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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 22 out of 8,753

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VAERS ID: 1861569 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event
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: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. No adverse affects reported.


VAERS ID: 1861599 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. No adverse effects reported.


VAERS ID: 1861606 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising
SMQs:, Haemorrhage terms (excl laboratory terms) (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: zolpidem
Current Illness: non listed or given
Preexisting Conditions: heart and lung conditions.
Allergies: neosporin
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: patient came in a week later with a golf ball size bruise at site of injection.


VAERS ID: 1861629 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. No adverse effects reported.


VAERS ID: 1861643 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. No adverse effects reported.


VAERS ID: 1861652 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. No adverse effects reported.


VAERS ID: 1861662 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Incorrect dose administered, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. Patient presented pain at injection site that extended to the armpit


VAERS ID: 1861805 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation administered, Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. Patient presented severe pain at inyection site and could not raise the arm for 48 hours


VAERS ID: 1861808 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

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

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

Write-up: vomiting, diarrhea


VAERS ID: 1861848 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. Patient presented mild pain at injection site the first 24 hours


VAERS ID: 1861854 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anal incontinence, Cardiac function test normal, Computerised tomogram normal, Dysstasia, Heart rate irregular, Muscular weakness, Urinary incontinence
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiac arrhythmia terms, nonspecific (narrow), Noninfectious diarrhoea (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: 2nd dose: extreme fatigue
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Post Hospital visit: stated that CT was fine and heart was fine.
CDC Split Type:

Write-up: Patient received vaccination on Friday. Started developing symptoms Saturday at around 5pm. ADR: lost all muscle control, unable to stand, lost control of bowels and bladder (urinary incontinence). Developed irregular heartbeat. Patient received fluid in ambulance


VAERS ID: 1861865 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. No adverse effects were reported.


VAERS ID: 1861872 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Lacrimation increased, Lip swelling, Rhinorrhoea, Swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Lacrimal disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen bump, possible hive, on lip two hours after vaccine, and one bump on cheek 3 hours after vaccine. Watery eyes and nose 4 hours after vaccine. Bumps mostly gone about 8 hours after vaccine. Benadryl given 3 hours after vaccine.


VAERS ID: 1861875 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Incorrect dose administered, Injection site pain, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. Patient presented nausea,vomiting, fever and pain at injection site and chest pain.


VAERS ID: 1861889 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Administration site pain, Lymphadenopathy, Product preparation issue
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended. Patient presented pain at administration site and lymphadenopathy that resolved after 72 hours


VAERS ID: 1862097 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
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: Pediatric vaccine was diluted with 0.13 ml instead of 1.3 ml so the patient got a more concentrated dosage than recommended.


VAERS ID: 1862100 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: No tests as of when she called in Thursday after 2pm I recommended that patient go to a Doctor
CDC Split Type:

Write-up: patient called and says that she has been itching on different parts of her body. She says that she got her pfizer vaccine on Friday and then had body aches in her joints and other areas on Saturday. she stated that she had no other symptoms. She then began to have itching on her hands Sunday morning and from Sunday to Thursday she has had itching in different areas of her body sometimes being over the entirety. She mentioned that she has taken benadryl and I asked about loratadine and she said she had already tried that as well. I then said that with the itching being in different areas that hydrocortisone may be hard to pinpoint so it would be better that she see a dr for perhaps oral steroids. I asked if she had trouble breathing throat closure or hives and she states she does not. I told her I would document and she said she would see a dr for treatment.


VAERS ID: 1862384 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 1 RA / SYR

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

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

Write-up: At approximately 1558 pt was given a vaccine a week early. She had been vaccinated with her first dose of Pfizer on 10/23/21 returned on 11/06/21 a week before her next dose was due. The pt did not have her vaccine card and before she was looked up in CIIS the vaccine was given, but instead of Pfizer she had received a booster dose of Moderna. Doctor and supervisors notified of the incident.


VAERS ID: 1862540 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Dizziness, Dysstasia, Fatigue, Gait disturbance, Headache, Limb discomfort, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament 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: Dulara (asthma), ibuprofen
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: None. Called online nurse on Day 7
CDC Split Type:

Write-up: Day 2: severe headache; bad pain in joints and muscles; trouble walking and standing, legs and arms felt very heavy; Day 3: fatigue Day 6: severe dizziness from 7am to 1pm; sick at stomach but no vomiting; could not walk--had to crawl, fatigue rest of day


VAERS ID: 1863796 (history)  
Form: Version 2.0  
Age: 3.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: Parent lied about the birthday for child, claiming the child was born 10-6-2016. We discovered the error when we went to enter the shot in our states vaccination recording system.


VAERS ID: 1863359 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-11-06
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), 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: Comments: no further information
Allergies:
Diagnostic Lab Data: Test Date: 20211108; Test Name: COVID-19 virus test positive; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20211119231

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; COVID-19 INFECTION; This spontaneous report received from a patient via a company representative concerned a male of unspecified age. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: no further information. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: unknown and expiry: unknown) 1 total, start therapy date was not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. It was reported that, he experienced flu like symptoms and not feeling any better, he did not know what type of Covid test taken. He, stated vaccine did not work for him. On 06-NOV-2021, He was started feeling bad and sick on Saturday and not much better since. On 08-NOV-2021, he made coffee in morning and could not taste it. He stated his wife bought a couple of home test Covid kits she tested negative while he was positive, then he made appointment at pharmacy and got positive results. On same day, he experienced suspected clinical vaccination failure. Laboratory data included: COVID-19 virus test positive (NR: not provided) positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected clinical vaccination failure and covid-19 infection was not reported. This report was serious (Other Medically Important Condition). This case is associated with product quality complaint: 90000201208.; Sender''s Comments: V0: 20211119231-covid-19 vaccine ad26.cov2.s-suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1863741 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Arm pain; High fever; Joint pain; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Arm pain), PYREXIA (High fever) and ARTHRALGIA (Joint pain) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 051F21A) for COVID-19 vaccination. No Medical History information was reported. On 05-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Nov-2021, the patient experienced PAIN IN EXTREMITY (Arm pain), PYREXIA (High fever) and ARTHRALGIA (Joint pain). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) for Adverse event, at a dose of 2. At the time of the report, PAIN IN EXTREMITY (Arm pain), PYREXIA (High fever) and ARTHRALGIA (Joint pain) outcome was unknown. Concomitant information was not provided. Treatment information was not provided.


VAERS ID: 1863780 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-01
Onset:2021-11-06
   Days after vaccination:309
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Inflammation, Mass, Swelling, Tenderness, Vaccination site pain
SMQs:, Anaphylactic reaction (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: large inflammation between my shoulder and the base of my neck/ shoulder; very tender; It''s soft, and it looks like a mass area; Shoulder pain; pain in the arm where I had the injection; in the area of her clavicle bone almost, the base of her neck to the begging of her shoulder, it''s very very swollen. It''s significantly swollen.; This spontaneous case was reported by a consumer and describes the occurrence of INFLAMMATION (large inflammation between my shoulder and the base of my neck/ shoulder), TENDERNESS (very tender), SWELLING (in the area of her clavicle bone almost, the base of her neck to the begging of her shoulder, it''s very very swollen. It''s significantly swollen.), MASS (It''s soft, and it looks like a mass area) and ARTHRALGIA (Shoulder pain) in a 55-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 04-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Nov-2021, the patient experienced SWELLING (in the area of her clavicle bone almost, the base of her neck to the begging of her shoulder, it''s very very swollen. It''s significantly swollen.). On an unknown date, the patient experienced INFLAMMATION (large inflammation between my shoulder and the base of my neck/ shoulder), TENDERNESS (very tender), MASS (It''s soft, and it looks like a mass area), ARTHRALGIA (Shoulder pain) and VACCINATION SITE PAIN (pain in the arm where I had the injection). At the time of the report, INFLAMMATION (large inflammation between my shoulder and the base of my neck/ shoulder), TENDERNESS (very tender), SWELLING (in the area of her clavicle bone almost, the base of her neck to the begging of her shoulder, it''s very very swollen. It''s significantly swollen.), MASS (It''s soft, and it looks like a mass area), ARTHRALGIA (Shoulder pain) and VACCINATION SITE PAIN (pain in the arm where I had the injection) outcome was unknown. The patient had pain in the arm where had the injection she expected that. On Saturday morning, in the area of her clavicle bone almost, the base of her neck to the begging of her shoulder. it was significantly swollen. It looks soft like a mass area were tender. Concomitant and Treatment medications details were not reported by the reporter. Most recent FOLLOW-UP information incorporated above includes: On 06-Nov-2021: F/U received on 08-NOV-2021: New events added, patient demographics updated.


VAERS ID: 1864026 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dyspnoea, Headache, Pain, Palpitations, Vaccination site pain
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (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:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19?:Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101526153

Write-up: Heart Palpitations; Shortness of Breath; Body Aches; Head Ache; Chills; Pain at injection site; This is a spontaneous report from a contactable consumer, the patient. A 35-year-old male patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the right arm on 05Nov2021 at 09:30 (at the age of 35-years-old) as a single dose for COVID-19 immunisation. Medical history included COVID-19, diagnosed prior to the vaccination. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient did not receive any other medicines within two weeks prior to the vaccination. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 15Oct2021 at 09:00 (at the age of 35-years-old) as a single dose for COVID-19 immunisation. On 06Nov2021 at 02:00, the patient experienced heart palpitations, shortness of breath, body aches, head ache, chills and pain at injection site. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events heart palpitations, shortness of breath, body aches, head ache, chills and pain at injection site were not resolved at the time of this report. The lot number for BNT162b2, was not provided and will be requested during follow up.


VAERS ID: 1864457 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-08
Onset:2021-11-06
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / OT

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? 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: USMODERNATX, INC.MOD20213

Write-up: received booster dose in less than 6 months after their primary series; This spontaneous case was reported by a nurse and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received booster dose in less than 6 months after their primary series) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 046C21A, 035C21A and 035C21A) for COVID-19 vaccination. No Medical History information was reported. On 08-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 04-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 06-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 06-Nov-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received booster dose in less than 6 months after their primary series). On 06-Nov-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received booster dose in less than 6 months after their primary series) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant and treatment information were reported by the reporter


VAERS ID: 1864478 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: West Virginia  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental overdose, Malaise, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Drug abuse and dependence (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow)

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

Write-up: Malaise; Nausea; Vomiting; Given a higher dose of the Moderna vaccine than the one required in error; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an other health care professional and describes the occurrence of MALAISE (Malaise), NAUSEA (Nausea), VOMITING (Vomiting) and ACCIDENTAL OVERDOSE (Given a higher dose of the Moderna vaccine than the one required in error) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032F21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 2.5 ml. On 06-Nov-2021, the patient experienced ACCIDENTAL OVERDOSE (Given a higher dose of the Moderna vaccine than the one required in error). On an unknown date, the patient experienced MALAISE (Malaise), NAUSEA (Nausea) and VOMITING (Vomiting). On 06-Nov-2021, ACCIDENTAL OVERDOSE (Given a higher dose of the Moderna vaccine than the one required in error) had resolved. At the time of the report, MALAISE (Malaise), NAUSEA (Nausea) and VOMITING (Vomiting) was resolving. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant mediation was reported. Patient received booster dose 2.5ml dose of the Moderna vaccine instead of the 0.25ml. Events were mostly ok the last check up on 7Nov2021. No medication was prescribed to alleviate the symptoms. Patient was under care of a doctor. Most recent FOLLOW-UP information incorporated above includes: On 06-Nov-2021: Follow up received contained significant information reporter details, product details and new events were updated.


VAERS ID: 1843849 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-03
Onset:2021-11-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 4/3/2021 Pfzifer Vaccine, second dose
Other Medications: Losartan, cymbalta, atorvastatin
Current Illness: None
Preexisting Conditions: Ehlers Danlos, high blood pressure, high cholesterol, depression
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: High pain level in joints especially on injection side. Predominately in hand, shoulder area. Muscle pain along right side of chest and arm pit.


VAERS ID: 1845907 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Blood pressure increased, Chills, Disturbance in attention, Dizziness, Erythema, Fatigue, Lymphadenopathy, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, advair, montuclast, antorvastatine, multivitamin, collagen
Current Illness:
Preexisting Conditions: Asthma, hashimito thyroiditis, lyphodemic colitis, high blood pressure
Allergies: Codeine, gluten-free
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling arm, redness, fever, chills, fatigue, joint pain, my entire back hurts end to end and into joints, lymph nodes under both arms swollen and blood pressure raised 15 points above range, dizziness, inability to consentrate


VAERS ID: 1845911 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-10-29
Onset:2021-11-05
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / UNK RA / IM

Administered by: Private       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: Patient received expired vaccine as it was marked for a frozen expiration date rather than a refrigerator storage


VAERS ID: 1845916 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777027398 / 1 LA / IM

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

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

Write-up: I tested positive with Covid on 10/08/2021, and was mandated by my employer to receive the vaccine. After this initial dose, all of my Covid symptoms I had during the active virus came back: fever, chills, insomnia, headache, body aches. These symptoms were just as severe as when I had Covid last month.


VAERS ID: 1845952 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21H / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hallucination, Metamorphopsia, Sleep disorder, Thirst, Vertigo
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Retinal disorders (narrow), Vestibular disorders (narrow), Dehydration (broad)

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

Write-up: I got the shot and was fine until I went to sleep. I woke up at around 1:00 am really thirsty and then i was hallucinating like I was on drugs or something. It wasn''t major hallucination but everything was distorted and kinda spinning.


VAERS ID: 1845964 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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: Child patient vomited in the middle of the night. This is very unusual behavior for her.


VAERS ID: 1845982 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-01
Onset:2021-11-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF25P3 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: I now have Bell?s palsy


VAERS ID: 1846027 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN: PATIENT DIDN''T SUPPLY ANY INFORMATION TO PHARMACY ABOUT CURRENT THERAPY,HE DOES NOT FILL PRESCRIPTIONS AT PHARMACY WHERE VACCINATION WAS ADMINISTERED
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NONE
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: UNKNOWN


VAERS ID: 1846036 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin XL 300 Mg, baby aspirin, Omeprazole 40 mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Woke up in the middle of the night feeling extremely nauseous. Tried to go back to sleep, but after an hour had to jump out of bed to throw up. I haven''t thrown up in years and I''ve never thrown up in the middle of the night. Felt better right away, but if I hadn''t waken up before vomiting, it might have bad.


VAERS ID: 1846074 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-29
Onset:2021-11-05
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Chills, Fatigue, Headache, Limb discomfort, Musculoskeletal stiffness, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient was positive for COVID-19 in July 2021 and reported symptoms of tingling of the extremities, chills, fever, fatigue, and headaches. Patient received her first dose of the COVID-19 Moderna vaccine on October 29, 2021 at 3:50 PM. Later that evening, she reported stiffness of the hands and heaviness of the legs. As of today, she is still experiencing stiffness and heaviness in the extremities in addition to fatigue and headaches.


VAERS ID: 1846081 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Ear discomfort, Extra dose administered, Headache, Heart rate increased, Pain, Pain in extremity, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna, 2/2021, 3/2021 age 69 Same symptoms
Other Medications: Bisoprolol Fumirate, Crestor, Xanax
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, Wheat
Diagnostic Lab Data:
CDC Split Type:

Write-up: 101 Fever with chills and shakes, heart rate around 100bpm, body and head ache, pain down whole left arm, Bruit in left ear.


VAERS ID: 1846086 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Sleep disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (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: No
Preexisting Conditions: No
Allergies: Latex
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Standard soreness at sigh of injection, but woke up around 2:30am shaking. As if I was cold but didn?t not feel cold, checked my temperature and it was normal, shaking lasted about 30 minutes then stopped.


VAERS ID: 1846091 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211!21A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Joint stiffness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, multi-vitamin, Afrin, calcium supplement, Motrin
Current Illness:
Preexisting Conditions: asthma, TMJ, PMDD
Allergies: penicillin, Sudafed
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Within 2 hours of vaccination: soreness at injection site; After 22 hours post-injection: muscle soreness, fatigue, joint stiffness, headache


VAERS ID: 1846177 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-11-03
Onset:2021-11-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33026BD / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Fatigue, Nausea, Rash, Rash pruritic, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra D daily. Today at 0800, took last dose of doxycycline 100mg BID she started 10/28/21 for sinus infection.
Current Illness: Sinusitis
Preexisting Conditions: Environmental allergies
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day One of vaccine, felt very fatigued Day Two after vaccine had stomach ache, lots of nausea Day Three of vaccine, was awakened at 0630 with itchy, bumpy rash on lower back. Called her PCP and was advised to take Benadryl and call the health department to report incident. Took 2nd dose of Allegra D and started to feel better. Took 50mg dose of Benadryl before ending phone call. Provided with direct line to contact on call nurse at health department to report progress over the weekend and to see her doctor on Monday if no improvement or to ER if symptoms worsen.


VAERS ID: 1846195 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: low blood pressure, cardiac dysrhythmias, history of severe COVID-19 illness requiring hospitalization
Allergies: Keflex, levothyroxine, penicillins
Diagnostic Lab Data: 11/5/21 cardiac workup during ER visit.
CDC Split Type:

Write-up: Patient reports "passing out" around 0400 at home. Patient arrived at work and fainted again. This resulted in ER visit.


VAERS ID: 1846213 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / UNK LA / IM

Administered by: Unknown       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:

Write-up: Given Janssen Vaccine outside of time frame for vial punctured


VAERS ID: 1846218 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: esomeprazole magnesium 40 mg capsule,delayed release 40 mg PO DAILY 10/06/21 [History Confirmed 10/07/21] albuterol sulfate 90 mcg/actuation aerosol inhaler (Ventolin HFA) 2 puff INH QID PRN gm 10/07/21 [History] carvedilol 3.125 mg tablet
Current Illness: Anxiety Chest pain Colon polyps COPD (chronic obstructive pulmonary disease) DDD (degenerative disc disease) Depression Diabetes Environmental allergies HTN (hypertension) with goal to be determined Insomnia due to mental condition Leukocytosis Renal insufficiency Tobacco abuse Weight loss
Preexisting Conditions: Anxiety Chest pain Colon polyps COPD (chronic obstructive pulmonary disease) DDD (degenerative disc disease) Depression Diabetes Environmental allergies HTN (hypertension) with goal to be determined Insomnia due to mental condition Leukocytosis Renal insufficiency Tobacco abuse Weight loss
Allergies: warfarin
Diagnostic Lab Data: na
CDC Split Type:

Write-up: No reaction


VAERS ID: 1846225 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, 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: unknown
Current Illness: None Reported
Preexisting Conditions: None Reported
Allergies: None Reported
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received a booster shot of Pfizer into her left deltoid. The vaccination that she received had been drawn up on previous day. The vaccination had been at room temperature for longer than the manufacturer''s recommendation.


VAERS ID: 1846251 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Sensitive skin
SMQs:, Peripheral neuropathy (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: penecillin, amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hypersensitive skin and burning sensation starting in torso and spreads to the legs and arms. No unusual physical appearance, markings, or temperature change can be seen. Second COVID vaccine dose (also PFizer) caused similar reaction, but symptom developed 24-36 hours later and then symptom dissipated within 48 hours, versus the current symptoms developed less than 18 hours later. Anticipating the symptoms to resolve within the next 48 hours.


VAERS ID: 1846267 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: At end of visit, after Covid vaccine given, chart was reviewed and provider, CPNP realized that while this visit was scheduled as a 5 year PE, patient is not yet 5 (will turn 5 in 5 days). Discussed with PCP. Mom made aware of error. While clinically, no adverse outcomes are expected, mom aware that this initial dose likely will not count toward patient being "fully vaccinated." We counseled on returning for Covid #2 in 3 weeks and advised that he will likely need a booster dose later if wants to travel internationally or be considered "fully vaccinated." Mom understanding of error and agreeable to plan/recommendations. Incident report and VAERS report filed.


VAERS ID: 1846269 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011FZ1A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site pain, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (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: Zoloft 50 mg, Sunflower Lectin, Prenatal vitamin
Current Illness: Gastroenteritis at the beginning of October
Preexisting Conditions: Arnold chiari malformation/Chronic motor tics
Allergies: Latex, Coconut
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pain at injection site, full body chills radiating from injection site, nausea.


VAERS ID: 1846273 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: sore throat, upper respiratory infection 10/29/21--had resolved at time of incident
Preexisting Conditions: none
Allergies: walnut allergy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: At end of visit, after Covid vaccine given, chart was reviewed and provider, CPNP realized that while this visit was scheduled as a 5 year PE, Patient is not yet 5 (will turn 5 in 5 days). Discussed with PCP. Mom made aware of error. While clinically, no adverse outcomes are expected, mom aware that this initial dose likely will not count toward patient being "fully vaccinated." We counseled on returning for Covid #2 in 3 weeks and advised that he will likely need a booster dose later if wants to travel internationally or be considered "fully vaccinated." Mom understanding of error and agreeable to plan/recommendations. Incident report and VAERS report filed.


VAERS ID: 1846295 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma, rheumatoid arthritis, sjorgens, beta Thalassemia, Raynaud syndrome, ibs-c,
Allergies: Donor blood products
Diagnostic Lab Data:
CDC Split Type:

Write-up: Throat/tongue swelling, slight breathing difficulty, itching


VAERS ID: 1846297 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-20
Onset:2021-11-05
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA COVID / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (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: Zoloft
Current Illness: None
Preexisting Conditions: No
Allergies: No allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient went to the hospital for a PE on Tuesaday-Wednesday


VAERS ID: 1846298 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5137 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 10mg prior to vaccination
Current Illness: No
Preexisting Conditions: ADHD
Allergies: NKDA, NKFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms of HA resolved with time. No treatment administered. Pt comforted by father, pt sitting on father''s lap.


VAERS ID: 1846306 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Fatty liver, borderline diabetic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated she had a "sensation" in her throat. Patient requested EMS on site. EMS and clinical staff on site attended patient. EMS offered injection of Benadryl and patient refused. Patient refused medical transport. Clinical staff on site monitored patient for additional time until patient was cleared to leave.


VAERS ID: 1846324 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-11-03
Onset:2021-11-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Rash erythematous, Vaccine positive rechallenge
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: same reaction with 2nd dose on 1/29/2021 moderna
Other Medications: antihistamine, ibuprofen, losartan
Current Illness: none
Preexisting Conditions: HTN
Allergies: penicillin, sulfa drugs, tramadol.....multiple food and environmental allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: fiery red rash on back, neck, ears, chest


VAERS ID: 1846340 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-02
Onset:2021-11-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, diphenhydramine , ibuprofen
Current Illness: None
Preexisting Conditions: Asplenic since 2002
Allergies: '' Seasonal allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Upon awakening the morning of 11/5/2021, I noticed a red rash on my extremities and on my back, possibly my head as it is also itching.


VAERS ID: 1846355 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5137 / 1 LA / IM

Administered by: Public       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: N/A
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt described feeling of dizziness post vaccination symptoms resolved on their own


VAERS ID: 1846363 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Immunodeficiency
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: Aspirin 81mg once a day Azelastine inhal twice a day Ezetimibe 10mg twice a day Fluticasone nasal spray twice a day Omeprazole 20mg once a day Rivastigmine 4.6mg/24 hr patch: one per day
Current Illness: HLD, HOH, elevated PSA, GERD, dementia, neurocognitive disorder, tinnitus, sleep apnea
Preexisting Conditions: HLD, HOH, elevated PSA, GERD, dementia, neurocognitive disorder, tinnitus, sleep apnea
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Primary Care Nurse Practitioner asked patient if he received his Pfizer booster shot (he qualifies based on his age). There was no record in his chart of a booster dose and he informed the NP that hadn''t received booster. NP informed RN to give booster and it was given. Patient did not report to the RN prior to giving the shot that he already received the booster. Patient does have a history of dementia. After visit, his wife called and informed RN that patient had already received a booster dose on 9/25/21 at pharmacy. Explained possible side effects and to inform his PCP NP if he has any side effects other than pain/swelling/redness at the injection site.


VAERS ID: 1846367 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / 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: Patient was observed in office for 30 minutes.
CDC Split Type:

Write-up: Patient was administered 1ml of Moderna vaccine instead of the 0.25ml booster dose.


VAERS ID: 1846376 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Dysphonia, Throat tightness, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (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: no
Current Illness: recent nasal cold, 3 weeks ago
Preexisting Conditions: asthma HTN
Allergies: morphine codeine cats mold
Diagnostic Lab Data:
CDC Split Type:

Write-up: after 3rd booster today, shortly after developed throat tightness and hoarseness. had to take antihistamine. This also occurred after the second dose I had shortly after getting the vaccine and I took antihistamine. Since it happened again on the third dose, I am inclined to report as if further vaccines are required, I may not be able to get one if developing signs of reaction that could lead to anaphylaxis or worse symptoms. May need to pre medicate if necessary in the future. No other history of reactions to other immunizations


VAERS ID: 1846388 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Blood test, Condition aggravated, Pharyngeal swelling, Rash
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Measles booster
Other Medications: Glyburide Metformin Novolog Lantus fenfibrate Jardience Rovostatin Vit D Calcium MVI
Current Illness: Asthma- obstructive and allergic, Syndrome X, hypothyroid, PCOS, polycystic breasts, Vitamin deficiency,
Preexisting Conditions: See above
Allergies: Penicillin class allergy, Keflex, refampin, Cipro, Levaquin, theophylline, bees, lamb, mutton, lanolin, Mustard,
Diagnostic Lab Data: Routine bloodwork
CDC Split Type:

Write-up: Asthma attack, throat swelling, rash


VAERS ID: 1846473 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol Inhaler, Gralise, Trelegy 100/62.5/25, Trulicity, Atorvastatin
Current Illness: Not Known
Preexisting Conditions: COPD, Diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a booster dose (0.25 ml) Moderna. She was told to stay for 15 minutes to make sure she was okay. She is an employee and said she would be around but had to get back to work. About 5 or so minutes after receiving the vaccine a member of management came to the pharmacy and said the patient had passed out and someone said they saw her having a seizure. 911 was called and I went to the patient. The patient was breathing, but not responding to voice. Patient is diabetic. Paramedics came and took over.


VAERS ID: 1846498 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Presyncope, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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: She went vesovagel and is fine now. She fainted and convulsed almost immediately


VAERS ID: 1846507 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Computerised tomogram, Deafness, Dyskinesia, Muscle spasms, Nervous system disorder, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: CT
CDC Split Type:

Write-up: Involuntary movements, memory loss, cramps, auditory loss, vision and nervous system.


VAERS ID: 1846514 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, 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: Pt is nonverbally autistic. When reconciling the vaccine form, pharmacist helped fill in questionnaire. When guardian stated that he met criteria for booster dose for Pfizer dose, pharmacist misread date of birth as 2002 and not 2005. Pt is 16.


VAERS ID: 1846517 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / -

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

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

Write-up: severe headache, chills, body ache all over, light headed,


VAERS ID: 1846532 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

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

Write-up: Pt experienced Dizziness, light haded, numbness and tingling. Nurse attended cleared.


VAERS ID: 1846551 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: About 10 minute post injection patient starting feeling nauseous, a minute late patient reports difficulty breathing, I provided water and monitored her, she continued to struggle and lips started turning blue. I administered an Epipen and called 911


VAERS ID: 1846569 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin 500mg jardiance 25mg trulicity 3mg/0.5ml tresiba
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received a second dose of Moderna booster ( 0.25ml) on 11/5/2021 patient received Moderna booster on 10/25/2021 patient received first moderna on 2/12/2021 patient received second moderna on 3/12/2021


VAERS ID: 1846571 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0003226809 / 3 RA / SYR

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: Taking HIV meds seizure medications ( Kepra) gabapentin ibuprofen Benadryl hydroxyzine Seroquel vitamin D Claritin avastatin Lisinopril
Current Illness: My right arm where I received my vaccination feels like I hit my funny bone and from my right shoulder to the middle of my back is severely hurting
Preexisting Conditions: Taking HIV medications and the above medications
Allergies: Aspirin,fish bees fire ants.
Diagnostic Lab Data: None
CDC Split Type: Yes

Write-up: Been talking ibuprofen


VAERS ID: 1846580 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

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

Write-up: VIAL EXPIRED ON 11/4/21 AT APPROXIMATELY 9:00 PM. VIAL WAS USED TO VACCINATE PATIENT ON 11/5/21 AT 12/20 PM.


VAERS ID: 1846588 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-31
Onset:2021-11-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Pre-eclampsia
SMQs:, Hypertension (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: Severe pre-eclampsia going to get emergency C section. 34W4D


VAERS ID: 1846617 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 2 LA / IM

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

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

Write-up: Patient was feeling dizzy, light headed, and was sweating. Symptoms passed after about 20 minutes. Blood pressure within normal limits. Do problems with breathing


VAERS ID: 1846622 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Headache, Hypoaesthesia oral, Musculoskeletal stiffness, Neck pain
SMQs:, Taste and smell disorders (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Red yeast rice, B12, D
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, Amoxicillin
Diagnostic Lab Data: N/A - still same day.
CDC Split Type:

Write-up: Slight metallic taste. Numbness in lower lip on right side. Headache. Neck ache/stiffness center back.


VAERS ID: 1846627 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-01
Onset:2021-11-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Injection site warmth
SMQs:, Hypersensitivity (narrow)

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

Write-up: Plum size rash at injection site that is a little warm to the touch. Told her to outline with a marker and if it gets bigger or doesn''t resolve in a couple of weeks to see Dr.


VAERS ID: 1846629 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: Patient was administer 1 dose of Janssen Covid-19 vaccine that had an expiration date of 9/19/2021. There were no adverse effects or allergic reactions.


VAERS ID: 1846641 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dehydration, Dizziness, Dizziness postural, Epistaxis, Eye contusion, Fall, Gait disturbance, Joint injury, Lip injury, Nasal injury, Pain, Paraesthesia, Poor quality sleep, Skin abrasion, Skin laceration
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (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: 81 mg aspirin
Current Illness: none
Preexisting Conditions: Leiden Factor VI
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received the 2nd dose of Moderna approx 8:45 am on 11/4/21. Started feeling the tingly and achy side effects by about 7 pm that night. Went to bed feeling pretty achy and weak and had a somewhat restless sleep. Just before 5 am, our home fire alarms went off - my husband and I walked through the house to turn them off. On my way back upstairs, I started feeling very weak and dizzy. I stopped at the hall bathroom to use the bathroom. Upon standing up I was feeling incredibly weak and dizzy as if I was about to pass out. I grabbed the sink vanity and the door frame, and the next thing I remember is waking up on the floor with my husband who rushed to my side when he heard the thud of my body hitting the floor. I had a bloody nose, a gash on the bridge of my nose, a gash near my eyebrow, and a slightly split lip (all on my right side of face). Also scraped my elbow. Got back to bed with the help of my husband but felt like I could barely walk I was so weak. Also felt slightly dehydrated. Put a cold compress and ice on my face and rested for the next 6 hours. Will likely have a black eye and suspect I may possibly have broken my nose during my fall. NOTE: I was forced to get this vaccine in order to keep my job; I did not otherwise intend to get the vaccine.


VAERS ID: 1846684 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: gummy vitamins
Current Illness:
Preexisting Conditions: denied
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received dose 1 of the Pfizer COVID vaccine (lot FK5127) at approximately 1115. At 1124, RN approached the patient and mother to inquire about how he felt. The patient reported feeling nauseous. RN transferred patient to zero-gravity chair. PHN and Paramedic approached to assess. At 1125, vital signs: blood pressure 98/72, respirations 12, O2 100%, pulse 96. Patient placed supine. Patient reported improvement in symptoms, no longer nauseous. Patient appeared pale; denied diaphoresis, blurry vision, pain, dizziness. Patient''s mother reported he had eaten breakfast and was well hydrated. Patient has no allergies, no medical conditions, and takes gummy vitamins. No history of fainting. Patient reported anxiety to needles. At 1133, PHN offered Benadryl, mother declined. PHN educated patient''s mother on remaining for 30min monitoring since report of symptoms, on following up with provider, and ER precautions. Patient sat up and drank water provided by Paramedic. At 1137, vital signs: blood pressure 96/68, pulse 84, O2 100%, respirations 22. Patient reported symptoms had resolved. PHN noted improved skin tone color. At 1140, patient stood up unassisted, continued to report no symptoms. At 1142, patient left with mother, against medical advice of remaining for 30min monitoring from time of reporting symptoms.


VAERS ID: 1846687 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Peripheral vascular disease Hyperlipidemia Paroxysmal atrial Fibrillation Obesity Insomnia Diabetes Type II
Allergies: No known drug allergy
Diagnostic Lab Data: N/A
CDC Split Type: Unknown

Write-up: At approximately 1320 hours, A patient housed in a facility was scheduled by Admin staff for a 3rd dose Phizer. This individual was registered in the system and was the first individual patient that was visited for the vaccination. After the nurses arrived back to the dining area to identify other patients to give vaccinations too, the patients CDC card was located. Note that the CDC cards were provided to staff in a Tupperware container, and all of the cards had to be checked to find the individual patients that we needed to provide. It was discovered that the first patient vaccinated had already received his 3rd dose Pfizer on October 15, 2021. I advised the staff that we will not provide any other doses unless we can verify the proper dose in database. The appropriate lead was advised of the situation and agreed with our method going forward. The clinical lead conducted a VAERS report on the incident and notified her chain of command.


VAERS ID: 1846692 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Nasal congestion, Pain, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore arm, weak, achy, stuffed nose


VAERS ID: 1846694 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium Vitamin D3, Ferrous sulfate, Flonase, Cozaar, Metformin, Prilosec, triamterene-hydroCHLOROthiazide
Current Illness: None
Preexisting Conditions: GERD, OSA, Osteoarthritis, Asthma-mild persistent, History of anemia, Wolff-Parkinson-White syndrome, Hypertension, Hyperlipidemia, Diabetes, Mild aortic stenosis, Gastric AVM.
Allergies: Ace Inhibitors
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient was given vaccine, afterwards it was found to be expired. The vile was expired on 11/1/21, and it was administered on 11/5/21. I am awaiting instructions/call back from the manufacturer, Moderna for next steps. The patient did not have any reaction or symptoms from this event yet.


VAERS ID: 1846700 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-03
Onset:2021-11-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Blood pressure increased, Chills, Extra dose administered, Musculoskeletal stiffness, Myalgia, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tamsulosin, finasteride, simvistatin, famotadine, magnesium, melatonin
Current Illness: None
Preexisting Conditions: Charcot-Marie-Tooth neuropathy High cholesterol Benign prostate hyperplasia
Allergies: possible penicillin allergy
Diagnostic Lab Data: None -- checked in with the doctor, MD, who assessed the episode of possibly related to the vaccine, with no other obvious causes.
CDC Split Type:

Write-up: 6:15 am Nov 5 2021: sudden extreme vertigo upon standing up from bed. Mostly resolved upon lying down, but turning head, or turning over produced moderate vertigo. This happened again at 7 am. After that it became less and less until by 9 am it was gone. Pt never had this before. No fever. BP was acutely elevated to about 160/90. Pulse was 56 (He usually runs a lower "marathoner''s" pulse, so this was high for him). 1 day after booster, Pt had chills and muscle aches/ mild joint aches / mild neck stiffness, resolved by evening. The vertigo was the morning of the 2nd day after the booster.


VAERS ID: 1846701 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-11-05
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

Administered by: Unknown       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: Tested NAAT positive for COVID 11/5/21 after being fully vaccinated.


VAERS ID: 1846705 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330268D / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1846726 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-02
Onset:2021-11-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Pfizer booster within 6 months of second dose. No adverse reactions occurred


VAERS ID: 1846740 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular 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: Amlodipine 10mg, atorvastatin 10mg, cyanocobalamin 1000mcg, Albuterol hfa, Trelegy 200mcg
Current Illness: N/A
Preexisting Conditions: Asthma, Hypertension, Hyperlipidemia
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient became dizzy and fell. She stated she had never had a reaction like this before. We called the ambulance and after checking her vitals she declined to go to the hospital. We contacted her husband and she came to pick her up from our store.


VAERS ID: 1846752 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Headache, Immediate post-injection reaction, Loss of consciousness, Nausea, Pallor, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: Unable to recall, but patient stated she "passes out with most injections".
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose of Pfizer vaccine in right deltoid muscle while seated in the front passenger side of the vehicle. Patient immediately had a suspected vagal response, fell back and passed out. Patient was unconscious for approximately 10 seconds. Patient was pale and clammy. 911 was activated by clinic staff. Patient was immediately reclined and put in the supine supine position. Ice packs were applied to post occipital/neck region, as well as left and right axilla. Patient regained consciousness after ice packs and complained of nausea/headache. Non productive emesis. Initial vitals: P47, R10, Unable to get BP, SPo2-94%. Patient was placed in semi fowlers position for emesis as EMS arrived on scene. Patient was answering questions and AAOx3 on EMS arrival. EMS vitals: BP-110/60, P-55, RR-12 SPO2-96, blood sugar 102. After EMS assessment, Patient was able to ambulate under own power around the vehicle. Patient refused further treatment by EMS. Patient stayed for 30 minute observation without further incident.


VAERS ID: 1846754 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-24
Onset:2021-11-05
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest pain, Chills, Cough, Fatigue, Feeling abnormal, Headache, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions:
Allergies: No known allergies.
Diagnostic Lab Data: 10/28/21-COVID19 Antigen Detected Abnormal.
CDC Split Type:

Write-up: 10/28/21-48-year-old male with a history of diabetes, hypertension and is fully vaccinated completed in April presents wanting a repeat rapid antigen because when he had his test done earlier at PRP he said that he received a call that he was negative but 20 minutes later his wife received a call to see that he was positive. Patient states he had been feeling bad for 2 days. He has had a cough but no shortness of breath and he has had a headache that is mild. He states that he is seems his chest hurts with a cough. He has had chills but no fever. .


VAERS ID: 1846765 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Injected limb mobility decreased, Pain in extremity
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient calls in and reports severe pain in her arm and that she can barely move her arm. Denies any redness at vaccine site. She received her vaccine earlier today. I advised to take Tylenol or Ibuprofen and use a cold compress on her arm. If it does not improve with nursing recommendations she should call her doctor.


VAERS ID: 1846783 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient had a reaction to a vaccine as a teenager administered in school. Unaware of name of vaccine. Patient advised by doctors
Other Medications:
Current Illness: Patient experienced congestion but resolved about 5 days ago.
Preexisting Conditions:
Allergies: Patient stated has egg allergy and had a reaction to a vaccine as a teenager. She does not know name of vaccine but was told to avoid vaccines extracted from eggs. Patient discussed COVID-19 vaccine with doctor and advised to get Pfizer''s COVID-19 vaccine.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the 1st dose COVID-19 vaccine at 2:47 pm. Advised healthcare professional at 3:15 pm, she felt as if weight on her chest; similar to chest congestion (resolved 5 days ago). At 3:30 pm patient shared she felt sweaty and still felt as if weight on chest.


VAERS ID: 1846788 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not specified
Current Illness: None stated.
Preexisting Conditions: None stated
Allergies: Not specified
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt experienced dizziness 5-10 minutes after vaccine administration. Pt lost consciousness and was diaphoretic and pale. Blood pressure was 73/42. Pulse was 44. Blood glucose 66. 4-lead EKG - slightly elevated T waves (per first responders). Pt slowly resolved to a more stable state. Color returned. BP - 107/77. Pulse 70. Patient refused transport and decided to return home about 1 hour after his vaccination.


VAERS ID: 1846789 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, 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: Patient consistently feels dizzy with any vaccine administration
Other Medications: Unknown
Current Illness: Mast Cell Activation
Preexisting Conditions:
Allergies: Red and orange food dye and coloring
Diagnostic Lab Data: Vital signs on 11/5/2021 at 1140: BP 104/61, HR 65, SpO2 98%, and RR 16
CDC Split Type:

Write-up: At 1135 client described feeling dizzy as she was waiting in observation. Clinicians layed client down in supine position on top of a foam matt. At 1140, vital signs were taken. At 1145 client stated she was feeling better and sat up. At 1147 client stated she was ?feeling okay now? and stood up. Pt ambulated away at 1149.


VAERS ID: 1846790 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 17822811 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, 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: 14 year old client was given Janssen Vaccine instead of Pfizer Vaccine. Complained of mild headache after receiving the vaccine at 3:32 pm. T 97.3 P 66 , BP 117/76.


VAERS ID: 1846792 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

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

Write-up: The patient was given booster dose of Pfizer COVID-19 vaccine.


VAERS ID: 1846814 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Loss of consciousness, Nausea, Syncope, Tension
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: none
Current Illness: none
Preexisting Conditions: Asthma
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: client fainted/ loss consciousness with both tension in both arms and eyes open staring blankly for approx 10 to 20 seconds post vaccination at 3:13pm. client stated that they did not eat all day as they "just woke up" and reported feeling "nauseous" right before incident. Client recieved food from brother after incident. No other treatments given. Vitals after eating stable. @3:14pm BP 78/35 HR 52 @3:16PM BP 86/58 HR 61 @3:26 PM BP 90/55 HR 73 @3:56PM BP 106/52 HR 81 @3:56PM BP 107/74 HR 89 O2 100% THROUGH COURSE OF INCIDENT


VAERS ID: 1846816 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

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

Write-up: Patient was suppose to receive second dose of Pfizer series. Patient was inappropriately given 0.5ml Janssen vaccine. Pt was notified and was understanding. Was given recommendation on next steps.


VAERS ID: 1846820 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-02
Onset:2021-11-05
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / N/A UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Asymptomatic COVID-19, Chest X-ray normal, Chills, Computerised tomogram abdomen abnormal, Condition aggravated, Cough, Culture urine negative, Discomfort, Fatigue, Feeling abnormal, Hyperhidrosis, Myalgia, Nausea, Night sweats, Pyrexia, Renal atrophy, Renal function test normal, SARS-CoV-2 test positive, Urinary tract infection, Urine analysis abnormal, Urine flow decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol (ZYLOPRIM) 100 MG tablet see pg 2 Additional information for Item 9: allopurinol (ZYLOPRIM) 100 MG tablet amLODIPine (NORVASC) 5 mg tablet Take 2.5 mg by mouth daily aspirin 81 MG chewable tablet Chew 81 mg by mouth. ben
Current Illness: 10/8/21 rec''d flu shot Influenza Vaccine (#1) 09/01/2021?
Preexisting Conditions: Hx of renal transplant, bladder CA, hypertension, anxiety
Allergies: Sulfa antibiotics, sulfur, lisinopril, simvastatin
Diagnostic Lab Data: 10/21/21 Chest xray-IMPRESSION: No acute cardiopulmonary radiographic abnormality CT Abd/Pelvis: Atrophic native kidneys with normal-appearing transplant kidney. No acute process
CDC Split Type:

Write-up: 10/21/21 The patient is a 64 yr/o female with a history of CKD, HLD, HTN, osteoporosis, cancer, right kidney transplant presents with multiple complaints. She reports that she''s had subjective fever, RLQ pain, cough, and fatigue over the past 13 days. She reports that she saw her nephrologist on 10/8/21, had labs done, got a flu shot, and has since developed her symptoms after that appointment. She reports that she feels fine during the day, however at night she is fatigued, develops a low grade fever with chills, muscle aches, headaches, nausea, and night sweats. She also reports decreased urinary frequency and urinary "pressure", and that she is concerned for possible UTI. Sent from clinic 10/21-10/23/21 Hospitalized: Admission Review of Systems Review of Systems Constitutional: Positive for diaphoresis, fatigue and fever. Negative for chills. Fever is subjective HENT: Negative for nosebleeds, sneezing, voice change and ear discharge. Eyes: Negative for discharge and redness. Respiratory: Positive for cough. Negative for chest tightness, shortness of breath and wheezing. Cardiovascular: Negative for chest pain and palpitations. Gastrointestinal: Negative for abdominal distention, abdominal pain, constipation, diarrhea, nausea and vomiting. Genitourinary: Negative for difficulty urinating, dysuria and urgency. Decreased urinary frequency, notes "pressure" with urination Musculoskeletal: Generalized muscle aches Skin: Negative for rash and wound. Neurological: Positive for headaches. Negative for dizziness, speech difficulty and weakness. All other systems reviewed and are negative. 10/23/21 Discharge summary: Patient was admitted to NAH with acute complaint of fevers and feeling poorly she has history of recurrent UTI and was noted to have +UA and was started on IV rocephin. She was also noted to be COVID19 + on rapid test, but was asymptomatic. She had previously been treated for COVID19 2 months ago. She is on RA and feeling okay from that standpoint. She was treated with IV abx, given history of renal transplant Nephrology was consulted and patient was resumed on home immunosuppressives. Renal function has been stable. Renal consulted and agreeable for discharge home. Patient doing well and no more fevers. She no longer meets sepsis criteria urine culure was negative. She will need to complete 5 more days of ciprofloxacin on discharge. Patient is agreeable for this. Urology was also consulted given recurrent UTIs and history of bladder CA treated by Doctor. Patient will need outpatient Cysto once UTI resolved per Urology. She will also need PCP follow up. Moderna vaccine and Influenza given at Physicians office.


VAERS ID: 1846825 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8027 / 1 LA / IM

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

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

Write-up: Administered 0.2mL of Adult Pfizer COVID-19 formulation instead of 0.2mL of Pediatric. Pfizer COVID-19 formulation.


VAERS ID: 1846828 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 LA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was inadvertently administered COVID-19 Pfizer Adult 0.2mL formulation instead of COVID-19 Pfizer Pediatric 0.2mL formulation resulting in larger dose.


VAERS ID: 1846842 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patients daughter and caregiver was not informed that her mother, PATIENT, had received her 2nd Moderna vaccine while in a rehab facility on 9/30/2021. It was also not recorded on her official vaccine card. The patient received a dose of 0.5ml at our location on 11/5/21 under the impression it was the patients 2nd dose. However, it was her 3rd shot. Patient at this point has not had any adverse events. I, informed patient and caregiver that she may not feel well tomorrow (fever, aches, chills) and to keep an eye on her.


VAERS ID: 1846843 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 100 mg and Nuvaring
Current Illness: None
Preexisting Conditions: None
Allergies: No known medications
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient began to become sweating and ended up throwing up about 10 minutes after the vaccination. The patient pulse was high, but never lost consciousness


VAERS ID: 1846845 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Injection site erythema, Injection site induration, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Headache, chills, naseau, site of injection red, hard, painful


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