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From the 7/23/2021 release of VAERS data:

Found 506,830 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 23 out of 5,069

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VAERS ID: 1490412 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination


VAERS ID: 1490418 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / -

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

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

Write-up: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination


VAERS ID: 1490421 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: ?Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490439 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination


VAERS ID: 1490450 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, 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: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received improperly stored vaccine. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, the patient will need revaccination


VAERS ID: 1490463 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

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

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

Write-up: ?Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490571 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, 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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: ?Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490598 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Loss of consciousness, Rash, Rash erythematous, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: proair albuterol inhailer, Buspar, cymbalta, flovent, motrin, lamictal, trazadone.
Current Illness: none
Preexisting Conditions: depression, asthma,
Allergies: coconuts
Diagnostic Lab Data: none
CDC Split Type:

Write-up: upset stomach , follow by Blacking out, red rash noted on chest. taken to ED after epi given . employees symptoms persisted for hours and included vomiting..


VAERS ID: 1490636 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-07-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0X8C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Anxiety, Blood test normal, Chest X-ray normal, Chest discomfort, Chest pain, Computerised tomogram normal, Electrocardiogram normal, Exposure during pregnancy, Foetal monitoring, Heart rate abnormal, Inflammation, Influenza like illness, Screaming, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamins.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Amoxicillin.
Diagnostic Lab Data: EKG, normal; Chest x-rays, normal; Blood work, normal; CT scan, normal.
CDC Split Type: vsafe

Write-up: I had flu-like symptoms at the beginning and when I woke up from a little rest my chest felt like very intense pain and tightness like someone was sitting on it. Very quickly it turned from a concerning feeling to me screaming out in pain. Terrible chest and heart area pain. I screamed for help and went to the ER. They saw that it looked like a person going into cardiac arrest and they prescribed morphine immediately. They quickly ordered an EKG, chest X-rays, blood work, and CT scan. Throughout this period of time I had extreme excruciating pain. The pain was correlated to the heart rate. The morphine wasn''t really making a difference on the heart rate. Over time, the pain started to subside probably over the course of 5 hours and they were able to see that there wasn''t anything else wrong after getting the tests back. They said that is was probably an inflammatory reaction to the vaccine. They watched the baby for a while. They sent me home and gave me Benadryl. They said that if it was related to the vaccine the symptoms should subside in about 24 hours. The pain was the most excruciating pain I have had I even thought I was gonna die in the way to the hospital. I had to stay for the day at the hospital but I did not stay over time. My pregnancy history was perfect until that time. This is my second pregnancy. No complications with either. Estimated date of delivery is 08/18/2021.


VAERS ID: 1490757 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490760 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-07-14
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: Unknown.
Preexisting Conditions: Unknown.
Allergies: Unknown.
Diagnostic Lab Data: Patient has not reported this to his provider. I did counsel him to make an appointment to get labs and testing done.
CDC Split Type:

Write-up: Patient has noticed a sudden onset of numbness and tingly sensations that began on this right thigh. Over the past week these symptoms have become more spread out.


VAERS ID: 1490801 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated


VAERS ID: 1490835 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Electrocardiogram, Malaise, Migraine, Palpitations, Vomiting
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C and D
Current Illness: none
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: On 7/17, Patient went to a walk in clinic and was given an EKG. He was sent to the emergency room.
CDC Split Type:

Write-up: 7/14-7/16 chills, SEVERE migraine, vomiting 7/17 heart pounding My son has NEVER been so sick! As of 7/21, he is still not back to normal.


VAERS ID: 1490847 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Poor quality product administered, 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: A vaccine that was drawn up into a syringe on 7/7/21 and placed into a refrigerator was accidentally used on 7/14/21. It should have been discarded on 7/7/21, after a no show appointment. It was placed into the refrigerator and then accidentally used on 7/14/21. The nurse thought it was a fresh syringe from 7/14/21.


VAERS ID: 1490867 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-23
Onset:2021-07-14
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Pulmonary embolism, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Massive bilateral pulmonary embolism. Tachycardia, chest pain, shortness of breath


VAERS ID: 1490881 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-02
Onset:2021-07-14
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 2 - / SYR

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

Write-up: Breakthrough COVID case


VAERS ID: 1490896 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Feeling cold, Gait disturbance, Loss of consciousness, Mobility decreased, Tremor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Rocephin
Diagnostic Lab Data: N/A,
CDC Split Type:

Write-up: Pt was administered Moderna on 07/14/2021. Pt called on 7/20/2021, left a Voice Mail stating he would like a call back to discuss side effects to the vaccine. I called patient back the morning of 07/21/2021, the patient states to me that two hours after the vaccine was administered he started to shake uncontrollably and was very cold, then he blacked out (Patient states he may have had a seizure.) Pt woke up outside behind his vehicle in a pool of his own vomit. I asked if 911 was called and the patient said no because he could not move or walk. The patient also stated that he felt bad all day, Thursday (07/15/2021), the day after the vaccine was administered, woke up on Friday (07/16/2021) feeling relatively normal still feels the urge to vomit when eating certain foods.


VAERS ID: 1490951 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-23
Onset:2021-07-14
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

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

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

Write-up: Patient stated her arm was a little red and itchy right away, then the redness and a lot of itchiness occurred again 3 weeks later.


VAERS ID: 1490992 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

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

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

Write-up: DIFFUSE RED RASH FROM UPPER ARM TO ELBOW. WARM TO THE TOUCH, NO PAIN OR FEVER.


VAERS ID: 1491005 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-14
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Erythema, Feeling abnormal, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Epinephrine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 7 minutes after pt received her 2nd Covid Vaccine, pt reported that she felt dizzy. Also noted pt was red in the face. Instructed pt to lay back and we put her legs up. Vital signs taken, elevated (96 pulse and 156/90 bp). Her breathing was fine and she was alert. As we were speaking, her redness started to subside, but her dizziness persisted. I went to get her a bottle of water. RN then went to call Rapid Response who evaluated pt, administered Benadryl, and observed for extra time. Pt was then released and walked out on her own 2 feet. Call to RRT at the vaccination clinic. Patient had sudden onset of dizziness/fogginess and left facial/neck rash a few minutes after taking the second Covid vaccine. Patient stated she had similar rash a few hours later with her first Covid vaccine that self resolved. She reported no chest pain, shortness of breath, throat/tongue swelling. She reports no cardiac history/risk factors. Patient noted to be lying supine face/with a rash on her face and neck. Vitals were noted to be stable(please see RN note). Blood sugar 107. She was given 50 mg p.o. Benadryl and symptoms significantly improved as per RN. Allergy to epinephrine. She had a chaperone take her home. Advised to continue benadryl Q6-8 hrs and follow-up with PCP. ER precaution explained.


VAERS ID: 1492838 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Louisiana  
Vaccinated:0000-00-00
Onset:2021-07-14
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: COVID-19, Ear pain, Laryngitis, Suspected COVID-19, 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: Alcohol use (Consumes wine twice a week); Non-smoker
Preexisting Conditions: Comments: The patient was healthy
Allergies:
Diagnostic Lab Data: Test Date: 20210713; Test Name: COVID-19; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20210733616

Write-up: EAR ACHE; LARYNGITIS; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 60 year old female. Initial information was processed along with the additional information received on 16-JUL-2021 and 19-JUL-2021. The patient''s weight was 137 pounds, and height was 64 inches. The patient''s concurrent conditions included alcohol user and non smoker and also the patient was healthy. The patient experienced drug allergy when treated with codeine for drug used for unknown indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805018 and expiry: unknown) dose was not reported, 1 total administered on 05-MAR-2021 to left arm for prophylactic vaccination. No concomitant medications were reported. On 13-JUL-2021, the patient underwent a covid-19 test and on 14-JUL-2021, the results came as positive (suspected clinical vaccination failure and suspected covid-19 infection). It was reported that the patient''s covid-19 symptoms started with an ear ache, scratchy throat and laryngitis. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from suspected covid-19 infection, and the outcome of suspected clinical vaccination failure, ear ache and laryngitis was not reported. This report was serious (Other Medically Important Condition). This report was associated with Product Quality Complaint -90000186156.; Sender''s Comments: V0:20210733616-COVID-19 VACCINE AD26.COV2.S-Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive 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: 1492844 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-07-14
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Deafness neurosensory
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies and the patient was not a drug abuse or illicit drug user.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210738424

Write-up: SUDDEN SENSORY NEURAL HEARING LOSS LEFT EAR; This spontaneous report received from a consumer concerned a 63 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-alcohol user, and non smoker, and he had no known allergies and he was not a drug abuse or illicit drug user. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry: unknown) dose was not reported, 1 total, administered on 18-MAR-2021 to right deltoid for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 14-JUL-2021, the patient experienced sudden sensory neural hearing loss left ear (ringing in left ear) and which was still ongoing and she visited physician''s office. On an unspecified date, the patient experienced ringing in left ear. The patient was treated with prednisone 50 mg first 2 days and taper over 10 days. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from sudden sensory neural hearing loss left ear. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0- 20210738424 - Covid-19 vaccine ad26.cov2.s-sudden sensory neural hearing loss left ear. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.


VAERS ID: 1492847 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-07-14
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure decreased, Blood pressure fluctuation, Blood pressure measurement, Blood pressure systolic, Heart rate irregular, Injection site pain, Injection site swelling, Pruritus, Rash, Urticaria, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Hypertension (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Drug allergy; Heart disorder; Non-smoker; Penicillin allergy; Renal disease
Preexisting Conditions: Comments: She had no history of drug abuse or illicit drug usage
Allergies:
Diagnostic Lab Data: Test Date: 20210714; Test Name: Blood pressure; Result Unstructured Data: dropped; Test Date: 20210715; Test Name: Blood pressure; Result Unstructured Data: fluctuating; Test Date: 20210715; Test Name: Systolic blood pressure; Result Unstructured Data: went down below 100
CDC Split Type: USJNJFOC20210738751

Write-up: BLOOD PRESSURE FLUCTUATING; RIGHT EYE VISION BLURRINESS; BLOOD PRESSURE DROPPED; RASH ON LEGS, BACK, AND IN PLACES; SWELLING AT SITE OF INJECTION; HIVES; SORENESS AT SITE OF INJECTION; ITCHING ALL OVER BODY; IRREGULAR HEART BEAT; This spontaneous report received from a patient concerned a 78 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high risk heart patient, stage 3 kidney patient, penicillin allergy, all different kinds of erythro allergy and allergic to 37 different types of medications (unspecified), non alcoholic, and non-smoker, and other pre-existing medical conditions included she had no history of drug abuse or illicit drug usage. The patient experienced drug allergy when treated with codeine for drug used for unknown indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, and expiry: UNKNOWN) dose was not reported, administered on 14-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 14-JUL-2021, the subject experienced itching all over body. On 14-JUL-2021, the subject experienced irregular heart beat. On 14-JUL-2021, the subject experienced right eye vision blurriness. On 14-JUL-2021, the subject experienced blood pressure dropped. On 14-JUL-2021, the subject experienced rash on legs, back, and in places. On 14-JUL-2021, the subject experienced swelling at site of injection. On 14-JUL-2021, the subject experienced hives. On 14-JUL-2021, the subject experienced soreness at site of injection. Laboratory data included: Blood pressure (NR: not provided) dropped. On 15-JUL-2021, the subject experienced blood pressure fluctuating. Laboratory data included: Blood pressure (NR: not provided) fluctuating, and Systolic blood pressure (NR: not provided) went down below 100. Treatment medications (dates unspecified) included: diphenhydramine hydrochloride. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rash on legs, back, and in places, itching all over body, right eye vision blurriness, swelling at site of injection, hives, soreness at site of injection, and irregular heart beat, and the outcome of blood pressure dropped and blood pressure fluctuating was not reported. This report was non-serious.; Sender''s Comments: V0: Medical Assessment Comment not required as per standard procedure as the case assessed as non-serious.


VAERS ID: 1492910 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-01
Onset:2021-07-14
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (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.MOD20212

Write-up: Heart Attack after vaccination; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart Attack after vaccination) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In April 2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-Jul-2021, the patient experienced MYOCARDIAL INFARCTION (Heart Attack after vaccination) (seriousness criterion medically significant). At the time of the report, MYOCARDIAL INFARCTION (Heart Attack after vaccination) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medication use was not reported. Treatment information was not reported. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1493591 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-07-14
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 LA / IM

Administered by: Public       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: PCR
CDC Split Type:

Write-up: positive for covid-19


VAERS ID: 1493610 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-07-14
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Exposure during pregnancy, Oropharyngeal pain, Productive cough, Rhinorrhoea, SARS-CoV-2 test negative, Sputum discoloured, Streptococcus test negative, Viral infection
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Strep test- negative Covid 19 test- negative
CDC Split Type:

Write-up: Runny nose, sore throat, cough with yellow phlegm, loss of taste and smell. Currently 32 weeks pregnant. Still no sense of taste or smell to date. No medications prescribed. No OTC medications taken. Diagnosed as viral infection.


VAERS ID: 1493613 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Bladder catheterisation, Blood culture negative, Blood glucose increased, Blood lactic acid decreased, Blood sodium decreased, Body temperature increased, Brain natriuretic peptide increased, C-reactive protein increased, Chest X-ray abnormal, Computerised tomogram head normal, Confusional state, Differential white blood cell count abnormal, Dyspnoea, Echocardiogram normal, Ejection fraction normal, Encephalopathy, Facial paralysis, Fatigue, Fibrin D dimer, Full blood count abnormal, Haematocrit increased, Haemoglobin increased, Headache, Hyponatraemia, Hypophagia, Hypoxia, Inflammatory marker increased, Influenza virus test negative, Lactic acidosis, Lethargy, Lymphocyte percentage decreased, Lymphopenia, Neutrophil percentage increased, Neutrophilia, Pericardial effusion, Polycythaemia, Pulmonary oedema, Pyrexia, Red blood cell sedimentation rate increased, SARS-CoV-2 test negative, Somnolence, Systemic inflammatory response syndrome, Tachycardia, Tachypnoea, Tremor, Urine sodium decreased, Vaccination complication, White blood cell count normal
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hearing impairment (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lantus, Metoprolol, Eliquis, Requip, Lexapro, hydrocodone prn, lipitor, torsemide, gabapentin
Current Illness: None
Preexisting Conditions: DM-2, Tobacco use, COPD/oxygen dep at 3L, Diabetic neuropathy, ckd stage 3, restless leg syndrome, depression, atrial fib, diastolic CHFHTN, Hyperlipidemia, hx CAD
Allergies: PCN, Naproxen
Diagnostic Lab Data: As above
CDC Split Type:

Write-up: Pt was admitted with a suspected Covid vaccine reaction on 7/14/21 < 48 hrs after her second covid vaccine was received resulting in systemic inflammatory response syndrome resulting in acute encephalopathy, pulmonary edema with small pericardial effusion, high fever, lactic acidosis, acute respiratory failure and high inflammatory markers. Pt received her 2nd covid vaccine at 6pm on 7/12 and was in her normal state of heath and was just on vacation a week ago. On 7/13 she complained of being fatigued and went to bed for a nap at 3pm. At 6pm she was witnessed as tremoring all over by family. At 7:45 pm she progressed to severe confusion and EMS was called. She was found hypoxic at 80% on room air. She had a right facial droop and was confused. Her BP was 159/103, pulse 100, rr 20, glucose 307 Her temp was 100 at the scene. She went to an ER and her temp was 103.5 with RR 25-30 hr 110 and bp 122/66-161/91 with o2 sats of 89% on 4L. Her cxr showed diffuse pulm edema, CT head neg for acute abnl. Cbc with lymphopenia, hgb 17.8, lactic of 2.2, bnp 367, flu and covid neg. She was transferred to our emergency room and admitted on 7/14/21. she was noted by her family after waking up from a nap to be confused, lethargic with a right facial droop. This occurred around 6 PM on the evening of 7/14. Per the family the patient had received her second dose of the Covid vaccine at 6 PM just the day before. She had COVID-19 infection back in November 2020. She underwent work-up in the emergency room and was noted to be encephalopathic and persistently febrile with a temperature of 103 she was tachycardic and tachypneic and hypoxic. CT of the head was unremarkable chest x-ray showed pulmonary edema there was a question of a urinary tract infection and a Foley catheter was placed. CT of the brain was negative she was given IV fluids antipyretics and IV Cipro and was transferred to our hospital for further evaluation. She was treated with Ancef. She also was given IV Lasix. The following morning Patient was complaining of severe fatigue and a headache. Patient''s labs were notable for polycythemia which was new with a hemoglobin of 17.1 hematocrit of 53 white blood cell count of 5.76 as well as neutrophilia and lymphopenia of 85% and 7% respectively. These were new findings compared to her previous CBCs. She also have an elevated sedimentation rate of 79 a D-dimer of 395 and a high-sensitivity CRP of 38.8. Patient''s lactic acidosis resolved. By the second day of her hospitalization patient''s differential improved with improvement of her lymphopenia and neutropenia and slowly improving polycythemia. Patient was noted to have hyponatremia of 130 post IV Lasix likely due to poor p.o. intake the day before. Her urine sodium was 15. Patient''s blood cultures are no growth to date Covid testing was negative. She has no complaints of dysuria, or frequency. She did have a CT of the chest which revealed pulmonary edema and trace pericardial effusion. Patient''s echocardiogram done the following day showed resolution of the pericardial effusion and ejection fraction of 70-75%. She was feeling better and her fatigue improved and her headache is improved and her shortness of breath is back to normal and she denies any shortness of breath and her oxygen saturation is 95% on her normal 3 L and she is felt stable for discharge to home.on 7/15/21


VAERS ID: 1493721 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The vaccine was beyond its 6 hours in the syringe, thus making it expired


VAERS ID: 1493790 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-12
Onset:2021-07-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 8721 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vulvovaginal mycotic infection
SMQs:

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

Write-up: Vaginal Yeast Infection started 2 days after second Covid vaccine. Purchased cream but it is not helping. Going to Dr. tomorrow. I have never had a yeast infection in my life, so the Covid vaccine definitely caused this.


VAERS ID: 1493886 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 25mg
Current Illness:
Preexisting Conditions: Anxiety, AR, Eczema, hx of syncope, hx of concussion
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had syncope within 5-15 minutes after shot. After LOC, fell and hit head.


VAERS ID: 1493938 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-10
Onset:2021-07-14
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknow
Current Illness: unknown
Preexisting Conditions: smoker, wt 280
Allergies: unknown
Diagnostic Lab Data: unkown
CDC Split Type:

Write-up: ER visit with positive COVID antigen test. Back home but back to hospital by EMS for respiratory distress.


VAERS ID: 1494085 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Poor quality product administered, 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: Pt received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the pt will need to be re-vaccinated.?


VAERS ID: 1494186 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-13
Onset:2021-07-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood creatinine, Condition aggravated, Laboratory test, Renal failure, Rhabdomyolysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: s/p 1st COVID vaccine, had worsening of renal function as well
Other Medications: acetaminophen 300 mg-codeine 30 mg tablet TAKE 1 TO 2 TABLETS BY MOUTH EVERY 6 HOURS AS NEEDED FOR PAIN (TRY TO AVOID DAILY USE) amitriptyline 10 mg tablet TAKE 1 TO 2 TABLETS BY MOUTH AT BEDTIME amLODIPine 5 mg tablet Take 1 tablet by
Current Illness: Otitis externa
Preexisting Conditions: Hx BR CA Essential hypertension asthma gastroesophageal reflux disease overweight osteopenia vitamin D deficiency Major depressive disorder, recurrent, unspecified migraine Migraine osteoarthritis hypothyroidism hyperlipidemia allergic rhinitis diabetes mellitus
Allergies: morphine oxycodone Sulfa (Sulfonamide Antibiotics) tramadol
Diagnostic Lab Data: Creatinine jumped from 1.18 baseline to 3.03. CK at 20988 1 wk out. Rechecking labs today, no other changes to medications or health to account for creatinine jump. Had some elevated CK and renal failure s/p 1st vaccine and COVID infection as well. May be hospitalized s/p recheck today if not improving.
CDC Split Type:

Write-up: Rhabdomyolysis with resultant acute on chronic renal failure


VAERS ID: 1494197 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-10
Onset:2021-07-14
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got Pfizer vaccine on 3/10/21 and 3/31/21. Symptom onset on 7/15 with cough, runny nose and nasal congestion. Tested positive for Covid-19 on 7/21/21.


VAERS ID: 1494202 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-31
Onset:2021-07-14
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got Pfizer vaccine on 3/10/21 and 3/31/21. Symptom onset on 7/15 with cough, runny nose and nasal congestion. Tested positive for Covid-19 on 7/21/21.


VAERS ID: 1494239 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-07
Onset:2021-07-14
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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: None
Current Illness: None
Preexisting Conditions: Chronic Fatigue Syndrome (not suffering from effects st time of vaccination)
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Egregious fatigue, muscle aches. Symptoms have not abated, they are ongoing.


VAERS ID: 1494314 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-10
Onset:2021-07-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Presyncope, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, Rescue inhaler
Current Illness: Bruising. PCP did blood test revealing elevated bilirubin
Preexisting Conditions: Asthma
Allergies: Seasonal allergies, seafood, nuts
Diagnostic Lab Data: PCP is out of town and mother did not want to take child to the ED since she was eventually back to baseline.
CDC Split Type:

Write-up: Three days after vaccine,case reported blurry vision, hands and legs numbness and tingling, near syncope. Ten days after vaccine case reported near syncope while riding bike.


VAERS ID: 1494388 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-12
Onset:2021-07-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein increased, Cardiac discomfort, Chest X-ray normal, Chest pain, Diarrhoea, Electrocardiogram, Orthostatic intolerance, Palpitations, Pyrexia, SARS-CoV-2 test negative, Tachycardia, White blood cell count decreased
SMQs:, Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: nortriptyline, zopiclone
Current Illness: none
Preexisting Conditions:
Allergies: iodine, tree nuts, maxeran
Diagnostic Lab Data: CRP 8.2 (elevated from below 1) WBC low at 3.7 (was normal prior) Chest xray clear Borderline ECG Covid19 test negative
CDC Split Type:

Write-up: Palpitations, tachycardia, chest pains after 2 days, orthostatic intolerance requiring wheelchair. 6 days post-vaccine fever 38C, diarrhea with cardiac sx. Outcome to be monitored still.


VAERS ID: 1497166 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Colorado  
Vaccinated:0000-00-00
Onset:2021-07-14
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Malaise, Pyrexia, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210740917

Write-up: BLURRED VISION; FEELING GENERALLY UNWELL; LOW GRADE FEVER; HEADACHE; This spontaneous report received from a patient concerned an 18 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 14-JUL-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On JUL-2021, treatment medications included: paracetamol. On 14-JUL-2021, the subject experienced blurred vision. On 14-JUL-2021, the subject experienced feeling generally unwell. On 14-JUL-2021, the subject experienced low grade fever. On 14-JUL-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from blurred vision, low grade fever, headache, and feeling generally unwell. This report was non-serious.


VAERS ID: 1497171 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-07-14
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Cough, Headache, Malaise, Pain, Pain in extremity, Productive cough, Pyrexia, SARS-CoV-2 test, Sinus congestion, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (once a week); Smoker (once a week)
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Dry cough; Fever; Generalised aching; Mucosal discoloration; Sickness; Comments: Patient had no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Not Provided
CDC Split Type: USJNJFOC20210741093

Write-up: DRY COUGH; SNEEZING; FEELING REALLY CRUDDY; PAIN IN MY ARM; LOW GRADE FEVER; HEADACHE; CHILLS; CONGESTED; CLEAR MUCOUS; BODY ACHE; This spontaneous report received from a patient concerned a 38 year old male. The patient''s weight was 209 pounds, and height was 67 inches. The patient''s past medical history included covid-19, got really sick, fever, body ache, dry cough, and mucus was really green, and concurrent conditions included alcohol user, and smoker, and other pre-existing medical conditions included patient had no drug abuse or illicit drug usage. The patient experienced drug allergy when treated with hydrocodone bitartrate/paracetamol. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 13-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. The batch number was not reported and has been requested. On 14-JUL-2021, the subject experienced body ache. On 14-JUL-2021, the subject experienced congested. On 14-JUL-2021, the subject experienced clear mucous. On 14-JUL-2021, the subject experienced chills. On 14-JUL-2021, the subject experienced pain in my arm. On 14-JUL-2021, the subject experienced low grade fever. On 14-JUL-2021, the subject experienced headache. On 15-JUL-2021, the subject experienced dry cough. On 15-JUL-2021, the subject experienced sneezing. On 15-JUL-2021, the subject experienced feeling really cruddy. Laboratory data (dates unspecified) included: COVID-19 virus test (NR: not provided) Not Provided. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from low grade fever, body ache, headache, dry cough, congested, clear mucous, chills, feeling really cruddy, pain in my arm, and sneezing. This report was non-serious.


VAERS ID: 1497693 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-14
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypersensitivity, SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
SMQs:, Angioedema (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hernia repair
Allergies:
Diagnostic Lab Data: Test Date: 20210719; Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210742023

Write-up: SUSPECTED VACCINE FAILURE; SUSPECTED COVID 19; ALLERGY SYMPTOMS; This spontaneous report received from a patient concerned a male of unspecified age, race and ethnic origin. Initial information was processed with additional information received on 20-Jul-2021. The patient''s height, and weight were not reported. The patient''s past medical history included hernia surgery. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) .5 ml, 1 total, administered on 07-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Patient had concomitant therapy of other therapeutic products unspecified. Patient thought that he had allergy symptoms which started on 14-JUL-2021. He also had hernia surgery on 16-JUL-2021. He lost taste and smell on 19-JUL-2021. On 19-JUL-2021, he was tested was positive for COVID. Laboratory data included: COVID-19 virus test (NR: not provided) Positive. Patient had suspected clinical vaccination failure and suspected covid-19 infection. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected clinical vaccination failure, suspected covid-19 infection and allergy symptoms was not reported. This report was serious (Other Medically Important Condition). This case, from the same reporter is linked to 20210741495. This report was associated with product quality complaint: 90000186465. .; Sender''s Comments: 20210742023-COVID-19 VACCINE AD26.COV2.S-suspected clinical vaccine failure. This event(s) is considered not related. The event(s) has a compatible/suggestive 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: 1469724 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-07
Onset:2021-07-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: Made me have period as I do not have them and have not had them for 3 years


VAERS ID: 1470123 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Loss of consciousness, Tinnitus
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), Hearing impairment (narrow), 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: Nasonex nose-spray as it was cold and rainy the days prior
Current Illness:
Preexisting Conditions: Had Asthma and Allergies while I was a kid, but no issues for about 10 years now
Allergies: Lactose intolerance
Diagnostic Lab Data: Examination by the doctor will be tomorrow (15th of July)
CDC Split Type:

Write-up: Felt dizzy a few minutes after the shot, then my chest suddenly started to feel very warm, then very dizzy and my ears started ringing, finally I''ve lost consciousness for a short while. I never had issues with vaccinations or needles and wasn''t consciously afraid of the vaccine that could have caused emotional stress, I was relieved the finally I''m getting the shot, so the whole thing really surprised me, and now I want to know whether it will be safe for me to the take the second dose on the 16th of August, which, as I''ve heard, actually has side-effects for most people.


VAERS ID: 1486480 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003607 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMHRAWEBCOVID20210714125

Write-up: Fainting; Feeling anxious; This regulatory authority case was reported by an other health care professional and describes the occurrence of SYNCOPE (Fainting) in an 18-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3003607) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 14-Jul-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) 1 dosage form. On 14-Jul-2021, the patient experienced SYNCOPE (Fainting) (seriousness criterion medically significant) and ANXIETY (Feeling anxious). On 14-Jul-2021, SYNCOPE (Fainting) and ANXIETY (Feeling anxious) had resolved. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not provided. Treatment information included observation after onset of the events. No additional treatment was reported. Patient reporting feeling anxious and fainted x 2 immediately after receiving vaccination. Observed and recovered afterwards Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1465980 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / IM

Administered by: Military       Purchased by: ?
Symptoms: Electrocardiogram, Laboratory test, Myocardial necrosis marker, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Syncope fever


VAERS ID: 1465984 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Military       Purchased by: ?
Symptoms: Electrocardiogram, Laboratory test, Myalgia, Myocardial necrosis marker, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Syncope, fever, myalgias


VAERS ID: 1466146 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-05
Onset:2021-07-13
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Muscle spasms, Sleep disorder
SMQs:, Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin Metformin Irbastartin
Current Illness:
Preexisting Conditions: Diabetic type2
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: All of a sudden I?ve been having lower leg cramps. Both legs. It?s like Charlie horse but severe where I have to get up and walk to fix it. Woke me up at night. Happened twice now.


VAERS ID: 1466473 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Crying, Dyspnoea, Headache, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions: Epilepsy
Allergies: Previous severe reaction to oxycodone that required medical treatment and hospitalization
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mother called to report pt having the following side effects: fever 102.5, whole body muscle aches, headache, anxiety and shortness of breath. She stated she went to bed around 10:30pm on 7/12/21 with not issues and when she awoke about 2am her daughter was on the couch crying and in pain from the body aches and headache. Mother calling to report event and questions about seeking medical treatment. Advised to go for evaluation or call emergency services if pt is having difficulty breathing or is short of breath.


VAERS ID: 1466486 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-11
Onset:2021-07-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Pain in chest, shortness of breath on 2nd day


VAERS ID: 1466505 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-09
Onset:2021-07-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011021A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Pain, Rhinorrhoea
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient was taking OTC prenatal vitamin and OTC probiotic.
Current Illness: Patient denies any illness at time of vaccine or one month prior.
Preexisting Conditions: Pt denies any chronic health conditions.
Allergies: Allergic to ceclor
Diagnostic Lab Data: Physical exam done on 7/13/21
CDC Split Type:

Write-up: Pt states that she got her second Moderna vaccina on Friday, July 9. Said she got some soreness and sniffles right after and then got better. Last night, Monday night at around 0415 Tuesday morning, she woke up from sleep with "excruciating pain" in her upper left arm (injection site). Said it was very localized to the deltoid muscle. Took some ibuprofen and went back to sleep. Said pain is better now - 2/10 at rest and goes up to 6/10 with movement. Upon exam, left deltoid area is very tender to palpation.


VAERS ID: 1466542 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0144 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dosage 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Taking Atorvastatin Calcium 40 MG Tablet Taking Aspirin 81 MG Tablet Chewable Taking Lisinopril 20 MG Tablet Taking Metoprolol Tartrate 25 MG Tablet Taking Metoprolol Tartrate 25 MG Tablet Taking amLODIPine Besylate 10 MG Tablet
Current Illness: L85.3 Xerosis cutis F20.0 Paranoid schizophrenia E78.5 Dyslipidemia Z71.6 Tobacco abuse counseling K21.9 Gastroesophageal reflux disease, esophagitis presence not specified F20.9 Schizophrenia, unspecified type E78.6 Hypocholesterolemia I10 Hypertension E11.9 Type 2 diabetes mellitus without complications F17.200 Tobacco use disorder
Preexisting Conditions: L85.3 Xerosis cutis F20.0 Paranoid schizophrenia E78.5 Dyslipidemia Z71.6 Tobacco abuse counseling K21.9 Gastroesophageal reflux disease, esophagitis presence not specified F20.9 Schizophrenia, unspecified type E78.6 Hypocholesterolemia I10 Hypertension E11.9 Type 2 diabetes mellitus without complications F17.200 Tobacco use disorder
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was administered the incorrect dosage of the Pfizer vaccine on 7/12/2021 at approximately 2:30 pm. Patient received all 6 doses of the pfizer instead of 1 dose from the vial. Patient was observed for 15 mins, no side effect or reaction observed. Incident was reported at 6:15 pm 7/12. Patient was notified at 6:30 pm via phone call by practice manager and a nurse , patient reported to be feeling OK with no reaction. Advised patient to call 911 to be monitored at the ER for 24 hours, patient agreed. Patient will be contacted on 7/13 for follow up.


VAERS ID: 1466588 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Patient stood up from a seated position after receiving vaccine, lost consciousness, fell to floor. Event happened with a few mintues after receiving dose. Patient maintained open airway/breathing and had pulse. Patient was seated and regained consciousness. Emergency services arrived, assessed patient and transported to hospital.


VAERS ID: 1466609 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1075 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect product formulation 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: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pfizer vaccine given as second dose. Received Moderna for first dose. First dose of Moderna given 6/17/21.


VAERS ID: 1466630 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-08
Onset:2021-07-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: chest pain, palpitations, elevated HR today: 121/84 HR102


VAERS ID: 1466675 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-01
Onset:2021-07-13
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Hypoaesthesia, New daily persistent headache
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I do not have health insurance due to its high costs. I am a single mom and simply can?t afford it.
CDC Split Type:

Write-up: 1. It started with a severe headache, which is now a daily occurrence. 2. In the last few weeks, I started feeling numbness (primarily arms and legs). I measured my pulse - it was 51 yesterday . Numbness is getting worse. 3. I have been experiencing severe fatigue since the vaccine. It never went away.


VAERS ID: 1466676 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Patient was administered the shot and shortly after started experiencing a shaking episode (not a seizure) and hot flashes.


VAERS ID: 1466682 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: She experienced nausea and vomiting throughout the night. Roughly 6 hours later she feels much better.


VAERS ID: 1466707 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dysgeusia, Immediate post-injection reaction, Nausea
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: METALLIC TASTE IN MOUTH IMMEDIATLY AFTER SHOT WAS GIVEN LIGHT HEADED/DIZZY/NAUSEOUS WITHIN 5 MINTUES OF SHOT 2nd reaction subsided after staying seated for about 10 minutes


VAERS ID: 1466722 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CITALOPRAM 20MG TABLETS. TYLENOL
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT BRIEFLY LOST CONSCIOUSNESS($g1 MIN). REGAINED CONSCIOUSNESS AND HAD DISCOLORATION OF FACE AND LIPS. EMS WAS NOTIFIED.


VAERS ID: 1466734 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hallucination
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)

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

Write-up: I experienced hallucinations around 0500, lasting only a few minutes. Very dark, disturbing imagery. I have never experienced any hallucinations before, even bad dreams are very rare for me and are never close to this severity. No drugs or alcohol used, no stressful events or scary movies prior to the event. No history of mental illness. This was very out of the ordinary. Reporting simply to inform as a person with mental health concerns may have a more severe reaction.


VAERS ID: 1466750 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Nausea, Syncope
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syncope, nausea Duration of approximately 20 to 30 minutes in total Loss of consciousness was only 30 seconds or less


VAERS ID: 1466755 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Incontinence, Musculoskeletal stiffness, Nervousness, Pallor, Presyncope, Pulse abnormal, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Patient stated she was nervous and received the vaccine without incidence. After receiving the vaccine while sitting the patient had what appeared to be a vasovagal response. She became pail and her eyes rolled back in her head. Patient appeared to have a seizure stuck both arms straight out and was incontinent. Patients was moved to the floor where her color returned and her pulse improved. Patient was taken to hospital via ambulance.


VAERS ID: 1466762 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO181 / 1 RA / 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: UNK
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Child was 11 years old. Vaccinated on 7/13/21.


VAERS ID: 1466784 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / ID

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral, Palpitations, Paraesthesia oral, Pharyngeal swelling, Tongue disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: renal tubular acidosis
Preexisting Conditions: renal tubular acidosis
Allergies: unknown
Diagnostic Lab Data: Pulse ox of 99 and holding, started reviewing at 1150 am until patient taken to ambulance shortly after.
CDC Split Type:

Write-up: Patient received second dose of Pfizer Covid-19 vaccine about 1105 am. About 1115 am patient complained of feeling lightheaded and dizzy. Patient was given some cold water and advised to sit for about 15 minutes to see if the dizziness would pass. About 1135 am patient complained that her lips felt a tingling sensation and her tongue felt thick. At 1140 am patient was administered 25 mg of diphenhydramine to help with current symptoms. Shortly after patient complained her throat felt swollen, her lips were numb and her tongue felt even more thick. Patient was administered 1 dose of Epi-pen at 1145 am in right outer upper thigh. Shortly before EMS arrived at 1150 am patient reported that her throat still felt swollen and that her heart was racing. EMS arrived at 1150 am and events and medication reviewed with EMS. EMS reviewed patient''s vital signs, which were stable with a pulse ox holding at 99, and then transported her to the ambulance.


VAERS ID: 1466789 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

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

Write-up: None.


VAERS ID: 1466802 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Posture abnormal, Seizure, Snoring
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: About 30 seconds after injection was administered, the patient''s face went blank and their head fell back. I took their mask off and they were snoring. I tried to get the patient to the ground and they started seizing and clutching at me. When the patient''s knees hit the ground, they came to and asked what had happened. The whole incident took a total of less than 5 minutes. EMTs were called and they checked out the patient and confirmed their vitals were ok. Patient stayed for 30 minutes after incident for monitoring and had returned to normal.


VAERS ID: 1466818 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient reported after the fact, that episode of syncope occurred with 1st dose
Other Medications: Blood pressure medications
Current Illness: none
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Homebound patient vaccinated with 2nd dose Pfizer at around 10:30 am after the first 15 minutes of observation, around 10:45 patient looked dizzy as she was getting ready to get up from the sitting position to escort us out. At this time, the patient indicated that this happened with the last dose. I noticed her dizziness and pale advised the patient to lie down legs propped up and gave her some water to drink. Attempted to take blood pressure with her own blood pressure cuff but the batteries died out. Continued to monitor for another 15 minutes, while patient continued to lie down and sipping water. After an additional 15 minutes passed I remembered we had a blood pressure cuff in the emergency kit , blood pressure reading was 138/56 and pulse was 76. Pt stated she felt better and wanted to escort us to the door. I advised against getting up and discussed the event with her son in law. Advised to monitor mother in law, call 911 if symptoms worsen. I also asked the son in law to escort us to the door so that the patient did not feel the need to get up out of the bed. Placed a call to person of contact on homebound list, Daughter currently out of town. Advise daughter of the event and to follow-up with her mother to see if she is okay, call 911 if symptoms worsen, and to follow up with PCP regarding event and any other concerns.


VAERS ID: 1466835 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Pain, Product preparation issue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness:
Preexisting Conditions:
Allergies: none known
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT RECEIVED UN-DILUTED PFIZER VACCINE EXHIBITED FEVER 101, ACHY AND FATUGUED


VAERS ID: 1466859 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Other       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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: None.


VAERS ID: 1466876 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Paraesthesia oral, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Patient had stated that they had an anaphylactic reaction with aspirin & ibuprofen. Prior to vaccination they were asked to stay in the area for 30 minutes for observation. About 25 minutes following vaccine patient was feeling a heavy chest and tongue was feeling funny. Pharmacist administered 50mg of liquid Diphenhydramine to the patient 30 minutes following vaccination and she waited in the pharmacy area until symptoms cleared. Only symptoms when she left was a little bit of drowsiness.


VAERS ID: 1466938 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Off label use
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: N/A
Current Illness: N/A
Preexisting Conditions: No
Allergies: KNDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Off label use


VAERS ID: 1466940 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue
SMQs:

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

Write-up: PT STATED SHE FELT TIRED AFTER WAITING 15 MINS.


VAERS ID: 1466961 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Limb discomfort, Oral pruritus, Oropharyngeal discomfort, Panic attack, Pharyngeal swelling, Piloerection, Pruritus, Throat clearing, Throat irritation, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pt was hospitalized with severe Covid in february
Allergies: Pcn, morphine, seasonal allergies
Diagnostic Lab Data: Sent to we by ambulance
CDC Split Type:

Write-up: Began itching around the nose and the mouth after about 8 to 10 minutes and the skin around nose and mouth began turning red. Continued getting worse she took a Benadryl tablet. She began mildly panicking. Then she felt goose bumps on her arms began getting hives, throat began itching and closing, increased panic, trying to clear throat. Felt throat swelling. nurse administered epinephrine 0.5mg called ambulance.


VAERS ID: 1466968 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

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

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

Write-up: Complains of heart palpitations , pulse 120 when checked. Please went down to 105.


VAERS ID: 1466973 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Extra 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: Juvenile Rheumatoid Arthritis
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt came into the clinic requesting dose #1 . He was acting nervous & claustraphic (not wanting to be inside). I did not check the state system to see whether or not he had received prior doses before administering the vaccine today. It wasn''t until afterwards that it was determined that he had received Phizer on 2/8/21 & 3/1/21. He received the 3 rd dose today. He was feeling fine when he left the clinic after observation.


VAERS ID: 1466976 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

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

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

Write-up: Pt did not dilute Pfizer vaccine before administration. According to two Ladies she received 0.3mL of undiluted Pfizer vaccine.


VAERS ID: 1466984 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

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

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

Write-up: Staff did not dilute Pfizer vaccine before administration. According to the Pt''s received 0.3mL of undiluted Pfizer vaccine.


VAERS ID: 1466993 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt. left the vaccination room and walked over 2 isles and then up past the middle of the store. Pt grabbed the mother''s arm and the mom helped her slow her decent to floor. Mom stated pt. fainted and unresponsive for a couple of minutes. Pt. regained consciousness and needed no further treatment.


VAERS ID: 1466994 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: Patient threw up 8 minutes after the vaccine was administered. Felt a little dizzy after the shot she said. No other side effect. Heart rate was normal. Sat down for 30 min in our waiting room. After 20 min mark, patient was given Gatorade. Felt better, dizziness went away. Left after 30 min. Offered to call 911 patient refused. Possibly related to nerves


VAERS ID: 1467003 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-03-06
Onset:2021-07-13
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Guillain-Barre


VAERS ID: 1467011 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Cardiomyopathy, Chest pain, Feeling hot, Lip swelling, Malaise, Sensory disturbance, Swelling face, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: January 2021, Covid-19 Pfizer--hives and diagnosed cardiomyopathy per client report
Other Medications: Unknown
Current Illness: N/A
Preexisting Conditions:
Allergies: Peanuts, Tree Nuts, Pollen, Apples, Miralax (developed after first Pfizer dose in January 2021)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received Pfizer in January and had a significant reaction, including hives for several days and a chest pain with a subsequent diagnosis of cardiomyopathy. She consulted with her provider who recommended that she try to take some Miralax to see if she had a reaction, which she did, including swelling of her face/lips. She states that her provider then recommended the Janssen as a second dose instead of the Pfizer. Client received the vaccine at 12:12 pm, noticed two small hives on her left forearm a few minutes later, and then reported that she did not feel well at 12:20 pm. She was placed on a cot with a BP reading of 130//72, P -88, O2-99%. She took some oral Benadryl that she brought at 12:30 pm. She reported that her face felt "funny" and she felt hot, but started to feel better when she laid down. 12:40 pm BP 118/76, P-82, O2 98%. Client reported that her throat felt a little scratchy, but that she was also very anxious. 12:50 pm Client reported that she started to feel better. 12:52 pm O2 98%, P - 80. 1:00 P- 85, O2 99%. Client felt well and left with her father.


VAERS ID: 1467048 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ataxia, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Allergies: NKDA
Diagnostic Lab Data: 7/13/2021 11:15am = BP (left leg): 99/45, HR: 77, SPO2: 99% (laying down) 11:20am= BP (left leg): 104/50, HR: 113, SPO2: 99% (laying down) 11:25am= BP (left leg): 118/73, HR: 95, SPO2:99% (laying down) 11:33am= BP (left leg): 121/75, HR: 70, SPO2: 99% (sitting down) 11:41am= BP (left leg): 114/80, HR: 92, SPO2: 99% (sitting down) 11:45am= BP (left leg): 118/60, HR: 102, SPO2: 99% (standing up)
CDC Split Type:

Write-up: Patient came in for second dose of vaccine. Patient and mother read and consented to the vaccination and read the prevaccination checklist. patient advised of potential side effects and recommendations of care for next few days (stay hydrated, possible soreness, take Advil or Tylenol for possible low grade fever or headache). Patient asked about hydration and meal prior to visit. Patient presented with nervousness/ anxiety and mother/ patient still consented to vaccination. vaccination was given, patient was taken to waiting area with crackers and juice given. while waiting the patient became diaphoretic. As patient walked to the back with mother to use restroom, patient showed signs of ataxia. patient was assisted into recovery position and never lost consciousness. Vital signs taken at 11:15 am BP: 99/45 (left leg), HR: 77, SPO2: 99%. Patient was fanned to cool off and decreased in diaphoresis. vital signs taken again at 5 min intervals. Patient monitored for 30 minutes, encouraged fluids with total intake of 700mL fluid. Last set of vitals taken while standing at 11:45 am were BP: 118/60, HR: 102, SPO2: 99%). Patient was given more fluids and monitored for 15 more minutes and then discharged from the clinic with parents.


VAERS ID: 1467064 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Vaccine was administered and 10 minutes later patient indicated he was getting dizzy with some vision changes and was sweating profusely. He was administered water and a snack and 20 minutes later was feeling better.


VAERS ID: 1467077 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: seasonal allergies worse this year- runny nose, sneezing, cough
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called this morning. He said he had raised red, itchy blotches all over. He said he had some benadryl at home and was going to take some. I followed up with him just now at 3pm. he said the welts have gone down and he''s not as itchy.


VAERS ID: 1467078 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: After his vaccination, patient was waiting 15 minutes in waiting room. Patient knocked on door and said he didn''t feel well. I closed door and turned to grab epi-pen and diphenhydramine. When I turned back around, patient fell on the floor and was unresponsive. I asked my technician to call 911. Patient regained consciousness in about 10 seconds and I told him an ambulance was coming. I observed his breathing to be normal. He sat up against the wall in a cold sweat and told me this has happened to him one time when he donated blood. The ambulance and paramedic arrived very promptly. They took him to the ambulance.


VAERS ID: 1467090 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-23
Onset:2021-07-13
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, 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: ALBUTEROL HFA 90MCG PROAIR
Current Illness: None
Preexisting Conditions: None
Allergies: Tapazole, zithromaz, celexa, ciprofloxacin, sulfa drugs, levaquin, darvocet-N, Hydrocodone, Demerol
Diagnostic Lab Data: Jul 13, 2021@09:07:10 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: None


VAERS ID: 1467103 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Heart rate of 135 and elevated blood pressure


VAERS ID: 1467106 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

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

Write-up: patient lost consciousness twice, lost all his color, and it was reported that he was tremoring as if having a seizure


VAERS ID: 1467135 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: patient inquired about the covid vaccine offered at this location. She was informed it was pfizer. She inquired if it is given at walk-in or by appointment basis. She completed consent & release form, and had answered NO to the question "have you ever received a dose of covid-19 vaccine". Upon billing claim, insurance rejected stating "manufacturer different than initial dose". I logged into database, discovered that patient received 2 doses of Moderna on 1/17/21 and 2/14/21.


VAERS ID: 1467140 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immune thrombocytopenia, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: osteoarthritis
Preexisting Conditions: osteoarthritis
Allergies: none
Diagnostic Lab Data: platelets currently 6 07/13/21
CDC Split Type:

Write-up: Patient developed ITP 3 weeks after, severe. Platelets dropped to 1


VAERS ID: 1467156 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-02-12
Onset:2021-07-13
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, 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: None
Current Illness: DM type 2, HTN
Preexisting Conditions: DM type 2, HTN
Allergies: No allergies
Diagnostic Lab Data: Jul 13, 2021@11:11:27 FLU A (CEPHEID) NEGATIVE , FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Covid screening


VAERS ID: 1467161 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-04
Onset:2021-07-13
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Disability, Headache, Magnetic resonance imaging head abnormal, Migraine, White matter lesion
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline (Zoloft)
Current Illness: None
Preexisting Conditions: Episodic migraine
Allergies: Sulfa
Diagnostic Lab Data: MIDAS (Migrant Disability Assessment) questionnaire, June 4, 2021. Score 51=Severe Disability HIT-6 Headache Impact Test, June 4, 2021 . Score 54 MRI Brain Scan June 23, 2021. Result--no masses or hemorrhages, evidence of white matter disease typical of migraine
CDC Split Type:

Write-up: Approximately two weeks after receiving my first COVID vaccine, the frequency, intensity and duration of my migraines increased dramatically. For about 20 years I''ve had one or two migraine headaches per month, usually associated with my menstrual cycle. Since March 20th until now (July 13th) I have averaged 19 headache days per month. I have now been diagnosed with chronic migraine with a MIDAS score (Migraine Disability Assessment test) indicating severe disability.


VAERS ID: 1467166 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 advised after the Moderna vaccine to sit down for 15 minutes for observation. 5 minutes after sitting down, patient felt nauseous, went black out , where he described it as "brain shutting down" and having a "vivid dream for 30 seconds". This last approximately 15-30 seconds. After blacking out he was able to open his eyes , completely conscious and alert. We offered him water and cracker and patient stated he felt much better, and declined 911.


VAERS ID: 1467174 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

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

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

Write-up: Approximately 5 minutes after receiving the Moderna vaccine, dose 2, the patient appeared to lose consciousness. Patient was seated in chair at the time and was with her sister. The sister held on to her so that she would not fall over (patient dropped cell phone on floor). About a minute or so later, the patient appeared to be conscious again and was resting in the waiting area of the pharmacy. At first the patient appeared confused and unaware of what was going on. Patient was given a bottle of water and paramedics were called. Paramedics arrived about 10 minutes later, checked all vitals and talked to the patient. Vitals appeared fine and no abnormalities noted. Paramedics then left and the pharmacist interviewed the patient, who by this time was aware and responsive. She indicated that she fainted shortly after receiving the vaccine but felt better after the paramedics left.


VAERS ID: 1467177 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 6 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Famotidine 20mg Cyclobenzaprine 10mg ProAir HFA
Current Illness: none
Preexisting Conditions: GI reflux
Allergies: Acetaminophen ASA Cipro Hydrocodone Naproxen PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt stated dizziness within 5 min of administration. bp checked and informed provider. pt vitals monitored. Pt had vomiting at 12:06 and informed provider Fair. Pt sx improved at 12:30 and released after informing provider. 11:42am- o2- 98, Pulse- 82 bp 129/82 in left arm, sitting, auto 11:45am- BP 132/86 manual in left arm lying down 12:07- BP 132/86 Manual right arm sitting


VAERS ID: 1467180 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 OT / IM

Administered by: Unknown       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? 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: Vomiting. Evaluated by EMS-Cleared


VAERS ID: 1467182 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: LESS THAN 5 MINUTES AFTER RECIEVING THEIR VACCINATION, THE CLIENT WAS FOUND LAYING DOWN ON A ROW OF CHAIRS IN THE OBSERVATION AREA. CLIENT REPORTS HAVING FELT WARM, FLUSHED, AND LIGHT HEADED. CLIENT REMAINED LAYING DOWN FOR SEVERAL MINUTES (AROUND 30 MINUTES). CLIENT WAS GIVEN WATER AND CLIENT''S FATHER GAVE HER STARBURSTS TO HELP, AS THE CLIENT STILL FELT LIGHTHEADED. CLIENT DENIES THIS EVENT HAPPENING BEFORE AND REPORTS HAVING HAD FOOD FOR LUNCH. CLIENT WAS ABLE TO WALK OUT OF THE ROOM ON HER OWN AFTER EATING STARBURSTS. NO OTHER CONCERNS PRESENTED.


VAERS ID: 1467190 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, Muscular weakness, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (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: Albuterol, Fluticasone-Salmeterol, Singulair, Flonase, Loratadine
Current Illness: None
Preexisting Conditions: Asthma
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: @1045 Nurse was called to the hallway because pt was feeling tachycardic. C/O dizziness, SOB, tachycardia with rate of 100s+ Upon seeing pt, he reported that the HR is better. C/O feeling hot, dizzy, numbness and weakness to bilat hands, SOB. Resp even and unlabored. RR22. VS 170/95 (110) 59 98%. Team alert was initially called but pt refused to go to the ED. Team alert cancelled. Pt wants to rest and wait it out. Assisted back to room. Pt ambulated with supervision and support of RN. Pt refused to use the wheelchair. Water provided. Pt was able to ambulate towards to room without any difficulties. Able to speak in full sentences. @VS 1117 VS 150/89 59. Pt''s symptoms are starting to get better. Dizziness is really mild. Denies SOB. Slightly better numbness and weakness to hands. Instructed to increase fluid intake. @1125 VS 140/92 (107) 60 97%RA. Pt is feeling better. Denies dizziness, tingling to hands. C/O mild weakness to hands but able to move it better than initial encounter. Pt stated that he wishes to leave, go to cafeteria and eat. Pt is confident of going home. Pt has a ride home, mother will drive him home. Checked with the Dr. Per MD, okay to go home. Encourage pt to follow up with PMD and to go to the ED for new symptoms or worsening symptoms. Pt verbalized understanding. @1142 VS 151/82 (109) 61 Pt stood up. Feeling better. Gait stable. Denies any dizziness. Mild weakness to bilat hands. No sob noted. No s/sx of distress noted. Resp even and unlabored.


VAERS ID: 1467196 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: School       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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer vial was diluted with 0.8 cc provided sterile NACL. Pt was given 0.3 cc dose from the vial resulting in a higher-than-authorized vaccine dose. Pt was observed for 15 min and let in satisfactory condition. Error was noticed 3 hours after administration, unable to reach pt at the time of this report but we are still trying.


VAERS ID: 1467212 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Condition aggravated, Dizziness, Feeling of body temperature change, Immediate post-injection reaction, Muscle spasms, Nausea, Tachycardia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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: thimethopin antibiotic started 4 days ago, 400mg magnesium, protopic for chronic vitaligo.
Current Illness: Sinus infection, prostate infection, chronic nausea, chronic vitaligo.
Preexisting Conditions: nausea and vitaligo.
Allergies: None.
Diagnostic Lab Data: Vital signs completed at time of event and 20 minutes after. At time of event: BP 121/70, HR 110, O2 99 20 minutes later: BP 124/70, HR 97, O2 99
CDC Split Type:

Write-up: Immediate stomach ache, pt threw up, nausea, tachycardia, leg spasm, hot/cold, dizzy.


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