improvement. She issued Prednisone and Methocarbomol, and referred me to a sports medicine specialist that I visited on 5/24, Dr did a physical exam, xrays and blood work. Following up with him on 6/7/21. No for certain diagnosis, although he did mention the symptoms were similar to Parsonage-Turner syndrome.
CDC Split Type:

Write-up: Injection on Friday, by Sunday afternoon had severe pain in upper arm/shoulder/neck...debilitating pain. Loss of strength in left arm over the course of the following week, accompanied by extreme discomfort and muscle issues.


VAERS ID: 1364911 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

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

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

Write-up: THE SYRINGE DID NOT FUNCTION PROPERLY. DOSE RAN DOWN PATIENT''S ARM. RPH GAVE ANOTHER DOSE.


VAERS ID: 1364912 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lovenox, insulins
Current Illness: wound vac, and wounds
Preexisting Conditions: diabetic
Allergies: lisinopril and tricor
Diagnostic Lab Data: none- will continue to monitor resident for adverse effects.
CDC Split Type:

Write-up: resident received a 2nd dose of covid vaccine today 06/01/2021. resident consented to the medication. No notation in his chart of a previous vaccine. MD and family notified. Resident was was informed of the medication he was about to receive and did not make mention to the nurse that he had it previously. No adverse effects noted at this time. first dose was 4-2-2021


VAERS ID: 1364916 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Patient had likely syncope. Fainted/felt dizzy after immunization. Patient waited at the pharmacy for 30min until she felt better, then went home.


VAERS ID: 1364921 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Eye movement disorder, Fall
SMQs:, Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Ocular motility 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: she stated that this happens all the time, although it was not indicated on her consent and release form
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient received the vaccine and approximately 5 mins later she fell to the ground, felt weak and eyes rolled back for just a second but did not completely lose consciousness. She was given a chair and she sat for approx 5 mins and when she went to leave the store, she fell to the ground again. Please note, she did not want to wait in the waiting room after the vaccine for the recommended amount of time that the pharmacist indicated.


VAERS ID: 1364940 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 1st dose of Moderna
Other Medications: Gabapentin, Albuterol, flonase, simvastatin, acyclovir, Benadryl, Calcium-VitD, Tylenol
Current Illness: none
Preexisting Conditions: HLD, CKD, MVP w/ pacemaker, osteopenia
Allergies: Alprazolam, Darvocet-N50, Flexeril, Fluoxetine, Naprosyn, nitroglycerin, Oxycontin, Percocet 5/325, Voxx, Zoloft
Diagnostic Lab Data: Pending evaluation in urgent care
CDC Split Type:

Write-up: Dizziness, lightheadedness, hypertension to 180/90


VAERS ID: 1364941 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Electrocardiogram normal, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: 58 y/o female with past medical history of Hypertension who presents with left arm numbness post vaccination. Patient states that this is her first vaccination in the two-dose series. Patient denies previous reactions to vaccinations in the past. Patient states that she received the vaccination to the Left arm. Patient states that her left arm feels numbness or like it has fallen asleep. NP and Paramedics at patient side. Patient with equal pulses to bilateral upper extremities, cap refill less than 3 seconds, patient with FROM of the left upper extremity. Patient denies sore throat, difficulty swallowing, difficulty breathing and/or chest pain. Instructed patient to move/exercise the left upper extremity. Patient with Hypertension on initial vitals, 173/104 BP, 98% RA, 78 HR, 12 Resp, EKG NSR. Patient states that she took both of her blood pressure medications this am (Losartan and Hydrochlorothiazide). Within 30 mins patient with resolution of left arm numbness but hypertension remained. BP taken siting, lying, standing with no improvement. Patient BP increased to 182/107 and Rescue notified. Fire rescue was delayed in arriving. Patient was monitored by NP and Paramedics for over an hour. Once rescue arrived patient BP normalized to 150/99. Patient refused transport to ER. Patient signed AMA with rescue and patient was provided with the AMA form, patient signed and ambulated off site without difficulty.


VAERS ID: 1364947 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-28
Onset:2021-06-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Patient complaint of shortness of breath and dizziness after receiving Covid 19 2nd dose. Felt as if her throat was constricting. Vital signs assessed and WNL. Patient stated symptoms were subsiding a few minutes after noticing and decreasing in severity. Patient was monitored for 45 minutes and displayed no signs of distress with vital signs remaining normal.


VAERS ID: 1364959 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: patient first dose of Covid 19 vaccine was Modena, but for second dose Pfizer vaccine was given to patient mistakenly.


VAERS ID: 1364963 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced syncope upon getting up from the chair after getting the shot


VAERS ID: 1364987 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-05-31
Onset:2021-06-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Patient mom says that son has tightness in chest when he breathes in and feels short of breath. Started sometime this morning.


VAERS ID: 1364990 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypertension, Palpitations, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (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: Denies
Current Illness: Denies
Preexisting Conditions: Anxiety
Allergies: Cephalexin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 37 y/o female with past medical history of Anxiety who presents with palpitations 10-15 mins post vaccination. Patient states that she received the Johnson vaccination. Patient states that the vaccination was placed to the left arm. Patient denies previous reaction to vaccinations in the past. Patient denies pregnancy. Patient denies sore throat, shortness of breath and/or difficulty breathing. Patient states that she is an anxious person. Patient initial vitals with noted Hypertension, 166/91 BP and Tachycardic 110, all other vitals within normal limits. Patient monitored for 15 mins with resolution of palpitations. Patient vitals reassessed and patient normotensive, 138/81 BP, all other vitals normal and patient discharged in stable condition.


VAERS ID: 1364999 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-22
Onset:2021-06-01
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Full blood count abnormal, Haematocrit increased, Phlebotomy, Polycythaemia vera
SMQs:, Haematopoietic leukopenia (broad), Blood premalignant disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrea 500 mg Lisinopril 30 mg Aspirin 82 mg Nattokinase 400 mg
Current Illness: N/A
Preexisting Conditions: Polycythemia Vera
Allergies: Intravenous dye
Diagnostic Lab Data: CBC Jan 22 2021 CBC Feb 19 2021 CBC and Phlebotomy April 22 2021 CBC June 1 2021 Phlebotomy tk
CDC Split Type:

Write-up: I believe this vaccine has increased my production of RED BLOOD CELLS to require, so far, two phlebotomies within a three-month timeframe. I have a chronic condition that requires me to take chemo drug orally, Hydrea, to suppress HEMATOCRIT or red blood production. I have taken this drug for approximately 10 years with no adverse reactions. In 2020, I only required one (1) phlebotomy for the entire year to keep my hematocrit below 45. I received my normal course of one phlebotomy per year (usually not more than three per year) on January 25, 2021, however, after receiving the Moderna Covid-19 vaccine Jan 22 2021, my hematocrit has been above 46, requiring phebotomies on April 22,2021, and again in June 2021. Highly irregular. Nothing in my life or disease has changed. This was caught because my doctor and nurse have been checking my numbers now every six weeks instead of every three months. I need to double my Hydrea and go back in 6 weeks.


VAERS ID: 1365026 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Client developed a reaction to 2nd dose of COVID-19 vaccine. Client described symptoms as a burning sensation on top of her left hand. At 8:32am on 6/1/21. Client refused vital signs. Ice pack was given. Client verbalized feeling better. Client exited the facility at 8:50am.


VAERS ID: 1365035 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

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

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

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


VAERS ID: 1365041 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1365049 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Client verbalized feeling anxious and his heart was racing. Client was observed/evaluated by Fire Rescue. Client was observed for additional 15 mins. Client was cleared to exit the facility at 11:26am. Per Fire Rescue, client stable no further evaluation needed.


VAERS ID: 1365066 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenopia, Feeling hot
SMQs:, Corneal 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: after patient received shot she was sitting in waiting area and within 5 minutes started fanning herself. I went to check on her and she said she was hot and started to close her eyes. I helped her to lay down and had technician get her a wet rag. Once she said she was ok we moved her out of the main aisle and let her lay with cold compress until she was feeling ok and her mother came to make sure she was ok.


VAERS ID: 1365072 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Incoherent, Seizure, Staring
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient does not fill medications at this pharmacy. This pharmacy was administering Covid 19 Moderna vaccine. It is noted that patient has a history of seizures on consent form.
Current Illness: History of seizures
Preexisting Conditions: History of seizures
Allergies: none
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient has a history of seizures. Patient received 2nd dose of Moderna Covid 19 vaccination. They did ok with the first vaccine. Approximately 5 minutes after receiving the vaccine the patient had a blank stare, which the caregiver noted and informed staff that patient was having a seizure. Within 30 seconds the patient was jerking, had clenched fists, and was not coherent. The caregiver was able to keep the patient in the chair and keep her from hitting her head. After jerking motions stopped the caregiver was able to contact the person responsible for medical decisions for patient and mother decided that she need to be taken to the hospital. EMS arrived and took patient to the hospital within 15 minutes after seizure. Patient was alert and oriented when EMS arrived.


VAERS ID: 1365104 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type: 10045664352

Write-up: INMATE INSISTED HE HAD NOT HAD THE COVID-19 VACCINE PREVIOUSLY. WAS GIVEN A SECOND DOSE OF THE JANSSEN VACCINE. INCIDENT DISCOVERED 3 HOURS LATER. INMATE WAS EXAMINED AND MONITORED. TEMP 97.4, BP 130/80, PULSE 76, RR 20. INMATE DENIES HEADACHE, CHILLS, BODY ACHES, UPSET STOMACH, AND FATIGUE. INMATES STATES THAT "HE FEELS FINE." HE HAD NO REACTION TO HIS FIRST VACCINE, JENSSEN, WHICH WAS GIVEN 3/25/21. DEPUTIES ARE MONITORING HIM FOR SYMPTOMS.


VAERS ID: 1365134 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RL / SC

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Dyspnoea, Erythema, Pruritus, Skin abrasion, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: I evaluated patient, following her shot today. She had 2nd dose Moderna at about 11:40 AM. She was complaining of generalized itching, throat tightness, and shortness of breath following her shot. She has a h/o multiple drug & environmental allergies. She has used an epipen many times before, last was about a year ago for a bee sting. She had her 1st dose Moderna last month and had pruritus and throat swelling, but this feels worse. Last time she took Benadryl here, and was monitored for about 2 hours. She refused an epipen that time or to go to the ED. On exam, she is mildly anxious, constantly scratching at neck, chest, and lower back. Lungs remain clear, but somewhat diminished. Heart regular. No rash, except for redness from scratching/excoriation. Patient had her atrovent inhaler and took two doses. She had taken Benadryl & Pepcid around 9 AM this morning. By 12:20 PM the patient said she was feeling worse. She agreed to treatment with an epipen, which she self-administered. EMS was called, and arrived around 12:35 PM. She was taken quickly to the ambulance and then to ED.


VAERS ID: 1365136 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient was given the Moderna vaccine for her 2nd Covid-vaccine and was originally given the Pfizer vaccine for her first dose. At this time no adverse effects have been reported


VAERS ID: 1365146 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-30
Onset:2021-06-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Ear pain
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: Keppra, Lamictal
Current Illness: N/a
Preexisting Conditions: Epilepsy
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Ear ache in left ear, same side vaccine was given.


VAERS ID: 1365151 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hypopnoea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

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

Write-up: Upon completion of administration, patients eye were closed and stated she felt faint. Patient became pale and breathing shallow and vomited once. Patient received an ice pack on back of neck and remained sitting with legs elevated on another chair. 911 was called and patient was taken by EMS.


VAERS ID: 1365155 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chromatopsia, Cold sweat, Dizziness, Gait disturbance, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received the 2nd COVID vaccine (Pfizer, Lot #: EW0185 and expiration date: 08/31/2021) on the left arm at 0918. Patient hailed medics attention and complained of "nausea, seeing purple, and lightheadedness" at 0921. Patient was conscious, alert, and oriented x4. Patient''s skins were normal for ethnicity, moisture and temperature. Pupils were equal, accommodating, and reactive to light. Patient appeared anxious and was coached by medic on her breathing. Signs and symptoms began about 2 minutes status post vaccine, but patient claimed no previous reaction with 1st dose. Patient denied any pertinent medical history, allergies, or medications. At 0923 patient was still conscious, alert, and oriented x4 and pupils were still equal, accommodating, and reactive to light. Patient then complained of "seeing everything in purple color," then stated she "could not see anything at all." Medic held up 5 fingers and patient advised she could not see them. Patient began to look pale and skins felt moist and warm. Patient was able to walk with assistance to anti- gravity chair. Nurse then responded to Medic with patient. Baseline vital signs were taken by Medic at 0926, while patient was sitting: blood pressure: 98/60, heart rate: 60, respiratory rate: 16. Patient stated that she runs cross country and that these vital signs were of normal range for her. Patient was given water to sip on. Color and moisture of skins were slowly pinking/drying up. Patient initially experienced nausea and lightheadedness but denied chest pain, shortness of breath, headache, dizziness, or blurry vision. Nurse informed the patient''s mother, who was waiting outside, of the situation and brought the mother inside to the patient. At 0935, patient was able to stand her own, with a steady stance. A second set of vitals were taken: blood pressure: 100/64, heart rate: 60, respiratory rate: 14. Patient was negative for orthostatic pressures. Patient stated that symptoms had resolved and that she "felt better, just tired." Patient remained in the observation area for an additional 15 minutes. Patient was conscious, alert, and oriented x4 and skins were normal for ethnicity, moisture, and temperature at 0949. Patient able to walk on her own accord with a steady gait. Mother was driving personal vehicle. Mother and patient were educated on when to contact their primary care physician with any other concerns and when to call 911 if symptoms warrant or when go to ED.


VAERS ID: 1365162 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / SYR

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

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

Write-up: Pt started having itching, no signs of hives or respiratory distress. Gave certirizine had patient wait.


VAERS ID: 1365167 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: B/P 114/72, 02 SAT 99%RA , HR 95 RR 20
CDC Split Type:

Write-up: Patient stated that she is feeling dizzy, nauseous, and shaky. patient is 3 months pregnant. Assessed done by the paramedics. patient stabilized and sent home in stable condition. No hospitalization needed.


VAERS ID: 1365186 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 10808978 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: B/P 106/65 HR 64 02 95%RA
CDC Split Type:

Write-up: PATIENT COMPLAINED OF DIZZINESS AND ALSO STATED THAT HE FEELS LIKE HE WANTS TO FAINT. ASSESSED DONE AND PATIENT SENT HOME IN STABLE CONDITION.


VAERS ID: 1365190 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: Pt received 2nd dose of vaccine after 15 days AMA after being informed of CDC recommendations.


VAERS ID: 1365191 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device connection issue, Exposure via skin contact, Immunisation, Needle issue, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Drew up dose in Safety Syringe. at administration, due to the lurer lock not being tight enough, the pressure of pushing the vaccine into the muscle caused the connection to come apart. the needle tip stayed in the patient''s arm as I held the barrel. The serum did not go into patient''s arm, instead sprayed onto the patient''s arm and shirt. I was able to remove the needle tip from her arm without incident. Administered a new dose into same deltoid muscle. Patient reports arm swelling. Advised to apply ice intermittently.


VAERS ID: 1365193 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 5 LA / IM

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

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

Write-up: SYNCOPE IS WHAT PATIENT EXPERIENCED. PATIENT LOST CONSCIOUS COUPLE MINUTES AFTER RECEIVING THE VACCINE. SHE FALL OFF THE CHAIRE SHE WAS SITTING AT , BUT WOKE UP DIRECTLY AFTER. PATIENT DID NOT HIT HER HEAD AGAINST THE FLOOR, NOR DID SHE HAVE ANY INJURY OTHER THAN A SCRATCH ON HER ARM. SHE WAS ALLERT, ORIENTED AND HAVE PROVIDED ME WITH EVERY SINGLE INFORMATION I NEEDED TO COMPLETE THIS REPORT. SHE LEFT THE PHARMACY WITH HER FATHER.


VAERS ID: 1365199 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Somnolence, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 was noted to be sleeping in the observation area at 12:42 pm. Staff member went over and tapped his on the shoulder when he did not immediately rouse to her asking if he was ok. He woke up and was alert and oriented, by stated that he was lightheaded. He was escorted to the cot and place on his left side. No tachypnea or dyspnea. HR 84 BP 136/98 O2Sat 99%. Two RN''s stayed in attendance with him. At 13:24 he stated that he was feeling much better and denied any further lightheadedness. HR 86 BP 128/82 O2Sat 98%. He was assisted to a sitting position and then a standing position without any lightheadedness. At 1:30 pm he was discharge to home with his friends in attendance.


VAERS ID: 1365200 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO178 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Throat tightness, Unresponsive to stimuli, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vicodin, atenolo, zoloft, diamox
Current Illness: fibromyalgia, becketts disease
Preexisting Conditions: asthma, fibromyalgia, becketts disease
Allergies: unk
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: Client requested to lay on stretcher for vaccine, provided. Almost immediately following vaccine, client closed eyes- briefly did not respond to name. Skin warm and dry, strong steady pulse. Responded to verbal stimuli, complained of throat tightening and wheezing. EMT called to client pod. vss. HR76, BP 109/74, sat 97 on room air. Client then closed eyes again, briefly did not respond - then opened eyes . vs''s continued stable. As per EMT positive slight wheeze. Ambulance arrived and client transported to ER.


VAERS ID: 1365205 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Diphenhydramine 50mg/mL IM
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After being vaccinated, patient began to experience numbness of the tongue that later extended to the throat.


VAERS ID: 1365215 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Posture abnormal, 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), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: he said he had fainted before
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: paramedics came and checked his vitals which were normal, patient declined to go to hospital
CDC Split Type:

Write-up: about 5 minutes after patient received shot , he came to pharmacy counter to say he felt light headed, as I ( the pharmacist) headed out to have him sit down, dropped to a sitting position on the floor, I was able to get him up to a chair and was fanning him and we got him some water. he the passed out and his lead lobbed backwards, I got behind him so he did not hit his head and he went into a mini seizure which only lasted about 5 seconds and then he came out of, he was in sweats and we called 911. He declined to go to hospital and his mom came and picked him up


VAERS ID: 1365220 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-24
Onset:2021-06-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion, alprazolam, pantoprazole, sumatriptan, ozempic, triamterene-hctz, metformin. hydroxychloroquine
Current Illness: none per patient
Preexisting Conditions:
Allergies: flexeril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA


VAERS ID: 1365225 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: patient received vaccine and was light headed and fell twice. had patient sit and have oral glucose gel and her color came back and after 20 minutes patient seemed okay and left with mother


VAERS ID: 1365233 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-22
Onset:2021-06-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Menstrual disorder
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:
CDC Split Type:

Write-up: My period started again after 3 days if taking my second dose. My last period prior started on 05/05/21


VAERS ID: 1365236 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Injection site haemorrhage, Injection site swelling, Loss of consciousness
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), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: She bleed at the injection site . Held cotton ball to injection site for about 1&1/2 minutes until the bleeding stopped. There was swelling at injection site. About 2 minutes later after Band-Aid had been applied she passed out and fell to the left. Immunizer caught her just as her head hit the counter top. Held her until she came to for about one minute. Room was closed and could not call for help. Patient then put her head between her legs and started to feel better and decided to walk out of immunization room after about 5 minutes to sit in waiting room. Got her a bottle of water and patient said she wanted to lie down. Went to immunization room and patient laid down for about 15 minutes. Immunizer kept her talking and watched for any reactions. Patient then said she was okay and sat in waiting room for another 10 minutes before leaving.


VAERS ID: 1365237 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Loss of consciousness, Pallor, 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), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received his Janssen Covid-19 immunization. The patient arrived at 11:00am on 6/1/21 and completed his pre-screening questions and temperature check. The patient then completed his "Patient Questionnaire and Consent Form." The patient was administered his Janssen Covid-19 vaccine around 11:05am. About 2 minutes after administration, the patient appeared pale and sliding out of his chair. The pharmacy technician responded and held the patient under his arms. The patient convulsed and then became unconscious. We called 911, checked the patient for breathing and responsiveness. The patient didn''t stop breathing and became conscious about 1 minute after losing consciousness. We placed the patient on the floor and placed cold compresses under his neck and on his wrists. EMTs arrived and evaluated the patient and made sure the patient was stable. EMTs offered to take the patient to the hospital but the patient declined.


VAERS ID: 1365238 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Nausea, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACCU-CHEK FASTCLIX LANCET DRUM Misc acetaminophen (TYLENOL) 500 MG tablet albuterol 90 mcg/actuation inhaler alcohol swabs (ALCOHOL PADS) ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG EC tablet blood sugar diagnostic (ACCU-CHEK AVIV
Current Illness:
Preexisting Conditions: Cardiovascular and Mediastinum Essential hypertension Hypertension associated with diabetes Respiratory Bronchiectasis without complication Digestive Gastroesophageal reflux disease without esophagitis Dysphagia Endocrine Multinodular goiter Hyperlipidemia associated with type 2 diabetes mellitus DM (diabetes mellitus), type 2, uncontrolled Musculoskeletal and Integument Primary osteoarthritis involving multiple joints Lumbar facet arthropathy Arthritis of carpometacarpal joint of left thumb Other Mixed hyperlipidemia History of breast cancer Obesity, morbid, BMI 40.0-49.9 Chronic bilateral low back pain without sciatica Weakness of trunk musculature History of sarcoidosis Pain of both breasts Bronchorrhea Cough Sarcoidosis
Allergies: CodeineUrticaria / Hives (ALLERGY), Shortness Of Breath (ALLERGY/intolerance) Demerol [Meperidine]Urticaria / Hives (ALLERGY), Shortness Of Breath (ALLERGY/intolerance), Nausea & Vomiting (ALLERGY/intolerance) Iv Dye [Iodinated Contrast Media]Anaphylaxis (ALLERGY), Urticaria / Hives (ALLERGY) OtherShortness Of Breath (ALLERGY/intolerance), Itching / Pruritis (ALLERGY/intolerance) TetracyclineUrticaria / Hives (ALLERGY), Shortness Of Breath (ALLERGY/intolerance), Itching / Pruritis (ALLERGY/intolerance) Venom-honey BeeAnaphylaxis (ALLERGY), Urticaria / Hives (ALLERGY), Shortness Of Breath (ALLERGY/intolerance), Itching / Pruritis (ALLERGY/intolerance) Multihance [Gadobenate Dimeglumine]Respiratory Distress (ALLERGY/intolerance) Nubain [Nalbuphine]Itching / Pruritis (ALLERGY/intolerance) TramadolItching / Pruritis (ALLERGY/intolerance), Nausea & Vomiting (ALLERGY/intolerance)
Diagnostic Lab Data: POCT Fingerstick Blood Sugar- 140
CDC Split Type:

Write-up: -nausea/vomiting, wooziness(light headedness) -was evaluated -was given Zofran for nausea


VAERS ID: 1365247 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-06-01
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Lightheadedness; Heart palpitations EMS at bedside.


VAERS ID: 1365258 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle spasms
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Post vaccine pt started feeling crumps on the right side of the chest and in the right arm. Pt reported to feel better after moving the arm and massaging the right side of the chest. Pt reported to have had breast cancer and has experienced crumps in the same area before. Vitals obtained and monitored. Pt was released at 1515. 1507 SITTING BP 168/82 HR 76 SpO2 98%


VAERS ID: 1365270 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: Was called to patient observation area, pt slide out of chair to floor stated she felt light headed and was going to pass out. Pt commented that she was fasting. Vital signs obtained, pt was hypotensive BP 65/52 P 63, R 16 pusle ox 98% RA. Pt was transported by wheelchair to a private observation room and was seen by Dr. who encouraged pt to drink fluids and eat some crackers. Pt was observed for another 30 min, vital signs at discharge BP 97/63 P 71 R18 pulse oximetry 100%. Pt stated that she was no longer light headed.


VAERS ID: 1365274 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

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

Write-up: 10-15 minutes after injection felt lightheaded/loopy--similar to 1st dose. vitals stable water given observed in car for an additional 20-30 minutes


VAERS ID: 1365283 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Patient felt faint, dizzy right after vaccine given


VAERS ID: 1365286 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO178 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall, Hyperhidrosis, Malaise, Pallor, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Immediately following vaccine, client c/o not feeling well, broke out in a perfuse sweat, started to lean into mom, c/o dizziness and light headedness, pins and needles, pale. EMS to pod : BP 85/44 HR 64 o2 sat 94-96. Client observed for one hour by EMS, vs''s returned to baseline, fluids encouraged. Client transitioned home as per EMS.


VAERS ID: 1365315 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: NA
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 13 year old patient became diaphoretic and lost consciousness. He immediately woke up and vitals were normal. Parent denies any previous health conditions or syncopal episodes.


VAERS ID: 1365331 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Florinol 0.1mg Cortif 10mg, synthroid 50mcg
Current Illness: none
Preexisting Conditions: bilateral hearing loss, hypothyroidism, diabetes
Allergies: Dust mites
Diagnostic Lab Data: N?A
CDC Split Type:

Write-up: After injection pt stated he was light headed and dizzy. Pt assessed BP92/55 P63 R 16 pulse oximeter 99% room air. Pt laid down with feet elevated, pt stated he had not eaten today. MD notified, continue to observe pt after eating a snack. Pt was observed by RN for 30 min. at time of discharge pt BP 95/55 p 61 pulse oximeter 98%. with no further complaints


VAERS ID: 1365339 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient got the first dose somewhere else and came to us for 2nd dose. He stated it was time for his 2nd dose. He didn''t the vaccine card with him. We gave the shot and advised him to return to the first location to get the card. He came back later with the card and we found out that he wasn''t due for the 2nd one yet (7 days earlier).


VAERS ID: 1365340 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Skin of right inferior medial mid back; biopsy by punch method - Subacute spongiotic dermatitis with eosinophilia (see below) erythematous scaly patches CLINICAL IMPRESSION Dermatitis Unspecified vs. Hypersensitivity Reaction vs. Contact Dermatitis Other GROSS DESCRIPTION Received in formalin fixative is a 0.4 cm punch x 0.2 cm which is inked black and bisected for histologic evaluation. GROSS DISCLAIMER (Gross Description measurements may be up to 1/3 smaller than actual size due to contraction during the fixation process) MICROSCOPIC DESCRIPTION The specimen reveals hyperkeratosis, parakeratosis, and spongiosis. A perivascular infiltrate of lymphocytes, histiocytes, and eosinophils is encountered. The histologic findings are those of a subacute spongiotic dermatitis with eosinophilia. The histologic findings support the clinical impression of allergic contact dermatitis. Atopic dermatitis, irritant dermatitis, as well as other causes of subacute spongiotic dermatitis with eosinophilia are all possibilities. Clinical correlation is required.
CDC Split Type:

Write-up: Received first COVID Vaccine in May 2nd; Rash developed post vaccine May 9th. Biopsy collected on 5/34, findings consistent with Cutaneous reactions reported after MODERNA and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. Journal of the American Academy of Dermatology. April 2021 (Online ahead of print).


VAERS ID: 1365342 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: shogrens , high bloiod pressure, baby aneurysm
Allergies: sulfur, amoxicillin, cephalexin, nizoral, doxycycline, household cleaners, dogs, cats, pollen, distmites, corticosteroids, benedryl, zyrtec, claritin
Diagnostic Lab Data:
CDC Split Type:

Write-up: itching on scalp, back of neck, red arm


VAERS ID: 1365349 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site indentation
SMQs:

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

Write-up: patient says she is having no pain or redness at the injection site, but there is a divot where the vaccine was administered. She says it is like the muscle tissue is gone. it is a small area and is only found upon feeling the area. patient is going to monitor the area and keep us updated.


VAERS ID: 1365360 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

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

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

Write-up: VACCINE GIVEN AFTER 42 DAYS AT PATIENT REQUEST


VAERS ID: 1365362 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Dizziness
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6/1/2021 Pt was observed post Covid-19 immunization for 15 minutes . During the observation period, she experienced an adverse reaction with the following symptoms: " feeling faint". Assessment : Time of assessment 355p. Complains of feeling faint, chest tightness, anxious. Actions taken: Vitals sign taken VAERS form obtained and completed by RN. VS at 3:55p- BP- 139/92, P- 83, O2- 100%, 4pm- BP- 131/89, P- 87, O2-- 100%, voices that she does have a history of anxiety, 4:05p BP- 132/80, P- 68, chest tightness resolved per patient, 4:10p BP- 133/80, P- 68, sitting up with no complaints, family here with patient Medications administered: No medication administered. Disposition: Reports no further symptoms of adverse reaction after observation for 30 minutes. Discharged home. Immunizations Administered Name Date Dose VIS Date Route Pfizer COVID-19 Vaccine 6/1/2021 3:35 PM 0.3 mL 2/25/2020 Intramuscular Manufacturer: Pfizer, Inc Lot: ER8736 NDC: 59267-1000-2


VAERS ID: 1365369 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: Fluoxetine 20 mg capsules, bio 3bg, black elderberry thousand mg, strand of men, black Spanish radish, hemp oil complex, vitamin C 1000mg, vitamin D3 50000 IU one time a week, magnesium threonate, calcium lactate, Aller Tec antihistamine, l
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Dairy sensitivity.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy lump in elbow crease.


VAERS ID: 1365374 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

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

Write-up: "Pt feels throat closing, reports mild shortness of breath. Patient is alert and able to communicate clealry- Speech is clear. No stridor. Lungs clear. Patient is not in apparent distress. Patient is accompanied by her father. 11:14 am patient reports slight improvement of throat swelling. Reports resolution of dyspnea. Discussed after care with patient and father-- follow up with PCP and ask for referral to allergist to clear patient for 2nd dose of Pfizer vaccine. 11:22 patient left via wheelchair with her father. Patient reports "less tightness of throat"" and resolution of dyspnea."


VAERS ID: 1365375 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: Needle hub detached from the syringe, pt received at least 50% of vaccine, no additional vaccine given


VAERS ID: 1365386 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Eye movement disorder, Feeling drunk, Feeling hot, Nausea, Neck pain, Nervousness, Posture abnormal
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Arthritis (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: Asthma Calcification of coronary artery Calcification of coronary artery Chronic low back pain Fatigue Gastritis IBS
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented today for first covid 19 vaccine. At 11:59 am (14 minutes) pt reports feeling nauseated and having sharp pain on left side of shoulder that radiates to neck. Pt indicated that this pain was new. Pt then tilted head back and eyes rolled. Pt reported feeling hot and stated she felt drunk. Pt also reports sob. Denies any constriction of throat. No labored breathing noted. Respirations normal, O2 at 2 liters applied. Doctor made aware and presented at pt''s side. Vitals obtained. Pt reported to Doctor that pain is gone. Continues to report feeling weak and shaky. Blood sugar 126. Doctor offered pt juice and crackers if needed. Pt indicated she is okay at this time. O2 remained in place. Will continue monitoring pt.


VAERS ID: 1365394 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Heart rate increased, Hyperhidrosis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Paramedics called 6/1/21
CDC Split Type:

Write-up: Increased blood pressure, increased HR, sweating, numb hands


VAERS ID: 1365397 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Sensation of foreign body
SMQs:, Anaphylactic reaction (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: 30minutes after injection having a sensation in back of throat--lump--no difficulty talking, swallowing, breathing no itchiness vitals stable 97%, HR84 gave oral benadryl, patient refused. observed in car for 45 minutes


VAERS ID: 1365398 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Head injury, Headache, Syncope, Tinnitus, Vital signs measurement
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None Reported
Diagnostic Lab Data: EMTs assisted and reported his vitals, including blood sugar, were normal
CDC Split Type:

Write-up: Pt received 1st Moderna covid vaccine at approx 10:25am with no apparent issue. He was sitting outside pharmacy in observation area playing on cell phone and approximately 10 minutes after receiving vaccine fell in the floor, hitting his head. EMTs were called immediately as a precaution. He was conscious when pharmacist reached his side. He reported remembering a buzzing in his ears and then woke up in floor. Pt reported no hx of seizures or fainting. He remained in floor for several minutes, reporting his head hurt, but was able to tell his name, location, and date with no issue.


VAERS ID: 1365402 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

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

Write-up: Patient received vaccine and after a few minutes patient had seizure.


VAERS ID: 1365417 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-04-16
Onset:2021-06-01
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

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

Write-up: Patient was beyond the 6 week deadline to receive vaccine.


VAERS ID: 1365418 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-14
Onset:2021-06-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol 0.05mg, Singulair 10mg, Citalopram 20mg, ProAir HFA 90mcg, Fluticasone 50mcg, Advair diskus 250mcg/50mcg
Current Illness:
Preexisting Conditions: Depression, Anxiety, Intermittent Asthma
Allergies: Mold, Pollen, Animal Dander
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received a total of 5 vaccines given at multiple sites


VAERS ID: 1365423 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysphagia, Heart rate, Oropharyngeal discomfort, Oxygen saturation, Tongue disorder, Vital signs measurement
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

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

Write-up: Patient was into clinic for dose 2 of moderna vaccine. Patient reports allergies to Topamax, Macrobid, and gluten. Patient states that after first vaccine she had tingling in the arm but desires to continue for dose 2. Patient was given vaccine using aseptic technique to left deltoid at 2:27 pm. Around 2:30 patient reports that was hard to swallow and tongue was beginning to feel thick. Vitals signs 116/82, heart rate 100, sats 98% on room air. Around 2:43 vital signs 122/82, heart rate 91, and sats 98%. No shortness of breath noted. Patient reports that was getting harder to swallow and that tongue was still feeling thick. Epinephrine was given to left anterolateral thigh via EpiPen and 50 mg Benadryl to R arm. EMS was activated. At 2:48 vitals signs were: 128/74 108 98% on room air. At 2:53 vitals 135/78, heart rate 99, sats 98% on room air; patient reports that "throat still feels fuzzy but tongue feel better". At 2:54 EMS arrived. Vital signs per EMS staff were 138/79, 101, and 93% on room air. At 2:59 with assistance with EMS staff patient was stood up and vitals were 126/90, no hives were noted. At 3:02 patient refused to be treated via ambulance to ER but will have friend who had accompanied patient to the appointment take her to ER. It was stressed by all nursing staff and EMS that this is recommended. Patient never lost consciousness.


VAERS ID: 1365435 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

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

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

Write-up: patient had a headache, felt very dizzy and "jittery" after her vaccine - did wait the 15 minutes but after about 15 more minutes needed to sit down again


VAERS ID: 1365439 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Patient started having generalized itching over whole body


VAERS ID: 1365444 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-12
Onset:2021-06-01
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ovarian Cysts (one ovary has been removed)
Allergies: None
Diagnostic Lab Data: I had an MRI, EKG, and chest X-rays done at the hospital but they said everything looked fine.
CDC Split Type:

Write-up: I went to the bathroom and realized I had gotten my period and was feeling lightheaded, I went to go get water and passed out while walking, my moms found me and called an ambulance, I had an MRI. EKG, and chest X-rays done at the hospital, they said I was fine but I have never passed out before, especially from my period.


VAERS ID: 1365446 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Feeling hot, 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: influenza 2 years ago
Other Medications: none
Current Illness: none
Preexisting Conditions: "mild" cerebral palsy, mom states not sure, mom states not treated
Allergies: lamotrigine
Diagnostic Lab Data: na
CDC Split Type:

Write-up: 10 minutes after vaccine patient stated she felt warm and clammy, gave her sip of water and cold rag, after 25 minutes she stated she felt a little better and wanted to go to bathroom, had syncope event on way to bathroom and passed out. 10 minutes vomitted. did not want to go to er and mom did not want her to. mom took her home.


VAERS ID: 1365451 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

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

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

Write-up: The patient received Pfizer for their first dose and Moderna for the second dose. No signs/symptoms reported yet.


VAERS ID: 1365453 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-30
Onset:2021-06-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Metabolic function test, Pericarditis, Troponin
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: chest pain starting at 7:30 AM, not relieved by Tylenol. Went to pediatrician office where EKG showed ST elevations in II, III, aVF. On arrival to ED EKG findings more consistent with pericarditis.


VAERS ID: 1365469 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Neck pain, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (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: Unknown
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient fainted and urinated. He said he was feeling pain briefly in his neck. He also said he had pain in his right chest. He laid down for 40 minutes. He did not want us to call an ambulance. He had someone pick him up and he said he was going to the emergency room.


VAERS ID: 1365477 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fainted before, not aware from which vaccine. (has major vaccine anxiety)
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was getting their 2nd covid immunization. They marked that they once had fainted from a previous immunization and had needle anxiety. I asked her if she had fainted anytime recently or during the first covid vaccine and she said no. Gave her the vaccine and let her remain in the chair. She then had gotten a little dizzie for a moment, and then told us she had just fainted. We called store management code white. We got her history, some soda, and ice pack. She didn''t fall out of the chair but thought it would help her feel better. She stated she hadn''t eaten much today and just got done working out at the gym and had low blood sugar. We checked her pulse Ox and heart rate and everything was within normal limits. We had her remain to she felt comfortable to leave. She didn''t have any HX of seizures and and no signs of allergic reaction. Staff Said when she was here first time she had immunization anxiety and hung out for 40ish minutes but didn''t faint first time.


VAERS ID: 1365491 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 RA / IM

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

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

Write-up: Patient received 2nd dose of Moderna. About 5 mins post vaccination patient felt hot, dizzy and faint. She motioned for help to her mother and mom notified the pharmacist on duty. Patient appeared to loose consciousness for a few seconds and then came back to. Pharmacy assisted in lowering patient to floor so she did not fall. We applied cool compress as she was very hot and we called 911. Ambulance arrived and took patient to hospital.


VAERS ID: 1365495 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, 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), Guillain-Barre syndrome (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient appear to have seizure just after receiving the vaccination. After apparent seizure or loss of consciousness patient appear weak and had a hard time answering questions. 911 was called and patient transported for medical care.


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