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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 231 out of 5,069

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VAERS ID: 1374661 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Moderna Covid-19 Vaccine EUA


VAERS ID: 1374663 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / -

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

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

Write-up: patient had dose 2 of the Pfizer vaccine. he had a seizure, after the seizure he immediately woke up. after 5 minutes he had a second seizure and he remained unconscious until EMS took him to the ER.


VAERS ID: 1374668 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: SECOND DOSE PFIZER . Client got a second dose of pfizer when he was not old enough.


VAERS ID: 1374710 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Unknown


VAERS ID: 1374729 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Front desk received white cards from patients and passed on the news that there were 2 second dose Moderna patients coming in. they were placed on our Moderna side and the vaccine given. The MA noticed that the cards were Pfizer 1st dose after the vaccine was given. The patient was observed for half and hr. Side effects and information was given to the patient about the Moderna vaccine. Patient was advised to seek medical attention if any adverse symptoms arise, such as chest pain, shortness of breath, or etc.


VAERS ID: 1374764 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-06
Onset:2021-06-04
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood electrolytes, Brain natriuretic peptide, COVID-19, Full blood count, Myocardial necrosis marker, Supraventricular tachycardia
SMQs:, Supraventricular tachyarrhythmias (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM, HTN, GERD, COPD, Breast cancer, hypothyroidism
Allergies: penicillin sulfur adhesive
Diagnostic Lab Data: Electrolytes; CBC; Cardiac enzymes; BNP
CDC Split Type:

Write-up: Patient was COVID positive 4/26/2021 and 6/4/2021; Patient was in surgery center about to get a breast surgery done; in Preop her BP was in the 200s and uncontrolled; when wheeled to the OR and placed on monitors; patient suddenly went in to SVT; Adenosine given to break SVT; Procedure was cancelled and anesthesia was not induced; Patient transferred to ER for cardiac consult;


VAERS ID: 1374768 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza Vaccination
Other Medications: Gabapentin, Claritin, Wellbutrin, Cymbalta
Current Illness:
Preexisting Conditions: Back pain, anxiety, depression
Allergies: Influenza vaccination- anaphylactic reaction 2016 Bees- anaphylactic reaction Penicillin Ceclor Codeine
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 1:28 Localized itching & mild redness just under vaccine site (left arm only), patient was given 60mg fexofenadine orally, vitals were stable (hr 82, pulse ox 99%, bp 110/60), no other symptoms. By 1:39pm itchiness improved. By 1:45pm redness resolved & itchiness fully resolved. No other symptoms.


VAERS ID: 1375018 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 RA / IM

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

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

Write-up: Vaccine given 2 weeks after first dose instead of 3.


VAERS ID: 1375021 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: seizure, passed out..called 911 refused service


VAERS ID: 1375029 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hunger, Loss of consciousness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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: Systemic: Fainting / Unresponsive-Medium, Additional Details: patient passed out from chair about 5 minutes after dose given. I was helping an intern get her 1-9 information into the ipad. There was another vaccine patient waiting in a chair, she immediately came and got me, I rushed to the patient to bring him back to consciousness. I shock his shoulders and he started to come back. Staff team members were extremely helpful. They came right away with water and help to assist with anything the patient needed. Patient stated that he felt hungry.


VAERS ID: 1375055 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Medium, Systemic: Nausea-Mild, Additional Details: about 7 minutes after the 2nd dose, pt complained of light headedness and nausea, his feet were elevated and bp was taken(79/53). 9 minutes later, bp was taken and was 95/68. About 5 minutes later pt stated that he felt better, bp was taken and was 113/74. counselled pt to self monitor any symptoms and call 911/ go into the urgent care/er if the symptoms reoccured.


VAERS ID: 1375057 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 RA / IM

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

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

Write-up: rash on right arm


VAERS ID: 1375062 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Ocular discomfort, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s reported that he had blurry vision about one hour post vaccination and eye pain. The blurry vision subsided but still had slight pain/pressure in his eyes.


VAERS ID: 1375063 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted, but was still awake and responsive, just lightheaded. Patient left on own accord after interaction with paramedics


VAERS ID: 1375067 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 RA / SYR

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: The patient fainted roughly 5 min after vaccine administration and became responsive again in less than a minute. She was monitored for 30 min with frequent blood pressure checks and took two glucose tablets while drinking plenty of water.


VAERS ID: 1375075 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Sensitivity to bitter taste, triggered by all substances including saliva. Consistent alkaloid taste.


VAERS ID: 1375080 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: LONG TIME AGO, CAN''T REMEMBER WHEN
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT STATED HAS BEEN WOOZY IN THE PAST WITH VACCINATIONS BUT SAID NOT FOR QUITE SOMETIME. RIGHT AFTER THE IMMUNIZATION, PATIENT STARTED TO LOSE CONSCIOUSNESS BUT SOON CAME TO AGAIN AND SAID HE FELT THAT HE HAD A DREAM. PATIENT SAT AND WAS OK SHORTLY THEREAFTER


VAERS ID: 1375099 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Woke up with headache at 9am. Fatigue, achy, sweats and chills starting around 10am and ongoing at present time of 245pm. Vomiting three times (as of now) between 12pm and 245pm.


VAERS ID: 1375101 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Dizzy,nauseated Brought via wheelchair to medical screening for evaluation by medics. No interventions Left in stable condition at 13:03 p.m. Recorded by RN


VAERS ID: 1375103 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nervousness, Paraesthesia, Pharyngeal paraesthesia, Tachycardia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NEXPLANON
Current Illness: Asthma Attack (3 Days Prior)
Preexisting Conditions: None
Allergies: Metronidazole
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient started feeling tingling and tightness at the throat, with some tachycardia approximately 20 minutes into the vaccination (Admin: 13:43). Due to area of concern and weight, patient was administered (2) tablets of diphenhydramine 25 mg [Geri-Dryl Allergy Relief by Geri-Care] at 13:07 from our travel clinic''s emergency kit. Patient reports that they had tachycardia and nervousness prior to the vaccine by 10 minutes. After further inquiry, patient had a recent asthma attack 3-days ago that was also newly diagnosed then. Patient did not have a rescue inhaler but has a prescription on hand. After, 45 minutes of watchful waiting and 32 fl. oz. of water during observation, patient was "feeling fine" and able to converse normally (with laughter), no lightheadedness or further throat sensations.


VAERS ID: 1375104 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Paraesthesia, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sertraline Sprintec birth control
Current Illness: none
Preexisting Conditions: non-ossifying fibroma in lower left leg
Allergies: bananas
Diagnostic Lab Data:
CDC Split Type:

Write-up: itchy, burning, tingling rash on both feet up to the ankles


VAERS ID: 1375105 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-29
Onset:2021-06-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

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

Write-up: Pt missed her menstrual cycle this month. She has been menstruating regularly since age 11 and 5 months without ever missing a period.


VAERS ID: 1375111 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Dizziness, Dyspnoea, Pain, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax, Zyrtec, multivitamins
Current Illness: COVID-19 - Apr 22 first positive test
Preexisting Conditions: Asthma
Allergies: Pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, and aches started around 1AM the night of the vaccination. Shortly after coughing, wheezing, shortness of breath, and dizziness began and lasted until about 8AM. It was severe enough that I almost went to the ER. But my rescue inhaler was helping to control the coughing some. This was by far the worst ~8 hours of my life. I have never felt anything like it, and I had Covid earlier this spring and it was not nearly as bad.


VAERS ID: 1375113 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Nausea, Pallor, Seizure, Syncope, Vision blurred, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Immediately after the patient received the vaccine, the patient turned pale and said, "I feel a little dizzy and my vision is blurry." The patient fainted and ended up having a seizure. Once the patient regained consciousness, the patient was nauseated and vomited. Minutes later she had another seizure but immediately came out of it. We asked the patient if this happen to her during the first dose and she said it did not. The patient does not have a history of epilepsy. The patient''s mother did say she had the exact same reaction when she had braces put on. The patient sat in the waiting room for 30 minutes while drinking water. Before the patient left, we had check up on her and she said she felt completely fine. I (the pharmacist) called the mother a couple of hours later to check up on the patient. The mother said she felt fine as if nothing ever happened. I did recommend to her that her daughter gets checked up at urgent care today just to be on the safe side. The mother said she has an appointment with her primary care next week.


VAERS ID: 1375122 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1077 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Night sweats, Sleep disorder
SMQs:

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

Write-up: woke up sweating, clothes wet; did not feel sick; changed clothes and went back to bed


VAERS ID: 1375130 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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: ASTHMA, UNSPECIFIED FOOD ALLERGY ATOPIC DERMATITIS
Preexisting Conditions:
Allergies: Dog Dander, Egg White, Fish - Dietary, Milk, Soybean
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose of COVID vaccine earlier this morning. A few minutes later, felt some throat tightness. No hives, wheezing, face swelling. On exam, no stridor, wheezing, rash; posterior OP clear. Doubt anaphylaxis, most c/f allergic reaction. Mother notes food allergies, no prior epi pen use. No hypoxia. Tolerating PO and secretions. Treated with dose of 25mg PO benadryl and will transfer to ED for continued observation. No stridor, facial swelling, posterior OP swelling throughout observation in clinic prior to transfer to EMS care. Deferred epinephrine.


VAERS ID: 1375131 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO173 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: TDAP
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies
Allergies: Codeine, Epinephrine, Pineapple, Reglan, Sulfa, Tdap, Tomatoes
Diagnostic Lab Data:
CDC Split Type:

Write-up: Due to allergenic history the patient was to be observed for 30 minutes. After 20 of the 30 minute observation the patient complained of tongue swelling, and some feeling of distress. Clinic RN and physician assessed patient and she was taken to the ED for evaluation and treatment.


VAERS ID: 1375147 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

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

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

Write-up: Fainted twice about three mins apart. Sprayed her with cool mist and gave her cold water. VS were taken by was 90/62 pulse was 82. Patient stated she hadn?t eaten anything this morning. Afterwards she was put into the van with air conditioner going and her mom went and got her some fruit from the gas station. Symptoms had resolved by time she went home. She was taken home by mother and was advised to call 911 if any other reactions occur.


VAERS ID: 1375148 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802048 / 2 LA / SC

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

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

Write-up: Patient had received the PFIZER vaccine back on 4/16/2021 and was given the JANSSEN vaccine 06/04/2021 NOT knowing he had already received the Pfizer vaccine previously


VAERS ID: 1375162 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol Sulfate 90 mcg, Aspirin 81 mg tab, Atorvastatin 20mg tab, Breo Ellipta, Cyclobenzaprine, Esomeprazole Magnesium, Incruse Ellipta, Ipratropium, Metoprolol succinate ER, Multivitamin tab, Sucralfate, Vitamin B, Vitamin D3
Current Illness:
Preexisting Conditions:
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt experienced mild non-painful left eye blurring 10 minutes after vaccination. Pt recommended to stay 30 minutes instead of 15 minutes. At 30 minutes blurring continued, but did not advance. Pt advised that if symptom persists till evening or next day, pt should contact health care provider


VAERS ID: 1375164 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: azathioprine, tamsulosin, simvastatin, lisinopril, prednisone
Current Illness: none
Preexisting Conditions: Takes constant immunosuppresive therapy.
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vaccine was diluted incorrectly, patient received higher dose than the intended diluted 0.3 ML


VAERS ID: 1375167 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 OT / IM

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

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

Write-up: Slight redness, stinging, and warmth to touch. Itching. Evaluated by EMS-Cleared


VAERS ID: 1375270 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

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

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

Write-up: Patient felt dizziness and flushing and then passed out 3 minutes after receiving vaccination and was out for approximately 1 minute.


VAERS ID: 1375275 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 RA / IM

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

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

Write-up: After receiving his vaccine at 1020, patient c/o dizziness and lightheadedness at 1037, reporting he had similar mild side effects with the first dose. VS monitored, initially exhibiting elevated BPs. The following VS were obtained throughout monitoring: 1037 BP149/85, HR 69, O2 Sats 100% 1040 BP 133/67, HR 70, O2 sats 100% 1043 BP135/67, HR 75, O2 sats 100% 1048 BP 133/72, HR 73, O2 sats 99% 1055 BP 131/72, HR 69, O2 sats 97% 1105 BP 122/77, HR 67, O2 sats 97% Patient was given a bottled water. No meds given. Patient just monitored for extra minutes with final VS as follows: BP 122/77, HR 67, O2 sat 97%. Pt discharged in stable condition accompanied by spouse.


VAERS ID: 1375282 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Confusional state, Dehydration, Fear, Hypotension, Immediate post-injection reaction, Seizure like phenomena, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (narrow), Hypokalaemia (broad)

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

Write-up: I administered a Janssen covid imz to patient at 1:07pm. Immediately following the patient proceeded to faint, his head fell back and limps went limp. I called for pharmacist to come into the immunization room for assistance and bring an ice pack. She ran into the room to help. At this time 1:08pm the patient began to shake and had what appeared to be a seizure. I dialed 911 and pharmacist was helping patient and protected his head. After shaking for about 10 seconds, the patient stopped. He then awoke, jumped awake confused and scared. We sat patient down and monitored him. At this time the pharmacy tech called management. After patient was calm and sitting, we called his wife into the room. Management arrived in pharmacy. At 1:12pm patient felt cold and clammy. He said he very much had to use the restroom. With assistance, he used the pharmacy bathroom. EMT arrived at 1:16pm. EMT determined low blood pressure. Patient had worked outside all morning in heat and was likely under hydrated. Over the next few minutes, EMT determined the patient''s blood pressure was increasing. At 1:22pm, patient declined to go to the hospital. EMT signed off and left. Patient remained in room until about 1:40 with his wife to rest. Management got him candy and a fan to help. His wife and management then took him to their car.


VAERS ID: 1375301 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: An expired vaccine dose that had been left in the fridge the previous night was erroneously administered to the patient the following morning.


VAERS ID: 1375306 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

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

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

Write-up: Patient received 2nd vaccine 10 days early. First vaccine administered on 05/17/2021 and received 2nd dose today, 06/04/2021.


VAERS ID: 1375307 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / IM

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

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

Write-up: An expired dose that had been left in the fridge from the previous evening was erroneously administered to the patient the following morning


VAERS ID: 1375312 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Patient was to receive Moderna Booster but was administered Pfizer vaccine


VAERS ID: 1375314 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (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: Migraine
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: COVID Second dose. Debilitating fatigue, body aches, joint pain, severe headache beginning 5 hours after injection and lasting for 48 hours. Milder symptoms of fatigue and injection site pain for an additional 72 hours.


VAERS ID: 1375315 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER / 2 RA / IM

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

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

Write-up: The patient got the vaccine at two weeks instead of three.


VAERS ID: 1375325 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: An expired dose that had been left in the fridge the previous evening was erroneously administered to the patient the following morning


VAERS ID: 1375332 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Syncope; 911 called; patient woke up promptly, was pale, but responsive


VAERS ID: 1375334 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Patient was to receive Moderna Booster but landed up getting Pfizer booster


VAERS ID: 1375336 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

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

Write-up: An expired dose that had been left in the fridge the previous evening was administered the a patient the following morning


VAERS ID: 1375337 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dizziness postural, Electrocardiogram, Headache, Neck pain, No reaction on previous exposure to drug, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BP meds
Current Illness:
Preexisting Conditions: HTN, HLD
Allergies: Allergy to PCN and Decadro
Diagnostic Lab Data: EKG performed by EMS, 6/4/21.
CDC Split Type:

Write-up: 44 yo female with PMHx of HTN and HLD with allergies to PCN and Decadron presented to community today (6/4/21)with her husband for 2nd dose of Pfizer vaccine. Pt states she did not have an adverse reaction to the 1st dose. Pt had an adverse reaction to her 2nd dose given at 1:03pm on 6/4/21. At approximately 1:26pm, patient started having a headache, rated 8/10, radiating down the back of her neck. Vitals obtained at 1:41pm: HR 98, O2 sat 96%, BP 130/90. Patient denied SOB, CP, difficulty breathing, vision changes. When patient stood up, she reported dizziness and lightheadedness with no relief of headache. EMS called and vitals repeated, vitals stable. Pt noted to have 4 episodes of emesis, however pt''s husband believes emesis to be unrelated to today''s events due to pt having a history of emesis episodes for the past several weeks and is being followed by a doctor for it. EMS arrived, vitals obtained again, vitals stable. EKG performed by EMS. EMS transported patient the hospital.


VAERS ID: 1375338 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 RA / IM

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

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

Write-up: Patient came in for second dose. Patient was scheduled in 21 days instead of 28 days for 2nd dose. This was not cough until after patient already received the vaccine. Patient was confused about what vaccine he got and timing. Patient did not bring card with him. Frist dose was Moderna. Patient received 2nd dose Moderna as well, but a received a week early.


VAERS ID: 1375344 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

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

Write-up: An expired dose that had been left in the fridge the previous evening was administered to the patient the following morning


VAERS ID: 1375348 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

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

Write-up: An expired dose that had been left in the fridge the previous evening was administered to the patient the following morning


VAERS ID: 1375352 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

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

Write-up: An expired dose that had been left in the fridge the previous evening was administered to the patient the next morning


VAERS ID: 1375354 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Nausea, Throat irritation
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer vaccine. Patient stated she was having some slight pain in her sternum area, then she stated it moved to her "belly" making her nauseas, then stated her throat felt like it was a little scratchy. Symptoms did not all happen at same time, the progressed. Patients blood pressure was115/75 pulse 81. Patient alert and oriented, appeared in no distress. Patients mom at side. Decided to drive her to the hospital. Did not want this RN to call 911.


VAERS ID: 1375356 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Dry mouth
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: same symptoms with 4/30/2021 Covid dose
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Five minutes after vaccine administration, during observation period, complained of dry mouth, feeling lightheaded. Placed in chair with both feet elevated, provided juice. BP 116/65. Finished juice at 1340, put legs down for 3 minutes then reported feeling well. 1343 stood for about a minute, then was able to walk while being observed, with no further complaints of being lightheaded. Left observation area at 1345.


VAERS ID: 1375358 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-30
Onset:2021-06-04
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C and D, multivitamin, Clomid, Prozac, ubiqunol, Prilosec
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: Cipro
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Woke up this morning and suddenly felt nauseous and dizzy, nearly fainted and started to sweat profusely. Lasted about 5-10 minutes, and have felt worn down with a mild headache the rest of the day. I wouldn?t think it?s vaccine related, but this has never happened to me before.


VAERS ID: 1375360 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 REPORTS FEELING LIGHTHEADED AND DIZZY IMMEDIATLY AFTER GETTING VACCINATED. PT STATS SHE HAD SIMILAR SYMPTOMS WITH FIRST DOSE. PT DENIES SHORTNESS OF BREATH, SYSPNEA, HIVES ITCHINNESS PT DID EAT BEFORE GETTING VACCINE WAS ENCARAGE TO STAY HYDRATED AND DRINK WATER. INSTRUCTED TO LAY HEAD BACK TO HELP WITH DIZZINESS. PATENTFELT BETTER AS SYMPTOMS SUBSIDED. INSTRACTED TO FINISH 30 MIN OBSERVATION TIME AND INSTRUCTED TO NOTIFY IF SYMPTOMS WORSEN


VAERS ID: 1375361 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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: No adverse events were reported. Reporting for vaccine administration error. Vial was not left out of refrigerator for 30 minutes before diluting and administering.


VAERS ID: 1375362 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Head injury, Heart rate normal, Hyperhidrosis, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not to my knowledge
Current Illness: No per intake form
Preexisting Conditions: No per intake form
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient came in for second dose of Moderna vaccine. on Friday 6/4/2021. Dose administered at 10:25am. Patient counselled to remain in area for 15 minutes. Temperature outside 85 degrees; temperature warm in immunization tent. Patient left immunization tent at 10:26am, passed the check-in table, immediately turned back around because he felt dizzy. Patient passed out, grabbed metal television stand on the way down, and hit his head on the metal bar on the way down to the floor. Patient was unconscious for 30 seconds. Patient had a normal pulse. Awoke and remained on floor with health care personnel for 10-15 minutes. Patient was sweating. Moved to chair with arms for 15 min. Drank water, cooled down, had a drink of orange juice, ate pretzel. Patient refused ambulance. Patient left under own power approx 11:15am.


VAERS ID: 1375363 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient experience what it look like a seizure right after getting the COVID-19 vaccine. He started shaking and lost consciousness. The patient was sitting on a chair and the immunizer technician hold the patient so he didn''t fell on the floor and requested 911 to be called. The paramedics came an assisted the patient. The patient recovered consciousness and stated that he felt fine. The paramedic help him get into his car. The patient''s wife was present at the time the event happened.


VAERS ID: 1375366 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Seizure following influenza vaccine, unsure of age at time of vaccine.
Other Medications: Alendronate, omeprazole, Symbicort, Eliquis, fluconazole, Keppra, phenobarbital, ProAir
Current Illness:
Preexisting Conditions: hereditary hemochromatosis, epilepsy, asthma, GERD, osteoporosis, sleep apnea, AFib
Allergies: cipro, Imitrex, indomethacin, Tylenol, influenza vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 5 minutes after vaccine administration patient had grand mal seizure lasting about 2-5 minutes.


VAERS ID: 1375374 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure via skin contact, Underdose
SMQs:, Medication errors (narrow)

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

Write-up: The pharmacist went to administer the second dose of my COVID pzifer vaccine. She pulled the needle out of my right arm when instantly I felt dripping down my arm. I told her immediately and she wiped my arm off. She stated that I would be fine it was a lot though more than just a drop. I voiced my concern about proper dosage. While sitting for my 15 minutes I looked on the CDC website and it says as long as I got half the vaccine I don?t need to repeat. I voiced my concerns again and she said I would be fine she was sure I got half of the vaccine but if I?d like she would give me another dose in my other arm. I refused as she said I got more then half the shot but I personally disagree. If she really thought I was vaccinated properly why even offer me another dose? She wasn?t sure herself.


VAERS ID: 1375566 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

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

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

Write-up: Pt was a homebound patient listed to receive 2nd Pfizer vaccine. Pt received Pfizer as second dose when his first dose was Moderna. when finished vaccinating, RN asked patient for CDC card. Pt did not have a card, did not know what vaccine he had received at his PCP. vaccine was already given upon verification via phone call back at vaccination service center.


VAERS ID: 1375578 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Dysgeusia
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Employee completed 15 minute observation time after vaccination, then informed observers that she had been feeling lightheaded and had a metallic taste in her mouth since just a few minutes after her vaccination had been given. She was advised to be seated again and did so. She was given water but refused juice. BP 132/80, Heart rate 60, Respiratory Rate 16 @ 1128. At 1132, recipient stated she felt better, we requested that she continue to stay for monitoring. At 1140, recipient said she felt fine, no longer lightheaded, but still had metallic taste in her mouth. She was able to ambulate without issues. Left at 1141.


VAERS ID: 1375584 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Muscle tightness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

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

Write-up: PT INJECTED. PT FELT BETTER REPORTS FEELING LIGHTHEAD AND TINGLING TIGHNESS OF THE JAW. DENIES SOB DYSPNEA OR HIVES. PT HAS A HISTORY OF ASTHMA IN WICH SHE HAS A RESCUE INHALER FOR EMERGENCY. REPORTS THAT SHE HAS ONLY A PAIN @ THE INJECTION SITE WITH FIRST DOSE. PT INSTUCTED TO STA HYDRATED AND EAT AS PT DID NOT BEFORE GETHING INJECTED. PT FELT BETTER AFTER A FEW MIN. AS SYMPTOMS SUBSIDED. INSTRUCTED TO FINISH OBSERVATION TIME AND TO ALERT TEAM IF SYMPTOMS RETURN OR WORSEN


VAERS ID: 1375586 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Stridor, Throat tightness, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: DENIED
Preexisting Conditions: NONE
Allergies: STRAWBERRIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: 02:20 Patient received Ist dose of Janssen. 02:24 Patient complained throat felt like it was closing and difficulty breathing, audible wheezing and stridor. Given Epi Pen 0.3mcg IM Right thigh. 911 called. 02:26 Given 25 mg of liquid Benadryl PO. 02:30 BP 140/94 Pulse 96 RR 26. 02:34 EMTs arrived BP now 100/60 Pulse OX 97% Pulse 85. 02:40 Walked out by EMT and Paramedics to the ambulance.


VAERS ID: 1375591 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

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

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

Write-up: Patient received 1st Covid vaccine dose with manufacturer on 05/07/2021. Second dose was given in error for manufacturer on 06/04/2021


VAERS ID: 1375592 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Presyncope, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt had a vasovagal episode with pt passing out few seconds. Pt received juice and crackers and felt better as well Pt vitals stable was watched 30 minutes


VAERS ID: 1375602 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8135 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hot flush, Throat clearing, Throat irritation
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies: Latex, Cephalexin, Demerol
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: 10:30 am--15 after receiving vaccine, patient described feeling dizzy and having a hot flash. Patient was taken to a clinic room, provided water and observed by nursing staff, vital signs BP 100/67, P. 68, R. 17, lung sounds clear bilaterally, patient alert. At 10:50 patient stated she "felt like something is in my throat" and was trying to clear her throat. At 10:51 Epinephrine 1:1000 0.3mg injected in right upper thigh per epi injector, 10:52 am O2 started at 15L via rebreather mask and EMS called. At 10:53 BP 130/90, P 80, R 20, lung sounds clear bilaterally, patient alert. At 10:57 am BP 132/92 patient alert. At 10:57 EMS arrived, care of patient transferred to EMT/Paramedic. Patient transferred to hospital via ambulance.


VAERS ID: 1375605 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-27
Onset:2021-06-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B12A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)

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

Write-up: period came 1 week earlier than usual. my periods are regular and timely.


VAERS ID: 1375612 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

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

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

Write-up: No adverse events. Just reporting age.


VAERS ID: 1375614 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Product administered to patient of inappropriate age
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

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

Write-up: Client originally given the 1st dose of Moderna on 05/07/2021, by previous healthcare worker, but client not in the age range for the Moderna vaccine. Per Dr. client was to receive the 2nd dose of Moderna, per off label use. Client denied any adverse reactions, denied difficulty breathing, denied itching, and reported just pain at injection site. Mom also present and denied all adverse reactions.


VAERS ID: 1375618 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 RA / 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? 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: Patient was feeling light headed like she was going to pass out. She also vomited multiple times.


VAERS ID: 1375619 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-11
Onset:2021-06-04
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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

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

Write-up: fully covid vaccinated as of 1/11/21. tested positive for covid on 6/4/21.


VAERS ID: 1375654 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Feeling hot, Hypersensitivity, Somnolence, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: chest tightness after first dose but cleared by on-site ems
Other Medications: none reported to pharmacy
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported to pharmacy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt had a scheduled appt at 1235 pm for her 2nd dose of pfizer covid vaccine on 6/4/21 at our store . Pt stated that she had some "chest tightness" shortly after the first dose (~4/24/21). After reviewing VAR filled out by patient today, I consulted with pt about having a reaction to the first dose. Pt stated that EMS observed her for 30 minutes after the 1st vaccination and patient self-reports that she recovered without the use of an epi pen (pt does carry an epipen on her at all times) within that 30 minute window and was allowed to leave. We administered 2nd dose with the understanding that patient recovered from 1st dose with no breathing difficulties or swelling of tongue or throat (just chest tightness as reported by pt). After administering the second dose today, Pt began to show signs of an allergic reaction ~ 5 minutes after administration and we administered the epi-pen and 911 was called. Observed that pt vomited and complained of chest tightness, tight throat , difficulty breathing and being hot and "sleepy" after second shot. Pt appeared to be alert and oriented and was sitting in a chair. EMS arrived and pt is now under their care. We dont know the lot number of the 1st covid vaccination but the lot used today was EW0167 with an expiration of 8/31/21.


VAERS ID: 1375672 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate irregular, Loss of consciousness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became dizzy, collapsed, and was unconscious for approximately 30 seconds. Called 911. Patient became aroused, still complained of lightheadedness, had an irregular heartbeat, remained laying down until EMS arrived, very pale in the face. Remained with the patient until EMS arrived. Patient went to the hospital.


VAERS ID: 1375788 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Flushing
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: Pt reported SOB on floor after receiving vaccine. Lungs CTA x 5 lobes. No stridor noted. Slight flushing in face upon arrival to med obs, resolved within approx 3-5 min. Pt drank 1 bottle water and guided through relaxation deep breathing exercises. Pt reports SOB resolved at 1614. Released w/ family after orthostatic VSS and pt reports SOB resolved and denies any other subjective symptoms. VS obtained over long sleeve shirt to accommodate for pt culture, religion, and/or modesty at pt request VS 1557 SITTING BP 140/95, HR 89, RR 20, 97%RA 1603 SITTING BP 136/96, HR 82, RR 18, 99%RA 1615 SITTING BP 143/97, HR 81, RR 16, 96%RA 1617 STANDING BP 145/95, HR 86, RR 16, 97%RA


VAERS ID: 1375790 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Dizziness, Hyperhidrosis, Hypoaesthesia, Nausea, Nervousness, Pallor, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Allergies: PCN and other abx, unable to state rest of allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Situation: Patient, 28 yrs old, had an appointment for 1st dose Moderna Lot# 007C21A today. Pt felt anxious prior to vaccination. As a precaution, pt was placed on a gurney and he received the vaccine while on the gurney. RN was bedside during the process. Pt started feeling shaky and dizzy 5 mins post vaccination. . Juice and crackers provided. Pt stated that he ate and drank liquids prior to coming in. Encourage to relax and take slow deep breaths Background: . He informed the vaccinator upon arrival that he has a hx of syncopal episode during vaccinations. Pt had a syncopal episode when he got the TB Test. Pt felt anxious prior to vaccination. Allergies: PCN and other abx, unable to state rest of allergies Hx: Asthma, MVA last April 2021, head injury, L wrist surgery Accompanied by mother Assessment: 1020 ? Pt c/o being more dizzy, queasy to throat and chest, lightheaded and started to look pale. VS 99.0F, 65, 98% RA, 97/40 (62), 22. Clear speech noted. 1030 ? VS 105/49 (67), 72, 99% RA, 26. Paler, diaphoretic, increased dizziness, nausea, numbness to hands, anxious, shaky. Mother at bedside, comforting patient. Encourage to take slower deep breaths and continue to lie back. 1034 ? VS 114/61 (74), 72, 100% RA, 22, color is better 1038 ? VS 106/65 (77), 65, 100% RA, 18. Pt is more relaxed. Tightness to throat is better. Clear speech. Can speak complete sentences. 1043 ? VS 103/65 (79), 64, 100% RA, 18. Color has improved. More color to lips, hands are less numb. Pt stated that he is back to ?almost normal.? 1044 ? Called Dr about pt. MD was expecting that pt will be better in a few minutes. If pt is worse or if his symptoms come back while at home, pt need to go to ED or call his doctor. Relayed MD?s recommendation to patient and mother. Both verbalized understanding. 1045 ? VS 102/61 (72), 74, 18, 94% RA 1050 ? VS 116/70 (80), 74, 16, 95% RA. Moved patient and mother to room 6. Pt stated that he is ?feeling way better.? Mother at bedside. Report given to RN 1100 ? VS 103/63, 68, 98% RA semi fowlers on the gurney? conversing with mother. VS 111/67, 72, 100% RA - sitting VS 116/68, 85, 100% RA standing. Denies any dizziness upon position changes. 1110 ? VS 97/65, 67, 95% RA. Pt stated that he feels okay. Drank juice. 1120 ? VS 109/65, 72, 95% RA. Able to stand and walk to wheelchair. 1125 ? ambulated to bathroom. No problems. 1130 ? wheeled to car. Denies any symptoms. Recommendations: Dr was called about pt and expected that pt will be better in a few minutes. If pt is worse or if his symptoms come back while at home, pt needs to go to ED or call his doctor. Relayed MD?s recommendation to patient and mother. Both verbalized understanding. Pt was wheeled to the car and went home with his mother.


VAERS ID: 1375791 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-06-04
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Pregnancy test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (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: Prenatal vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Positive pregnancy test 5/8/2021
CDC Split Type:

Write-up: Did not know we were pregnant, received vaccine. Got positive pregnancy test a few days later and miscarried the next month at 8 weeks with baby measuring 6 weeks. Have no history of miscarriage and two full term healthy babies prior to this. Unknown if related for sure, but this is the only change and timing seems important to report as possibly correlated.


VAERS ID: 1375792 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

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

Write-up: patient received moderna first shot and accidently received pfizer the second time. There was a language barrier and pt said they received pfizer and actually had pfizer paperwork so was given pfizer vaccine


VAERS ID: 1375804 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Social anxiety, cognitive deficit
Allergies: Penicillin: full-body rash
Diagnostic Lab Data: BP: 92/61 mmHg; HR 71 bpm
CDC Split Type:

Write-up: Patient passed out immediately after the shot was administered. He was out for about 1 minute. He regained consciousness, then faded again about 3 minutes later. That second time he was out for about 30 seconds. We monitored breathing and heartrate, which remained normal through and after the events. We monitored for 30 minutes before allowing him to leave. At 4:20pm (10 minutes after leaving) the family called and reported the patient vomited


VAERS ID: 1375807 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / SYR

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

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

Write-up: Rash on torso


VAERS ID: 1375810 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / N/A LA / IM

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

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

Write-up: Vasovagal syncope in POD 10. Lowered to ground, positioned supine w/ BLLE elevated on chair. Pt reports resolving once supine and guided through breathing techniques. Slight diaphoresis and pallor noted, Skin color returned to baseline once transferred to MED OBS via WC and given 1 botttle water and 1 bag pretzels as pt reported eating "light today" with moderate caffeine intake and little other fluids. Pt reports dizziness resolved completely @ 1647. Released at 1655 VS 1640 SITTING BP 116/78, HR 84, RR 16, 96%RA 1650 SITTING BP 112/77, HR 82, RR 16, 95%RA 1652 STANDING BP 128/89, HR 78, RR 16, 97%RA


VAERS ID: 1375811 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Vaccine given 7 months too early. Patient turns 12 on 12/28/2021.


VAERS ID: 1375821 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0502C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: Allergic to all nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clot in right eye.


VAERS ID: 1375823 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 RA / IM

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

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

Write-up: Patient received first dose of Moderna covid vaccine. About 5 minutes after vaccine the patient experienced syncope and fell to the ground. He did was aware, but a little dizzy when I got to him. My partner called 911 and the paramedics took the patient to the hospital.


VAERS ID: 1375831 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash erythematous, Tenderness
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to shrimp
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Arm tenderness, itcy and has a big red patch.


VAERS ID: 1375838 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Nausea, Wrong product administered
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Estradiol, Lipitor, Lisinopril, Metfomin, Metoprolol, oxybutinin, potassium, proventil, singulair
Current Illness: none
Preexisting Conditions: Ovarian Cancer, metabolic syndrome, anemia, hypothyroidism, hyperlipidemia, pace-maker, menopause
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was supposed to get Moderna. Patient had Moderna for the 1st vaccine. She came in with her daughters that were given Pfizer and was given Pfizer by error instead of Moderna. The only side effect the patient has reported is nausea one hour after administration. The nausea has subsided. Patient has been notified of the error.


VAERS ID: 1375839 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hospitalization for bilateral pleural effusion. Patient discharged on 5/12/2021.
Preexisting Conditions: Atrial fibrillation, unspecified type Essential hypertension Bilateral pleural effusion Oxygen dependent Fluid retention
Allergies: No Known Drug Allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient given Pfizer vaccine on 6/4/2021 after having received Moderna vaccine on 3/11/2021.


VAERS ID: 1375841 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: felt faint, lightheaded
Other Medications: Unknown
Current Illness: None noted by patient
Preexisting Conditions: Smoker
Allergies: None noted by patient
Diagnostic Lab Data: None performed
CDC Split Type:

Write-up: Patient received shot at 3:21. Alerted to feeling sweaty, lightheaded at about 3:25. Administered Ice pack to back of neck at 3:27, Administered ice pack to front of chest at 3:30. Offered wet cloth to patient at about 3:35. Patient was feeling better by about 3:35 - noticeably less sweaty, less hot. breathing better. Was monitored continuously until patient felt well enough to leave


VAERS ID: 1375842 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-06-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Vaccination site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Red, itchy and swollen around the vaccination site. This adverse symptom popped up one week and 2 days after the vaccine was given


VAERS ID: 1375844 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / IM

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

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

Write-up: Patient came too early for 2nd Moderna shot. Patient had 1st shot on 5/24/21. We gave 2nd shot on 6/4/21. Pharmacist talked to patient on the same day and advised patient to go to ER if does not feel good.


VAERS ID: 1375849 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A LA / IM

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

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

Write-up: syncope right after vaccination, patient gained consciousness after few seconds. then he passed out again for few seconds, patient has phobia from needles , right after his second episode , he became extremely pale, started sweating heavily and his pupils dilated, the episode passed on its own, the paramedics still took him to the hospital to make sure he didn''t hurt his head when he fell.


VAERS ID: 1375853 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 AR / IM

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

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

Write-up: Pt received second dose of Moderna at 21 days vs 28 days


VAERS ID: 1375854 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / ID

Administered by: Public       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (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: n/a
Current Illness: N/A
Preexisting Conditions: n/a
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt. Had a vasovagal symptom at 1410, Laid down pt elevated legs and took BP, which was 110/70 followed by 120/81 at 1420 and 1415 respectively, pt recovered immediately without difficulties, have pt sit , drink water. ER precaution was given for both pt and parent, who was with the pt. Pt and Parent acknowledge understanding. Pt was put for another observation for 15 minutes and was let go after acknowledgment with no sign of dizziness and full recovery.


VAERS ID: 1375912 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

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

Write-up: Patient was inadvertently administered a Pfizer covid-19 dose that was beyond 6 hours from first puncture of vial.


VAERS ID: 1375917 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

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

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

Write-up: Patient developed pruritic rash 10 min after vaccine administration. She was given antihistamine with improvement in her rash, and symptoms. She was discharged home from the vaccination site in improved condition.


VAERS ID: 1375923 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / SYR

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

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

Write-up: Low- grade fever 99.3, body aches, chills, headache


VAERS ID: 1375924 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not available
Current Illness: no
Preexisting Conditions: not available
Allergies: not available
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1415 Patient experienced dizziness post vaccination. Provided juice. VS HR 100 regular rate. B/P 110/60 RR 20 even and non labored. Pulse ox rate of 96%. Asked patient to stay an additional 15 minutes for observation. Spoke with patient''s father who was present on site. Advised of current situation and the need to stay an additional 15 minutes. 1430 no further complaints voiced. Followed up with patient and father, provided education on after care and to contact MD for any additional issues. Voiced understanding. 1445 no complaints at this time and allowed to leave vaccination site at this time. RN.


VAERS ID: 1375932 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril/hctz 20-25mg
Current Illness: n/a
Preexisting Conditions: hypertension
Allergies: sulfa
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: During the 15 minute post immunization observation period, the patient complained of difficulty breathing. The pharmacy called 911 immediately. EMS arrived and assessed the patient and determined that she didn''t need an Epipen to be administered. The patient''s lungs and breathing were determined to be good and clear upon further assessment by EMS. The patient refused to leave with EMS. Her breathing returned to normal before leaving the pharmacy.


VAERS ID: 1375936 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO168 / 3 AR / IM

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

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

Write-up: Patient received a third dose of the vaccine. Patient was asked whether it was the first or second dose to which they replied 2nd dose. Upon attempting to enter into the database, it was discovered that this was in fact the patient''s 3rd dose.


VAERS ID: 1375939 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Chest discomfort, Dizziness, Heart rate increased, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: High BP, slight dizziness, fast heart rate, later had upper back pain and chest pressure
Preexisting Conditions: HTN, Hyperlipidemia
Allergies: No Known Allergies
Diagnostic Lab Data: called 911, transferred member to ER via ambulance.
CDC Split Type:

Write-up: At about 1050, After receiving 2 nd dose of pfizer, patient reported feeling slightly dizzy, and feeling of fast heart rate. Brought patient back to observation gurney. Vitals taken BP 180/106, P 88, o2 sat 99% RA. 02 applied and advised patient to rest. Patient stated, she did not take her BP meds this morning, has hx of high BP. After few minutes of rest patient felt better, BP came down to 195/93. Within few minutes she reported feeling of heart racing again and upper back pain. Called 911, supervisor was notified. After 911 call patient reported having chest pressure, called 911 again to notify change in patient''s condition. At about 1135 paramedics arrived, BP 191/86, patient stable, husband at bedside. At about 1150 patient transferred to emergency room by paramedics, belongings given to husband.


VAERS ID: 1375942 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: had redness around and below the injection site. area was slighly raised and felt warm to the touch.


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