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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 219 out of 4,799

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VAERS ID: 1367862 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Systemic: Dizziness / Lightheadness-Medium


VAERS ID: 1367864 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Anxiety, Dizziness, Fall, Flushing, Hyperhidrosis, Mouth haemorrhage
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Stomach aches-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Pt started feeling lightheaded 1-2 minutes post-vaccination at 2:50PM and fell down on her backpack. Pt was conscious and mouth showed mild bleeding. RPh on duty had pt lie down on floor with both legs raised on chair and continuously monitored pt''s BP and pulse. Pt''s BPM was 109/73 and pulse was 88 at 3PM. Of note, pt reported PMH of vertigo x7 years and attributed her lightheadedness to anxiety. At 3:20PM, pt recovered and was able to stand and walk on her own.


VAERS ID: 1367865 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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), 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: Fainting/Unresponsive-Mild.


VAERS ID: 1367869 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

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


VAERS ID: 1367871 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Stomach aches-Mild, Systemic: Flushed / Sweating-Medium, Additional Details: Pt started feeling lightheaded and signs of flushing at 3:05PM post-vaccination. RPh had pt lie down on the floor and continiously monitored BP and pulse. BP and pulse were 96/55; 52 and 122/74; 80 at 3:08PM and 3:17PM, respectively. Pt had no relevant PMH and attributed his lightheadness to anxiety and witnessing his partner experience vertigo post-vaccination. Pt fully recovered and left the pharmacy at 3:35PM. Pt''s temp was 95.5 F at 3:24 PM.


VAERS ID: 1367872 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Hypoaesthesia, Pain, Pain in extremity, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Olmesartan and Contrave
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 104.5 fever, severe headache, left leg and left arm pain and numbness, body aches, chills


VAERS ID: 1367875 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1367879 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pruritus, Nausea, Pruritus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Itching at Injection Site-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Allergic: Itch Generalized-Mild, Systemic: Headache-Mild, Systemic: Nausea-Mild


VAERS ID: 1367880 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

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

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

Write-up: Immediately after vaccine patient stood up and became dizzy and passed out. B/P 95/61 at 6:02 had patient lay down and gave crackers and juice. B/P 101/65 at 6:39. Patient was feeling better and left with significant other


VAERS ID: 1367884 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Systemic: Allergic: Rash Generalized-Mild


VAERS ID: 1367888 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Memory impairment, Nausea, Seizure, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient received first dose of vaccine with her mother. Prior to administration, patient mentioned she was anxious receiving shots having a history of fainting. Immediately after administration, patient stated that she was relieved. About 2 minutes later, patient''s mother called for the pharmacist for help claiming patient was having convulsions and was unconscious. Paramedics were called. Patient regained consciousness after 20 secs with nausea & no recollection of loss of consciousness.


VAERS ID: 1367895 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood pressure decreased, Chills, Dizziness, Dyspnoea, Feeling abnormal, Feeling cold, Heart rate increased, Muscular weakness, Tremor, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: blurry vision-Mild, Systemic: Shakiness-Mild, Systemic: Weakness-Mild, Additional Details: Patient reported leg weakness and blurred vision and dizziness/slight difficulty breathing upon getting ready to leave observation area. Said she hadn''t eaten in a while and felt cold due to A/C in the store as well. BP was low and HR high, so called 911 to get her emergency help as she didn''t feel like she could walk out of store safely. Felt strange and that her legs might give way. EMS arrived, vitals looked good, pt refused ambulance.


VAERS ID: 1367899 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 RA / IM

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

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

Write-up: Systemic: see comments-Medium, Additional Details: pt was given expired vial of moderna vaccine. vial was punctured on may 30 2021 at 11am


VAERS ID: 1367904 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Booster Given Too Early


VAERS ID: 1367914 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: Vaccine given at 4:05pm. Pt''s dad reported dizziness at 4:10pm. Pt appeared pale/had pale lips, was otherwise alert & oriented. Rx called 911. EMS arrived ~10 mins later. EMS check vitals & asked pt to go to the ER, however pt was feeling better and pt''s dad refused. Pt''s dad stated he''ll take her to the ER if symptoms do not improve. Pt denied any pain, shortness of breath, palpitations, nausea/vomiting, or rash. EMS escorted pt and dad out of pharmacy.


VAERS ID: 1367920 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ES0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient Too Young for Vaccine Administered


VAERS ID: 1367921 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Back pain, Headache, Pain, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pt experienced weakness in body and blurry vision 5 minutes after 2nd dose of COVID-19 Pfizer. Pt woke up the next day to sharp lower back pain, body aches, HA and stomach discomfort.


VAERS ID: 1367945 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-06-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: blood work, today Dr. also ordering Augmentin
CDC Split Type:

Write-up: LAD, left side, supraclavicular


VAERS ID: 1367948 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

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

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

Write-up: A dose was wasted due to a dull needle. Patient received new vaccine.


VAERS ID: 1367959 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PHENYTOIN 100MG
Current Illness: SEIZURE DISORDER
Preexisting Conditions: SEIZURE DISORDER
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: APPROXIMATELY 10 MINUTES OR SO AFTER RECEIVING SECOND DOSE OF MODERNA, PT EXPERIENCED A SEIZURE. PT''S MOTHER WAS NEXT TO THE PATIENT. THE PATIENT REMAINED SEATED IN HER CHAIR THROUGHOUT THE DURATION OF THE SEIZURE. MOTHER STATED THAT THE PATIENT HAS A HISTORY OF SEIZURES AND IS ON MEDICATION FOR THEM. SHE HAD ALREADY HAD MORNING DOSE AND STILL NEEDED EVENING DOSE. MOTHER DECLINED EMS SERVICES AND TOOK THE PATIENT HOME AFTER A 30 MINUTE OBSERVATION PERIOD AT THE PHARMACY. THE PATIENT WAS CONSCIOUS AND MOVING A FEW MINUTES AFTER THE SEIZURE OCCURRED.


VAERS ID: 1367960 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Skin discolouration
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: he said he did have a similar reaction with Hep. B vaccine but did not reveal that info deal after he received his vaccine and d
Other Medications: no, I asked him and he is not on any medications and that is confirmed after checking his profile
Current Illness: none
Preexisting Conditions: none
Allergies: cephalosporins and penicillins as seen in his profile
Diagnostic Lab Data:
CDC Split Type:

Write-up: about 5 minutes after receiving the pfizer vaccine patient became sweaty and skin got clammy and he felt like he was going to faint. He lost all color to his face. Blood pressure was taken and it was 92/60. We gave him a cold pack on the back of his neck and had him lay down and elevate his feet and legs. Also got him some cold water to drink. He started to feel better in about 15 minutes after that. We continued to monitor blood pressure about every 5 to 10 minutes and it got to 99/72 and last check was 120/65. He did not want the ambulance or to go to urgent care. We told him to take it easy the rest of day and to have somebody with him til next morning. And then he and his friend left to go to his parents house.


VAERS ID: 1367964 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

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

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

Write-up: Dose wasted due to syringe malfunction. Patient received dose.


VAERS ID: 1367965 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT RECEIVED DOSE TWO ON DAY 15 INSTEAD OF RECOMMENDED DAY OF 21. NO SYMPTOMS REPORTED.


VAERS ID: 1367968 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-05-24
Onset:2021-06-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gummies vitamins once a day.
Current Illness: In that moment was not sick.
Preexisting Conditions: Asthma and anaphylaxis.
Allergies: Yes, he is allergic to crustaceans, cockroaches, ants and pollen mites.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large hives in the area of ??the vaccine and near the clavicle on the right side.


VAERS ID: 1367983 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

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

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

Write-up: GAVE MODERNA VACCINE TO PATIENT UNDER 18.


VAERS ID: 1367990 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

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

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

Write-up: GAVE MODERNA VACCINE TO PATIENT UNDER 18.


VAERS ID: 1367995 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nervousness, Seizure, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Shakiness-Mild, Additional Details: Patient appeared to have short (<1min) seizure approximately 5 minutes after having COVID vaccine administered. She woke up, eventually alert and oriented. EMS was called and responded to call. She refused ER visit stating she was feeling fine, just a little shook up.


VAERS ID: 1368001 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

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

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

Write-up: GAVE MODERNA VACCINE TO PATIENT UNDER 18.


VAERS ID: 1368002 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / IM

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

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

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


VAERS ID: 1368003 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient presented at the pharmacy asking to receive his Moderna Covid-19 immunization. Patient stated it was his first shot. Moderna vaccine administration was billed through Medicare. Vaccine was administered to patient. Patient was monitored for 15 minutes with no apparent reaction. When pharmacy technician attempted to add the vaccination information, it was discovered that patient had 2 previous Moderna Covid-19 vaccines reported on 2/11/2021 and 3/11/2021. Dr. was notified of the 3rd dose administered. Nurse stated she would report it. Called and left a message with the patient to call. No return call has been received at this time.


VAERS ID: 1368030 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-17
Onset:2021-06-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (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: Site: Bruising at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild


VAERS ID: 1368054 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Systemic: Abdominal Pain-Medium, Systemic: Nausea-Severe, Systemic: Vomiting-Severe


VAERS ID: 1368055 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis 5mg 2x daily , iron tablet one daily
Current Illness: Anemia, blood clotting disorder
Preexisting Conditions: Anemia, migraine headaches, blood clotting disorder
Allergies: Penicillin, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen upper right arm, warm to the touch, itchy skin


VAERS ID: 1368103 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

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

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

Write-up: Patient received a vaccine and was told that he needed to stay in the store for 15 minutes. He went to purchase a water about 5 minutes after vaccine in a different register and was feeling lightheaded. After the transaction he fainted with the back of his head fell on the hard floor. He was being assisted by the store staff as well as a pedestrian who claimed to be a health care professional. He was given an orange juice, one water and a battery powered fan to provide cool air. He also requested to lay down on the floor, and he ended up laying on the floor for about 30 minutes. After that he stood up and regained color on his face. He then walked out of the store. Staff asked him if he wanted the ambulance to be called and he declined. Pharmacist called patient the next day to check on patient, and was unable to reach the patient.


VAERS ID: 1368107 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-24
Onset:2021-06-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047CZIA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site cellulitis
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: Topamax 100mg, Trazodone 100mg, Effexor XR 75 and 150 mg, Requip 1 mg, Emgality 200 mg,
Current Illness: n/a
Preexisting Conditions: Epilepsy, anemia,
Allergies: Tramadol, Benadryl, Lyrica,
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Cellulitis Left am at injection site Dr put me on antibiotics for 10 dats


VAERS ID: 1368135 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 RA / IM

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

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

Write-up: Pt received Moderna vaccine on 5/4/21. Then again on 6/1/21. Was inadvertently also vaccinated with Pfizer vaccine on 6/1/21 so had both Moderna and Pfizer vaccines on the same day in different arms


VAERS ID: 1368137 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-28
Onset:2021-06-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Electrocardiogram, Full blood count, Metabolic function test, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (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: denied
Current Illness: denied
Preexisting Conditions: denied
Allergies: denied
Diagnostic Lab Data: CBC, BMP, TSH, EKG
CDC Split Type:

Write-up: Palpitations


VAERS ID: 1368138 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hunger, Hypoacusis, Nausea
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Reports did not eat today, usually eats. Reported lightheadedness that resolved within about 2 minutes, followed by nausea for about 2 minutes resolved - was followed by hunger, and muffled hearing for about 3 minutes resolved. Denies chest pain, change in vision, and other s/sx. 03:57pm LUE 112/62 P62 R20. Reports lightheadedness, nausea, and muffled hearing, all s/sx resolved, stated "I feel normal", drank a cola and ate a protein bar. Observed for 30 minutes. Ambulated with steady gait off floor with his parent.


VAERS ID: 1368149 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-30
Onset:2021-06-01
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Flash fevers when exerting /moving 2 days after vaccination date.


VAERS ID: 1368161 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-22
Onset:2021-06-01
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: SARS-CoV-2 test, Unevaluable event
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown. Patient was tested at our mobile testing site. No primary care provider on file.
Current Illness: Unknown. Patient was tested at our mobile testing site. No primary care provider on file.
Preexisting Conditions: Unknown. Patient was tested at our mobile testing site. No primary care provider on file.
Allergies: Unknown. Patient was tested at our mobile testing site. No primary care provider on file.
Diagnostic Lab Data: Unknown. Patient was tested at our mobile testing site. No primary care provider on file.
CDC Split Type:

Write-up: Unknown. Patient was tested at our mobile testing site. No primary care provider on file.


VAERS ID: 1368182 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-12
Onset:2021-06-01
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Erythema
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine reaction 3 years ago, had redness at site injection site. She was approx 83, at the time and is not sure of brand.
Other Medications: atenolol, amlodipine, atorvastatin not sure if she was taking atorvastatin or not during time of vaccine), lisinopril, gingko bibola, multivitamin biotin, calcium, CoQ10. In January 2021 got steroid injection into knee. triamcinolone ace
Current Illness: None
Preexisting Conditions: CAD- stent HTN hyperlipidemia cerebral migroangiopathy
Allergies: no known allergies
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: After 4 hours after first vaccine had redness and burning in face and skull (4/21/21) was date of first vaccine), it resolved in the afternoon 4/22/21. June 1, 2021, which was 20 days after her second vaccine., she facial redness and burning sensation sensation on face. Noticed that her forehead was hot.


VAERS ID: 1368183 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA C54C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/1 moderna vaccine- No reactions
CDC Split Type:

Write-up: Patient received Moderna vaccination and he is currently 17 years which has not been approved yet for his age. I did call back this morning to follow up with patient but I let a VM to callback for update on how he is feeling.


VAERS ID: 1368193 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-06-01
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: pt tested positive for COVID, asymptomatic


VAERS ID: 1368200 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad)

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

Write-up: 30 minutes after vaccine patient began to hyperventilate, and felt chest tightness. I stayed with patients until the paramedics arrived.


VAERS ID: 1368204 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Work       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: During observation patient states he felt faint then collapsed. RN standing nearby helped assist member to the floor. No injuries noted. Patient was monitored for an extended period of time. Vital signs stable.


VAERS ID: 1368222 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1. Atorvastatin 2. Citalopram 3. Fenofibrate 4. Novolog 5. Omeprazole
Current Illness: n/a
Preexisting Conditions: 1. Type 2 Diabetes 2. Hyperlipidemia 3. Male erectile dysfunction 4. Anxiety 5. Depression 6. Acid Reflux
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came in for 2nd dose of Moderna vaccine and received Janssen instead.


VAERS ID: 1368285 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Remicade
Current Illness:
Preexisting Conditions: Chron''s disease
Allergies: Allergic to Morphine. Given in a hospital setting where she had a generalized hives reaction.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1645 pt vaccinated with 1st dose of Pfizer 1701 pt expressed itchiness around throat, upper chest, and upper arms. redness visible on chest and arms, small hives appearing under chin/on upper neck. 1704 more small hives appearing under chin/upper neck, redness expanded laterally across entire upper neck/under chin. HR 76 RR 18 O2: 94 BP 140/90. pt complained of legs itching. 50mg Diphenhydramine (Benedryl) oral tablets given. 1726 pt hives and redness decreased. no longer complained of itching. skin color returned under chin, although small bumps remained. HR 76 O2 94 BP 132/80 1730 pt asked to leave, we explained risks of having Benedryl and driving. She said she has taken Benedryl before and no fatigue side effects. 1735 pt left clinic


VAERS ID: 1368352 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-12
Onset:2021-06-01
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Dysmenorrhoea, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), 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: Zyrtec, fish oil, bilberry, rhodiola, B12 & D
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very painful mensural cycle, fever, abnormal abdominal pain, muscle aches and joint pain. I typically have bad cycles with pain, but this is on another leave, and Advil is not working.


VAERS ID: 1368402 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient was administered the vaccine. After administration we stood talking to his mother who had questions. After about 2 minutes they turned to walk away and he lost consciousness and hit his head on a counter. I unfortunately did not witness him falling. He regained consciousness almost immediately and I told him he needed to stay laying down for a few minutes first. After a few minutes he said he felt fine and we moved him to a chair. Within a few minutes, he became ill again so we had him lay down again in the consultation room. He then laid there for about 15 minutes before we moved him to a chair. He stated that before he lost consciousness his heart was racing. His mother states he''s never had any problems with vaccinations in the past. After sitting for the second time he said he felt fine except where he hit his head which was a little sore. We contacted the father later that night and he said that he too had a similar episode with a needle stick a few years prior. The patient felt better later night per his father.


VAERS ID: 1368403 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: norethindrone, fluoxetine, androderm, lamotrigine
Current Illness: n/a
Preexisting Conditions: asthma
Allergies: n/a
Diagnostic Lab Data: emt took blood pressure
CDC Split Type:

Write-up: patient was shaking with seizure-like movements, never lost consciousness, felt light-headed and dizzy, gave a cold compress then patient became ill, 911 was called, patient was evaluated and refused transport, this all happened over a 30 minute period


VAERS ID: 1368419 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

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

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

Write-up: Light headed, dizziness Vitals: BP 122/70 HR 86 Resp 20 O2Sat 96 Skin Signs: Warm and dry Circulation: 1 Respiratory: Breath sound clear bilaterally Initial Treatment: Moved patient to triage, placed in supine recovery position, gave patient juice box 6:02 PM Vitals: BP 125/68 HR 84 Resp 20 O2Sat 96 Skin Signs: Warm and dry Circulation: 1 Respiratory: Breath sound clear bilaterally 6:17 PM Vitals: BP 110/62 HR 88 Resp 24 O2Sat 96 Skin Signs: Warm and dry Circulation: 1 Respiratory: Breath sound clear bilaterally Notes: Clinic lead advised parent to take patient to hospital if symptoms worsen or left baseline. Patient released with parent.


VAERS ID: 1368421 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-29
Onset:2021-06-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test abnormal, Chest pain, Electrocardiogram abnormal, Troponin
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG, Troponin
CDC Split Type:

Write-up: Patient presented to ED 3 days after Moderna vaccination with chest pain. EKG and blood work reflective of possible Pericarditis.


VAERS ID: 1368426 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / IM

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

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

Write-up: Patient was given vaccine that had been stored in the refrigerator for greater than the recommended 30 days. The product was placed in the refrigerator on 4/13/2021 and the vaccine given 6/1/21, so after 47 days in the refrigerator. Moderna was contacted, but no further stability information was given or recommendations given by them. There are press releases from end of April that Moderna has stability data for storage under refrigeration for up to 90 days. Patient was notified, issue discussed, and pharmacists recommended she not repeat the vaccine.


VAERS ID: 1368431 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Arizona  
Vaccinated:2020-12-18
Onset:2021-06-01
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: fully vaccinated - 1st dose 12/18/2020 and 2nd dose 1/8/2021 and positive covid on 6/1/2021


VAERS ID: 1368440 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

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

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

Write-up: Patient was inadvertently administered pfizer vaccine dose that was less than 30 minutes beyond use time. No known treatment or adverse effects. Unable to reach patient.


VAERS ID: 1368475 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-30
Onset:2021-06-01
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Rash, Rash papular, Rash pruritic
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: None. Completed treatment with Augmentin 5/27/2021
Current Illness: Viral upper respiratory illness from 5/13/2021-5/27/2021
Preexisting Conditions:
Allergies: Pcn-Rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: pruritic papular rash to arms, legs, and painful rash to left palm


VAERS ID: 1368521 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 8 hours after injection feeling headache and achy 12 hours after injection feeling fatigue, nausea, fever, and vomited 28 hours after injection feeling fatigue and headache


VAERS ID: 1368526 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-28
Onset:2021-06-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / UNK LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Erythema, Limb discomfort, Pain of skin, Skin warm
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: Insulin, Cymbalta, Atorvastatin, Aspirin, Wellbutrin, Buspar, Zyrtec, Bentyl, librium, flonase, folic acid, gabapentin, levothyroxine, metoprolol, oxycodone, reglan, sucralfate, thiamine, trazodone,
Current Illness: K31.84 Gastroparesis, L03.114 Cellulitis of left upper limb, G47.33 Obstructive sleep apnea (adult) (pediatric), R11.0 Nausea, K59.00 Constipation, unspecified, M62.81 Muscle weakness (generalized), I15.9 Secondary hypertension, unspecified, I48.0 Paroxysmal atrial fibrillation, J30.1 Allergic rhinitis due to pollen(History of), E03.9 Hypothyroidism, unspecified, E08.40 Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified, E11.21 Type 2 diabetes mellitus with diabetic nephropathy, E66.01 Morbid (severe) obesity due to excess calories, F10.21 Alcohol dependence, in remission(History of), F32.9 Major depressive disorder, single episode, unspecified, F41.1 Generalized anxiety disorder, G47.00 Insomnia, unspecified, R52 Pain,unspecified, A04.72 Enterocolitis due to Clostridium difficile, not specified as recurrent (RESOLVED) , E78.49 Other hyperlipidemia, K21.00
Preexisting Conditions: K31.84 Gastroparesis, L03.114 Cellulitis of left upper limb, G47.33 Obstructive sleep apnea (adult) (pediatric), R11.0 Nausea, K59.00 Constipation, unspecified, M62.81 Muscle weakness (generalized), I15.9 Secondary hypertension, unspecified, I48.0 Paroxysmal atrial fibrillation, J30.1 Allergic rhinitis due to pollen(History of), E03.9 Hypothyroidism, unspecified, E08.40 Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified, E11.21 Type 2 diabetes mellitus with diabetic nephropathy, E66.01 Morbid (severe) obesity due to excess calories, F10.21 Alcohol dependence, in remission(History of), F32.9 Major depressive disorder, single episode, unspecified, F41.1 Generalized anxiety disorder, G47.00 Insomnia, unspecified, R52 Pain,unspecified, A04.72 Enterocolitis due to Clostridium difficile, not specified as recurrent (RESOLVED) , E78.49 Other hyperlipidemia, K21.00
Allergies: Amide, codeine sulfate, Dexchlorpheniramine Maleate ER, Penicillins, promethazine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient complained of discomfort of left arm, nurse noted area was reddened, tender, and warm to the touch. No loss of sensation reported per the patient. No additional formation of hives surrounding the area. Primary Care Physician prescribed Benadryl 25 mg every six hours as needed as well as a Medrol dose pack. No further adverse events.


VAERS ID: 1368546 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-31
Onset:2021-06-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abnormal dreams, Anxiety, Back pain, Chills, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: The night following injection, the patient experience increased anxiety, chills, possible fever, headache, backache, generalized muscle aches, and abnormally vivid dreams throughout the night. Monitoring of symptoms is continually being addressed by the patient''s mother.


VAERS ID: 1368569 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety
SMQs:, 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: c/o anxiousness. pt. went home after symptoms resolved.


VAERS ID: 1368591 (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: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram head, Electrocardiogram, Full blood count, Immediate post-injection reaction, Loss of consciousness, Metabolic function test, Syncope, Tremor
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), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: CBc, cmp, ekg, ct head.
CDC Split Type:

Write-up: Pt had loss of consciousness x 2 immediately after injection. , shaking of extremities described. Lasting appx 1 min each. return to baseline after . Differential was seizure vs. more likely vagal syncope


VAERS ID: 1368611 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Minocycline, sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: My side effects were body aches, very sore arm, fever of 100.3, headache, chills, and vomiting.


VAERS ID: 1368619 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Incorrect route of product administration, No adverse event
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: PT RECEIVED VACCINATION 5 DAYS EARLY, DID NOT EXPERIENCE ANY ADVERSE EFFECTS NOR SIDE EFFECTS. ADULT SISTER MADE AWARE.


VAERS ID: 1368638 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

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

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

Write-up: Pt received incorrect mfg of covid vaccine, She should have received her second moderna , not the janssen. Pt had received her first covid shot (moderna mfg) in January. She thought that since it had been so long she should start over with a different mfg. The patients history was not checked prior to giving vaccination.


VAERS ID: 1368690 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-28
Onset:2021-06-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aleve with Pseudofedrine, Benadryl, prednisone 40mg, Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: Seasonal allergies
Diagnostic Lab Data: Physical examination
CDC Split Type:

Write-up: Swelling in extremities, face and body


VAERS ID: 1368707 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O36C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Fatigue, Feeling cold, Headache, Lymphadenopathy, Nausea, Pain, Pyrexia, Sinus congestion
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamins Digestive enzymes Biotin Vitamin c Vitamin d
Current Illness: HSV-2
Preexisting Conditions: Hsv - 2
Allergies: Eurythromicin Dairy Almonds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in every tissue and bone of my body. Cold to the bone. Shivering, often uncontrollable. Temperature of 101.6. Intense nausea - kept thinking I was going to vomit. Tummy felt like I was going to have diarrhea so kept running to the toilet, but nothing happened. Swollen throat glands. Intense back pain. Head feels like it?s in a vice. Congestion in sinuses. Intense fatigue.


VAERS ID: 1368721 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-29
Onset:2021-06-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EV0168 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Condition aggravated, Cough, Echocardiogram normal, Electrocardiogram PR segment depression, Electrocardiogram T wave abnormal, Myocarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gummy multivitamin
Current Illness: None reported
Preexisting Conditions: none reported
Allergies: Allergic to pollen
Diagnostic Lab Data: Cardiac troponin level increased with evolving EKG changes (depressed PR segment and t-wave changes) and preserved ventricular function Noted when he came in with coughing and associated chest pain. Received second dose of covid vaccine 72 hrs prior ( 5/30/21). Echo notes normal cardiac function.
CDC Split Type:

Write-up: Myocarditis: Patient reports developing intermittent non-radiating substernal chest pain (5/30/21 at 7am) one day following his second Pfizer vaccine. He had also been experiencing cough for the last few weeks starting in early May about a week after his first Pfizer vaccine . He states having an intermittent non-productive cough since receiving his first COVID vaccine in early May. Symptoms are worsened by walking or exertion. No leg swelling. Patient presented to the ER where troponin was elevated to 9000 and EKG was consistent with myocarditis . Patient admitted for NSAID treatment, cardiology evaluation and observation. Troponins quickly down-trended and patient clinically stable. Anticipate discharge home in next 24-48 hours.


VAERS ID: 1368725 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-28
Onset:2021-06-01
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Antinuclear antibody negative, Differential white blood cell count, Lymphocyte count, Metabolic function test, Platelet count, Rheumatoid factor negative
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ambien, Ativan, Birth Control.
Current Illness: None
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data: Basic blood tests done on 5/26, CBC with differential/platelet, comp metabolic panel (14), with the results of high lymphs, Rheumatoid arthritis factor less then 10 for current result and flag. direct negative.
CDC Split Type:

Write-up: Moderna COVID?19 Vaccine EUA


VAERS ID: 1368747 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

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

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

Write-up: Moderna COVID-19 Vaccine EUA: Higher-than-authorized dose volume administered Patient received 0.5 ml dose of Moderna Covid Vaccine on 1/11/21 and a 1 ml dose of Moderna Covid vaccine on 6/1/21.


VAERS ID: 1368754 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

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

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

Write-up: Moderna COVID-19 Vaccine: Higher-than-authorized dose volume administered Patient received 0.5 ml dose of Moderna Covid Vaccine on 1/11/21 and a 1 ml dose of Moderna Covid vaccine on 6/1/21.


VAERS ID: 1368762 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / IM

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

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

Write-up: Moderna COVID-19 Vaccine EUA: Higher-than-authorized dose volume administered Patient received 0.5 ml dose of Moderna Covid Vaccine on 5/4/21 and a 1 ml dose of Moderna Covid vaccine on 6/1/21.


VAERS ID: 1368768 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-31
Onset:2021-06-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

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

Write-up: Patient reported received his Johnson and Johnson COVID 19 vaccine 05/31/2021. Reported stated having generalized joint aches, HA and left axillary swelling. Reported symptoms stated 06/1/2021 at 8pm. patient reported did not take any medications for symptoms.


VAERS ID: 1368770 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

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

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

Write-up: Higher-than-authorized dose volume administered Patient received 0.5 ml dose of Moderna Covid Vaccine on 4/20/21 and a 1 ml dose of Moderna Covid vaccine on 6/1/21.


VAERS ID: 1368791 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 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? 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: Patient waited 15 min after dose was administered and the patient was fine. Followed up the next day and patient had no side effects.
CDC Split Type:

Write-up: Patient received wrong vaccine. Patient received a Moderna vaccine as a first dose but was accidently given Pfizer as a second dose


VAERS ID: 1368815 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C214 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Incontinence, Pollakiuria
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: 1 per day: aspirin 81 mg, trazadone 75mg, escitalopram 20 mg (am), escitalopram 10 mg (pm), oxybutynin 10 mg, metoprolol 100 mg, losartan 50 mg, hidroclorotiazida 12.5 mg 2 per day: omeprazole 20 mg,
Current Illness: none
Preexisting Conditions: over-active bladder, depression, high blood pressure, gastric by-pass,
Allergies: codeine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Sudden frequent urination and incontinence post 4 hours after 2nd dose. Continuing through next day post injection. Currently unresolved.


VAERS ID: 1368846 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Insomnia, Pain in extremity, Product storage error
SMQs:, Tendinopathies and ligament disorders (broad), 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: None listed
Preexisting Conditions: Developmental Disability
Allergies: None listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Best use date recorded by HD as 3 months from receiving. Received on 3-2-2021. Marked to discontinue use on 6-2-2021. Maintained in cold chain management 36 to 46 degrees F. Administered on 6-1-2021 Vial opened for the client. The other 4 doses were discarded at the end of the clinic. On 6-2-2021 an e-mail from DH was noted with expiration of Lot 1802068 on 5-25-2021. Johnson & Johnson was contacted and reported to Pharmacist. Reference ID EZR20210078918(VO) case # 02242111. Client has a Developmental Disability. His guardian (mother) was contacted expiration date reported. The mother states that client c/o sore arm 6-1 with difficulty sleeping. Today he is feeling back to normal. No problems or concerns.


VAERS ID: 1368850 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-15
Onset:2021-06-01
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aspartate aminotransferase increased, Blood bilirubin increased, C-reactive protein increased, Chest X-ray normal, Chest pain, Echocardiogram abnormal, Electrocardiogram repolarisation abnormality, Intensive care, Mitral valve incompetence, Myocarditis, Troponin I increased
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (narrow), Conduction defects (narrow), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: History of asthma first diagnosed at age 6 months. No symprtoms for more than 1 year. Only medication used for asthma is albuterol MDI as needed, last use more than 1 year ago.
Allergies: None
Diagnostic Lab Data: Troponin :I 5.39 ng/ml. CRP 5.0 mg/dl AST 47 Tbili 1.7 on 6/1 but down to 0.8 on 6/2 CXR normal, EKG with early repolarization, otherwise normal, echo normal except for trace mitral regurgitation
CDC Split Type:

Write-up: Acute myocarditis presenting with chest pain and elevated troponin I. Admitted toi the PICU at Hospital on 6/2/21 (previously had been in the ER on 6/1/21 at the start of chest pain).


VAERS ID: 1368862 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 LA / SYR

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

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

Write-up: Patient received their second vaccine dose in the series (Moderna) at 22 days instead of the recommended minimum of 24.


VAERS ID: 1368872 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / IM

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

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

Write-up: Co-Lead Ancillary alerted Lead RN over waki taki at 13:25 that a mother and her minor daughter were on site so the minor could receive her 2nd dose of Moderna vaccine. The minor had received her first Moderna dose on 04/20/21 at another facility. Lead RN check-in RN to assist mother and minor once they had completed the check-in process and came upstairs to be vaccinated. Once upstairs, Check-in RN escorted minor and mother to an RN vaccination station so the minor could receive the vaccine. RN performed verification procedures regarding minors who are accompanied by a parent and reviewed the minor?s vaccination card to confirm the minor had been vaccinated inappropriately on 04/20/21. The minor had received Moderna dose #1 COVID vaccine, Lot# 001C21A. Lead RN confirmed it was appropriate for the minor to receive the 2nd dose of Moderna to complete the series, per CDC Guidelines. RN vaccinator educated the minor and her mother regarding Moderna''s suggested application of 18 years and older only. RN vaccinator then confirmed with the minor and mother that the minor had not experienced any type of adverse reaction to the first dose. The minor and her mother also denied the minor having any significant medical history, current medications, supplements, or allergies. The minor and mother verbalized understanding and expressed a desire to proceed with the second vaccination. RN vaccinator reinforced to the minor and her mother to please stay for the full 15 minutes in the observation area, and explained that both a VAERS and VERP report would be submitted to document the incident of the minor receiving Moderna as an unauthorized age group. The minor received Moderna vaccination #2 lot# 027C21A at 13:39. Minor and mother proceeded to the observation room at 13:43. Lead RN checked on minor client in the observation room at 14:00 where both the minor and her mother denied any side effects and left the observation room. Lead RN observed the minor was ambulating independently with a steady, even gait, with when exiting with her mother.


VAERS ID: 1368894 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Bradycardia, Dizziness, Hyperhidrosis, Hypotension, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt states he had a similar experience 20 years ago.
Other Medications: Unknown
Current Illness: NA
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt became weak, dizzy, pale and very diaphoretic a few minutes after receiving the vaccine. When further evaluated it was found that he was hypotensive and bradycardic. His blood pressure was initially 77/42 with a pulse of 54 following the vaccine at 11:21. As patient rested and drank water he was continuously evaluated and his BP increased to 91/53 a few minutes later and then it was up to 111/40 with a pulse of 60 at 11:29. Due to his condition EMS was activated @ 11:27 and they arrived on scene at 11:36 for further evaluation and transport to a higher level of care.


VAERS ID: 1369026 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Eye pruritus, Hypersensitivity, Migraine, Pruritus, Rash erythematous, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Client (received the COVID vaccine (Pfizer dose 2, lot # EW0187, expiration 6/28/2021) at 1800. At 1829, the client reported itching on his skin and in his throat. EMT, EMT #2, PHN, and RN responded at this time. The client was sitting comfortably in his chair, alert and oriented x4. The client''s vital signs were as follows: heart rate 57, O2 97, respiratory rate 14, blood pressure 150/92. The client''s skin was pink, warm, and dry. The client denied any shortness of breath or chest discomfort. The client was able to speak in full sentences and had no visible swelling on his face or tongue. The client declined Benadryl at this time. The client stated he has environmental allergies and has had an anaphylactic reaction to trees in the past. The client stated he has a medical history of anxiety, acid reflux, migraines, and hay fever; he takes antacids, sumatriptan, and allegra. The client stated that he took 1 allegra at 1816, but stated he didn''t know the exact dosage and did not have the medication bottle with him. The client was able to speak in full sentences. At 1835, the client identified a small, red, erethematous area approximately 1 centimeter in length on the left medial area of his elbow, which he stated itched. He also stated his eyes were itching; neither eye or eyelid appeared red. The client stated his throat was dry and was offered and accepted water. The client declined Benadryl again at this time. The client was transferred to the zero gravity chair at this time, denied any dizziness during ambulation or transfer. At 1839 the client''s vital signs were as follows: blood pressure 142/84, heart rate 74, O2 97%. The client stated "I had an itchy throat this morning" and said that he had a migraine that morning but did not remember if he had taken any medication for the migraine. At 1849, the client''s vital signs were as follows: blood pressure 122/84, heart rate 73, respiratory rate 16, O2 99%. At 1853, the client stated "I feel less itchy." At 1900, the client initially requested Benadryl, but then refused both the medication and vital signs when offered. The client stated that his arm "still itched" but denied that it was getting worse. The client stated "I wanted a Benadryl for the road but now I think I''m going to wait." The client denied shortness of breath, chest tightness or pain, or any difficulty breathing. The client did not appear to be in any distress and had no swelling visible on his face or tongue. The client continued to chat with staff and spoke with a pleasant demeanor. Education provided by PHN, EMT, and RN regarding primary care follow up and when to seek medical care. At 1915, the client requested Benadryl and stated "I think my rash is growing." The client''s vital signs at that time were as follows: blood pressure 138/92, heart rate 88, O2 99%, respiratory rate 12. At 1922, the client was given 50mg Benadryl orally. At 1927, the client stated "my wife is here, it''s time for me to go." RN reiterated the importance of staying for a 30 minute observation time, but the client continued to leave the building. EMT accompanied the client outside, where he ambulated with a steady gait. He walked to the outdoor observation area and then sat down, requesting to be evaluated by EMS. EMS was called by RN at 1933. The client was sitting comfortably and denied any shortness of breath or chest pain. EMS arrived on scene at 1936. At 1938, the client''s vital signs were as follows: blood pressure 140/90, heart rate 60, and O2 100%. The client stated at that time that he "felt better" and declined transport to the hospital. The client signed AMA paperwork at 1945 and ambulated to his car with a steady gait, accompanied by his wife, who he stated was going to drive him to an urgent care.


VAERS ID: 1369063 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

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

Write-up: Patient experience entire body rash 6-8 hours after second dose of Moderna COVID vaccine. Patient self treated with oral Benadryl. Symptoms did improve with Benadryl therapy. Slight rash still evident on 6-2-21


VAERS ID: 1369085 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Dizziness, Fall, Gait disturbance, Head injury, Headache
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient became dizzy/started losing his vision fairly quickly after receiving the vaccine. He kept repeating he couldn''t see. He stumbled forward then fell down. Patient did hit his head. Store associate got him up and into a chair and started asking him questions. Mom stated he had just received vaccine. They were not told by the pharmacist on duty to stay to be monitored for 15 minutes after. He did say that he had a headache. Gave the patient some water, had him move his arm around, and monitored patient until pharmacy closed.


VAERS ID: 1369299 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Feeling abnormal, Feeling hot, Flat affect, Headache, Malaise, Nausea, Somnolence, Speech disorder
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Lexapro
Current Illness:
Preexisting Conditions: Sickle Cell Anemia
Allergies: Toradol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received the 1st COVID vaccine (Pfizer Lot #EW0187 and 06/28/2021) at 1848. At 1859, Office Assistant was walking past the client when she noticed that the client appeared unwell. Assistant asked the client if she was feeling ok, the client responded, ?I feel dizzy.? Assistant alerted PHN that the client was feeling dizzy. PHN responded. The client appeared drowsy but was oriented to person and place. The client?s eyelids were open halfway, and the client was mumbling answers to the questions. The client stated, ?I feel dizzy and hot under my skin.? Vital signs were taken by EMT at 1901 (Heart rate 92, Oxygen 99%, blood pressure 112/P?client was wearing a long-sleeved shirt). Client?s skin was warm and dry. At 1902 client appeared more alert, and PHN gave the client juice to drink, which she accepted and drank. Client stated that she has a history of vasal vagal reactions to needles and was anxious about receiving today?s vaccine. EMT and PHN transitioned client to zero gravity chair at 1904 and gave client chips and a granola bar to eat. The client accepted the snacks and started to eat them. At 1905 client stated, ?my head feels weird like I want to lay back.? PHN advised client to lay her head back onto the gravity chair head rest. Client laid her head back for less than 30 seconds than continued to eat. PHN offered the client Benadryl and she refused. Client stated that the last time that she ate was around 1100 or 1200. Client was wearing a beanie and long sleeves, we asked the client if she can remove her hat and outer layer, however, she refused. The client had a flat affect and was soft spoken. Vital signs taken at 1915 (oxygen 98%, heart rate 94, blood pressure 138/84). Client denied any shortness of breath. At 1919, client stated, ?I feel like I?m going to throw up.? The zero-gravity chair was positioned into a seating position and the client was given an emesis bag. Client did not vomit, and she sat with the emesis bag until 1923 and then stated that the feeling was gone. Client has a history of sickle cell anemia and stated that she receives blood transfusions every 2-3 weeks but had not received a transfusion in 8 weeks. Client is currently prescribed Metformin but has not taken the medication because ?she does not trust it.? Client stated that she was prescribed Lexapro 1 month ago and took her first dose the day before the vaccine but did not take it the day of the vaccine. She stated that she has anxiety but denied any other medical conditions. She is allergic to Toradol. Vital signs taken at 1924 (oxygen 98%, heart rate 91, blood pressure 146/102). At 1925 she sated ?my head hurts, it?s a sharp pain.? PHN called EMS at 1926. EMS arrived at 1928 and assumed care. EMS medic stated that her blood glucose levels were at 82 and advised her that they wanted to take her to the emergency room to be examined. The client refused transport to the hospital and stated, ?I don?t want to go to the hospital, it?s so expensive.? Client continued to refuse transport and stated that she will have her boyfriend take her to the hospital. Client?s boyfriend entered the building and client signed an AMA at 1953. PHN provided education to client and boyfriend on life threatening symptoms and to call EMS if any symptoms appear on their way to the hospital. PHN also advised client to follow up with her primary care provider and to follow up with an allergist before receiving her second vaccine. Client left the facility AMA at 1954 with her boyfriend, unassisted and with a steady gait. Client and her boyfriend stated that they would go to the hospital.


VAERS ID: 1369307 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-04-30
Onset:2021-06-01
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Tinnitus ringing in right ear and muffled left ear. Not subsiding after 16hrs


VAERS ID: 1369321 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-01
Onset:2021-06-01
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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? 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: Shortness of breath


VAERS ID: 1369363 (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: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Incorrect dose administered
SMQs:, Peripheral neuropathy (broad), Medication errors (narrow)

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

Write-up: Pharmacy reported to patient that he was given a full vial of the vaccine instead of one dose. They indicated the error was not diluting it before giving him what they thought was one dose. He reported that it burned when he was injected with the vaccine.


VAERS ID: 1369790 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Client received his 1st Pfizer vaccination (Lot# EW0187, EXP 08/31/21) in his left arm at 19:15 from RN. Client?s parents and sister were with him. Client?s parents only spoke Spanish and an interpreter was present. After receiving his shot, client sat in a chair next to his sister while RN administered a shot to her. Five minutes later client stated he felt nauseous. RN immediately called out to Vaccine Runner RN and Check-in Nurse who were in the hallway to get an EMT. Check-in Nurse radioed for an EMT to come to station 3 while Vaccine Runner RN rushed to the EMT room to ensure an EMT got the call. Check-in Nurse stayed with the client and placed a trash can next to him in case he vomited. RN stated the client looked pale and clammy. At 19:26 EMT1 arrived at station 3 and collected the client?s medical history. Interpreter was also translating the EMT?s questions and statements to the client?s parents. Client stated he had no known allergies, no underlying conditions, and is not currently taking any medications. Client also stated he was not experiencing shortness of breath, chest pain, or having trouble breathing. EMT2 arrived at station 3 at 19:27 and brought the client a vomit bag. The client had not vomited, but still felt nauseous. EMT1 gave the client a bottle of water and juice, and took client?s vitals at 19:28 (HR: 64, BP: 120/70). Client stated he felt a lot better. While walking out of station 5 Lead RN saw individuals grouped together at station 3 with the EMT and arrived at station 3 at 19:28. Lead RN was updated on client?s status. Lead RN observed that the client was mildly pale and clammy and asked client?s mother if his current coloring was normal for the client. Interpreter translated to both parents and client?s mother stated that the client did look a little pale. Client stated he felt better and was just nervous about getting the shot. At 19:30 Lead RN asked client to try and stand up. Once client was standing, Lead RN asked client if he felt dizzy and client stated no. Client stated he felt just fine. Lead RN and EMT?s directed the client to the observation room to sit in a zero-gravity chair for additional monitoring of 30 minutes. EMTs walked the client and his family to the observation room and sat him in the zero-gravity chair. Client stated he felt much better and at 19:47 EMT1 took client?s vitals (HR: 66, BP: 100/70, SpO2: 98). EMT1 stated client?s color was returning. EMT1 took client?s vitals again at 20:04 (HR: 67, BP: 104/78, SpO2: 99). Lead RN arrived in observation room at 20:10 with Lead Ancillary to check on client who stood up and stated he felt good. Lead RN observed that client was no longer pale or clammy. Lead RN educated parents and client on potential side effects vs adverse effects of the vaccine. Lead RN further instructed client and parents to see the client?s HCP or visit urgent care if client started to experience additional common side effects for more than 24-48 hours and to call 911 if the client began to experience trouble breathing, shortness of breath, or chest pain. Lead Ancillary translated all the information to the client in Spanish. Lead RN observed the client leaving with his family at 20:15. Client left walking with a steady gate.


VAERS ID: 1369802 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / ID

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Choking, Cough, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

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

Write-up: After half an hour after i had left the pharmacy after the first dose of Covid Pfizer vaccine, Hamza(12 yrs) started clutching his neck saying its on fire, tears were coming from his eyes and he started choking and coughing. He barely managed to say that his throat felt like something burning hot was pouring down. I immediately gave him cold water to drink. He drank and continued to drink in small sips for the next hour and was feeling normal in an hour. He had not eaten or drank anything after his vaccine. He had also had lunch at 3 pm, a full 2 hours before the vaccine.


VAERS ID: 1369819 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-30
Onset:2021-06-01
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness:
Preexisting Conditions: Celiac disease, raynaud?s, autoimmune hepatitis
Allergies: Shellfish, mango
Diagnostic Lab Data:
CDC Split Type:

Write-up: Late/possibly missed menstrual cycle after the second dose of Pfizer


VAERS ID: 1369945 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO173 / 2 RA / SYR

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

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

Write-up: about 3 hours after shot, experienced severe vertigo and dizziness, causing nausea. 36 hours later still moderate dizziness and occasionally extreme dizziness. no treatment except rest. also moderate pain in left ear beginning 12 hours after shot.


VAERS ID: 1369954 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Hyperhidrosis, Injection site pain, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: I felt completely fine for the first 5 minutes. I left the store. After 5 more minutes I started feeling bad (I was seated). My whole body was sweating and my vision was affected (everything was bright). I was able to return to the store but was close to passing out. I sat down for about 10-15 minutes while the symptoms persisted and I was not able to see well. After that time the sweating stopped and my sight was no longer affected. This was not anxiety and I have no history of fainting with shots. This was a reaction to the shot. After about an hour I felt fine except for muscle soreness at the injection sight. If the reaction was any worse I would have passed out or asked for help. I am hesitant to get a second dose out of concern that the reaction could be worse.


VAERS ID: 1369970 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PATIENT DOES NOT FILL AT OUR PHARMACY
Current Illness: NONE
Preexisting Conditions: NONE KNOWN
Allergies: NONE REPORTED
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PATIENT WAS FINE WHEN HE LEFT THE PHARMACY. HE CALLED ABOUT AN HOUR LATER STATING THAT HE HAD SEVERE ABDOMINAL PAINS SUCH THAT HE COULD ONLY STAY ON HIS HANDS AND KNEES WITHOUT MAJOR DISCOMFORT. TRIED APAP AND NAUSEA MEDICATION AND THAT DID NOT WORK. HE CALLED BACK 2 HOURS LATER STATING THAT HIS CONDITION WAS NOT ANY BETTER. I ADVISED THAT HE MAKE HIS WAY INTO THE ER.


VAERS ID: 1369981 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-29
Onset:2021-06-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Full blood count, Injection site swelling, Metabolic function test, Ultrasound scan
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: left arm swelling from site of injection up to shoulder


VAERS ID: 1369986 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-06-01
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / UNK - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Computerised tomogram thorax, Dyspnoea, Fatigue, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: oral contraceptive, prozac
Current Illness: NA
Preexisting Conditions: NA
Allergies: Mangos
Diagnostic Lab Data: CTA Chest demonstrating PE
CDC Split Type:

Write-up: Fatigue, increasing shortness of breath for 1-2 weeks, diagnosed with pulmonary embolus on 6/2/21 in emergency department


VAERS ID: 1370000 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO186 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Throat irritation, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Anaphylaxis to flu vaccination 14 years ago
Diagnostic Lab Data:
CDC Split Type:

Write-up: On June 1, 2021 at approximately 1500 hours, patient received the Pfizer-BioNTech) vaccination. At approximately 1517 hours, the attendee abruptly left the observation area quickly moving toward the restroom. Registered Nurse observed this reaction and immediately followed behind the attendee to the restroom. The attendee vomitted a small amount of fluid at this time and was escorted back to the observation area. At approximately 1520 hours, vitals signs were taken with the result of BP:128/78, HR 90, SPO2 99, Temp 97.9. At approximately 1525 hours, the attendee reported an itchy sensation on the left side of her throat and subjective symptoms dizziness and warmth. The attendee was administered 50 mg of Benadryl at this time and instant ice packs were applied to the back of the neck. Symptoms resolved within minutes and the patient was released home with instructions about adverse effects and when to seek medical attention.


VAERS ID: 1370301 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210602328

Write-up: ITCHING OFF AND ON TO ARM; A LITTLE REDNESS TO ARM; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included unknown. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 31-MAY-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 01-JUN-2021, the subject experienced itching off and on to arm. On 01-JUN-2021, the subject experienced a little redness to arm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from itching off and on to arm, and a little redness to arm. This report was non-serious.


VAERS ID: 1370304 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Unknown  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210602478

Write-up: INCORRECT PRODUCT STORAGE; This spontaneous report received from a pharmacist concerned a 62 year old of unspecified sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1821288, and expiry: 1-AUG-2021) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced incorrect product storage. The action taken with covid-19 vaccine was not applicable. The outcome of incorrect product storage was not reported. This report was non-serious.


VAERS ID: 1370838 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Hypotension-Mild, Additional Details: 1st Dose given at 6:05 PM, lightheaded within 5 minutes. also developed chills. BP read 115/60, 5 mins later 108/67 and sat for 30 minutes. patient had improved since then and was able to leave.


VAERS ID: 1370974 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Vaccine positive rechallenge
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: Same symptoms as on 2nd dose
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Ibuprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu like symptoms. Extreme fatigue, body aches, back pain, joint pain, chills and fever.


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