National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 235 out of 8,010

Result pages: prev   136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334   next


VAERS ID: 1759971 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-20
Onset:2021-09-09
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood test, Laboratory test, Lymphocyte count, Marginal zone lymphoma
SMQs:, Guillain-Barre syndrome (broad), Malignant lymphomas (narrow), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypogammaglobulinaemia; In vitro fertilization; Melanoma
Allergies:
Diagnostic Lab Data: Test Name: blood test; Result Unstructured Data: Test Result:normal; Comments: last blood test 18 months previously normal:; Test Date: 20210909; Test Name: Exploration by immunophenotyping; Result Unstructured Data: Test Result:lymphoma of the marginal zone.; Test Name: hyperlymphocytosis; Result Unstructured Data: Test Result:3500 /mm3; Comments: last blood test 18 months previously normal:; Test Date: 20210909; Test Name: hyperlymphocytosis; Result Unstructured Data: Test Result:5400 /mm3
CDC Split Type: FRPFIZER INC202101239563

Write-up: deep asthenia; Marginal zone lymphoma; This is a spontaneous report from a contactable physician downloaded from the regulatory authority number FR-AFSSAPS-MA20213639. A 57-year-old female patient received bnt162b2 (COMIRNATY) at the age of 57-year-old, dose 2 intramuscular on 20May2021 (Batch/Lot Number: Unknown) as dose2, single for covid-19 immunisation. Medical history included malignant melanoma (melanoma in 2013 treated by surgery), hypogammaglobulinaemia, in vitro fertilisation (IVF) from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient previously took first dose of bnt162b2 (COMIRNATY) for covid-19 immunization. The patient experienced marginal zone lymphoma on 09Sep2021 with outcome of not recovered, deep asthenia on an unspecified date with outcome of unknown. Seriousness criteria of the event marginal zone lymphoma was medically significant. The patient underwent lab tests and procedures which included blood test: normal (last blood test 18 months previously normal) , laboratory test: lymphoma of the marginal zone on 09Sep2021, lymphocyte count: 3500 /mm3 (last blood test 18 months previously normal), lymphocyte count: 5400 /mm3 on 09Sep2021. The clinical course was reported as follows: 57-year-old woman having presented a lymphoma of the marginal zone at Day 113 post Dose 2 COMIRNATY. No usual treatment. History of the disease: 20May2021: Dose 2 COMIRNATY (batch number unknown). It follows a deep asthenia. 09Sep2021: biological assessment showing hyperlymphocytosis at 5400 / mm3. Exploration by immunophenotyping showing a lymphoma of the marginal zone. Note, last blood test 18 months previously normal: lymphocytes at 3500 / mm3. Hematology consultation scheduled. No follow-up attempts are possible; information about batch/lot number cannot be obtained. No further information is expected.


VAERS ID: 1760055 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-22
Onset:2021-09-09
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Apraxia, Autonomic nervous system imbalance, Biopsy skin, Blood pressure measurement, Body temperature, Electrocardiogram, Heart rate, Hemiparesis, Hyperhidrosis, Investigation, Ischaemic stroke, Magnetic resonance imaging head, Oculocephalogyric reflex absent, Office visit, Oxygen saturation, Pallor, Physical examination, Speech disorder, Thrombectomy
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aphthous ulcer; Filmy vision; Migraine with aura (without background treatment); Miscarriage (Multiple miscarriages in the 1st trimester); Paraesthesia (Multiple sulfatase deficiency paresthesia, normal computerized tomography assessment); Recovered smoker (Quit smoking in 2020 1 pack/day.)
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: skin biopsy; Result Unstructured Data: Test Result:unknown results; Test Date: 20210909; Test Name: Blood pressure; Result Unstructured Data: Test Result:170/90 mmHg; Comments: Asymmetrical hypertension; Test Date: 20210909; Test Name: Blood pressure; Result Unstructured Data: Test Result:140/90 mmHg; Comments: symmetrical, Optimal blood pressure control without background treatment.; Test Date: 20210909; Test Name: Body temperature; Result Unstructured Data: Test Result:apyrexia Centigrade; Test Date: 20210909; Test Name: Body temperature; Result Unstructured Data: Test Result:37.2 Centigrade; Test Date: 20210909; Test Name: Electrocardiography; Result Unstructured Data: Test Result:normal; Comments: regular sinus rhythm at 95/minute, normal axis, narrow QRS, no atrial or ventricular hypertrophy, no ST segment abnormality, isolated Q wave in D3.; Test Date: 20210909; Test Name: heart rate; Result Unstructured Data: Test Result:95/minute; Test Date: 20210909; Test Name: blood sugar; Result Unstructured Data: Test Result:1.15 g/l; Test Date: 20210909; Test Name: blood sugar; Result Unstructured Data: Test Result:0.96 g/l; Test Date: 20210909; Test Name: investigation; Result Unstructured Data: Test Result:No thrombolysis, transfer to thrombectomy unit. Pr; Comments: No thrombolysis, transfer to thrombectomy unit. Presence of a confirmed clot, no appearance of fibromuscular dysplasia. Thrombus collected and sent for pathology; Test Date: 20210909; Test Name: Magnetic Resonance Imaging of the brain; Result Unstructured Data: Test Result:strokes; Comments: finding strokes of different ages, including a recent one in the right superficial sylvian territory, several sequelae visible in fluid-attenuated inversion recovery. Appearance of right middle sylvian obstruction.; Test Date: 20210909; Test Name: dermatological evaluation; Result Unstructured Data: Test Result:abnormalities associated with the neurological cli; Comments: abnormalities associated with the neurological clinical picture leading to the suspicion of Sneddon syndrome; Test Date: 20210909; Test Name: ginecological evaluation; Result Unstructured Data: Test Result:abnormalities associated with the neurological cli; Comments: abnormalities associated with the neurological clinical picture leading to the suspicion of Sneddon syndrome; Test Date: 20210909; Test Name: Oxygen saturation; Test Result: 87 %; Test Date: 20210909; Test Name: Physical examination; Result Unstructured Data: Test Result:deficient; Comments: deficient with oculocephalogyric deviation to the right, no response to simple commands, left hemiparesis.; Test Date: 20210909; Test Name: Thrombectomy; Result Unstructured Data: Test Result:Thrombolysis in Cerebral Infarction score 2B; Test Date: 20210909; Test Name: Thrombectomy computerized tomography angiogram; Result Unstructured Data: Test Result:Right M2 thrombus, initial Thrombolysis in Cerebra; Comments: Right M2 thrombus, initial Thrombolysis in Cerebral Infarction score 0
CDC Split Type: FRPFIZER INC202101239512

Write-up: Ischemic stroke; hemiparesis of the upper left limb; dysautonomic signs; sweating; pallor; ideomotor slowing; orientation Speech problems; oculocephalogyric deviation to the right; This is a spontaneous report from a contactable physician downloaded from the RA, regulatory authority number FR-AFSSAPS-RS20212906. A 35-year-old female patient received bnt162b2 (COMIRNATY), dose 1 intramuscular on 22Aug2021 (Batch/Lot Number: Unknown) as single dose for covid-19 immunisation. The patient medical history included Filmy vision from Aug2021, Recovered smoker from an unknown date to 2020 (Quit smoking in 2020 1 pack/day), paraesthesia from Jul2020 (Multiple sulfatase deficiency paresthesia, normal computerized tomography assessment), Multiple miscarriages in the 1st trimester, migraine with aura without background treatment, oral aphthosis. The patient''s concomitant medications were not reported. The patient experienced ischemic stroke on 09Sep2021 with outcome of not recovered, and hemiparesis of the upper left limb, dysautonomic signs, sweating, pallor, ideomotor slowing, orientation speech problems, oculocephalogyric deviation to the right all on 09Sep2021 10:00 with outcome of unknown. The patient was hospitalized for ischemic stroke from 09Sep2021 to an unknown date. Clinical course: On 09Sep2021: while the patient was at her workplace, sudden appearance at 10 a.m.of hemiparesis of the upper left limb associated with dysautonomic signs (sweating, pallor), ideomotor slowing with preservation of orientation Speech problems, oculocephalogyric deviation to the right. No associated headache. No loss of consciousness. Call to the emergency medical assistance service by a colleague at 10:10 a.m. Upon arrival of the ambulance: Asymmetrical hypertension 170/90 mmHg, apyrexia, blood sugar 1.15 g/l. Transfer to the emergency department as part of the thrombolysis unit. At the emergency department: Blood pressure 140/90 symmetrical, heart rate 95/minute, temperature 37.2?C, 87% air saturation, blood sugar 0.96 g/l. Clinically, awake patient still deficient with oculocephalogyric deviation to the right, no response to simple commands, left hemiparesis. Magnetic Resonance Imaging of the brain finding strokes of different ages, including a recent one in the right superficial sylvian territory, several sequelae visible in fluid-attenuated inversion recovery. Appearance of right middle sylvian obstruction. No thrombolysis, transfer to thrombectomy unit. Presence of a confirmed clot, no appearance of fibromuscular dysplasia. Thrombus collected and sent for pathology. Following the medical care: Thrombectomy computerized tomography angiogram on 09Sep: Right M2 thrombus, initial Thrombolysis in Cerebral Infarction score 0. Time of initial opening: 1:08 pm. Time of final intracranial recanalization: 01:17 pm. At the end of the intervention, angiographic monitoring with residual Thrombolysis in Cerebral Infarction score 2B distal thrombus, large parenchymographic defect, or underlying intracranial stenosis. No adjuvant treatment. No complication during procedure. Sequelae of dissection under petrous portion of the right internal carotid artery. No fibromuscular dysplasia. Supra-aortic trunks on 09Sep: Conclusion: several ischemic strokes of different ages and regions, predominant in the right superficial middle cerebral region where there is recent involvement ($g 4:30 p.m.), suggesting a cardio-embolic origin but with a suspicion of underlying stenosis. Electrocardiography in regular sinus rhythm at 95/minute, normal axis, narrow QRS, no atrial or ventricular hypertrophy, no ST segment abnormality, isolated Q wave in D3. Summary of the hospitalization: At the diagnostic level, multiple ischemic strokes of different ages, symptomatic in the right superficial sylvian on M2 thrombus. At the etiological level:- Absence of tight stenosis of the supra-aortic trunks. Appearance of right sub-petrous carotid dissection sequelae. No appearance of fibromuscular dysplasia. - Telemetry without rhythm disturbance demonstrated. Optimal blood pressure control without background treatment.- Skin (livedo racemosa) and gynecological (recurrent early spontaneous miscarriages) abnormalities associated with neurological clinic picture suggesting Sneddon syndrome. Livedo skin biopsy. At the therapeutic level:- Thrombectomy: Thrombolysis in Cerebral Infarction score 2B at 3:15 a.m. at the onset of the symptoms.- Introduction of Kardegic 160 mg. Prevention of the risk of venous thromboembolism with Lovenox 4000. 35-year-old patient who presented with an ischemic stroke (Magnetic Resonance Imaging of the brain finding strokes of different ages, including a recent one in the right superficial sylvian region) 18 days after Dose 1 of Comirnaty. Skin and gynecological abnormalities associated with the neurological clinical picture leading to the suspicion of Sneddon syndrome. Hospitalization still ongoing at the time of reporting. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1760130 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-07
Onset:2021-09-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7208 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Headache, Menstrual disorder, Ovulation pain, Pain in extremity, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Colitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: CAPFIZER INC202101252275

Write-up: Bleeding started 10 days early; Sore arm and shoulder; Sore arm and shoulder; Extreme ovulation pain; Multiple headaches; large red rash on left side of stomach; This is a spontaneous report from a contactable consumer (patient) via (RA) A 47-year-old female patient received bnt162b2 (BNT162B2), via an unspecified route of administration, administered in arm left at the age of 47 years old on 07Sep2021 (Batch/Lot Number: FD7208) as dose 1, single for covid-19 immunisation. Medical history included colitis. Concomitant medications were not reported. On 09Sep2021, the patient had extreme ovulation pain came two weeks earlier than usual accompanied by large red rash on left side of stomach and multiple headaches. The bleeding started 10 days early on an unspecified date. The patient also experienced sore arm and shoulder on an unspecified date. The outcome of the events was not recovered.


VAERS ID: 1760172 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-10
Onset:2021-09-09
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC1440 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210910; Test Name: Coronavirus SARS-CoV-2 PCR; Test Result: Positive
CDC Split Type: DEPFIZER INC202101237614

Write-up: COVID-19; COVID-19; This is a spontaneous report from a non-contactable consumer or other non hcp downloaded from the Regulatory Authority WEB, authority number DE-PEI-202100191395. A 31-years-old female patient received second dose of bnt162b2 (COMIRNATY, Solution for injection, Batch/Lot Number: FC1440, Expiry date was not reported) via an unspecified route of administration on 10Jul2021 as single dose for COVID-19 immunisation. Also, the patient was received first dose of bnt162b2 (COMIRNATY, Solution for injection, Batch/Lot Number: FD5996, Expiry date was not reported) via an unspecified route of administration on 19Jun2021 as single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 09Sep2021 the patient experienced covid-19. The patient underwent lab tests and procedures which included sars-cov-2 test positive on 10Sep2021. The outcome for the events was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1760620 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Sinus headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMITRIPTYLIN; LORATADIN
Current Illness: Sinusitis
Preexisting Conditions: Medical History/Concurrent Conditions: Headache (every time, I have a vaccine headaches are triggered)
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC202101243201

Write-up: Condition aggravated; Sinus headache; This is a spontaneous report from a contactable consumer received from the regulatory authority. The regulatory authority report number is GB-MHRA-EYC 00260566, and Sender''s (Case) Safety Report Unique Identifier is GB-MHRA-ADR 25935513. A 38-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), parenteral on 08Sep2021 (Lot/batch number was not reported) as dose number unknown, single for COVID-19 immunisation. Medical history included ongoing sinusitis; and headache from an unknown date and unknown if ongoing, every time, I have a vaccine, headaches are triggered. Concomitant medications included amitriptyline hydrochloride (AMITRIPTYLIN); and loratadine (LORATADIN). The patient experienced sinus headache on 09Sep2021 with outcome of not recovered, and condition aggravated on an unspecified date with outcome of unknown. The events were reported as serious, other medically important condition. Sinus headache. Seek Advice Details: spoken to the doctor, on more medication. Doctor doesn''t believe it is linked to the vaccine however every time, I have a vaccine, headaches are triggered and do not subside after a few days. I have had sinusitis for years however I do believe that these symptoms are being worsened by the vaccine. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1760630 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-01
Onset:2021-09-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Fatigue, Hot flush, Migraine, Palpitations, Vertigo
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC202101239849

Write-up: Hot flush; Tired out; Palpitations; Tight chest; Migraine; Vertigo; This is a spontaneous report from a contactable consumer downloaded from the regulatory authority with regulatory authority number GB-MHRA-WEBCOVID-202109150818458610-KLAW7, Safety Report Unique Identifier GB-MHRA-ADR 25944023. A 32-years-old male patient received first dose of bnt162b2 (PFIZER BIONTECH COVID-19 VACCINE, Solution for injection, Lot number: not reported) via an unspecified route of administration on an unspecified date in Sep2021 as DOSE 1, SINGLE for COVID-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. Patient had not tested positive for COVID-19 since having the vaccine. Patient was not enrolled in clinical trial. Adverse reaction did not occur as a result of an exposure during pregnancy. Patient had not had symptoms associated with COVID-19 and not had a COVID-19 test. On 10Sep2021, the patient experienced hot flush, tired out, palpitations and tight chest. On 09Sep2021, the patient experienced vertigo and migraine. The events were assessed as medically significant. Outcome of the events vertigo, migraine, hot flush were not recovered, tired out was recovered with sequelae and other events was recovering. No follow-up attempts are possible, Information about Batch/Lot Number cannot be obtained. No further information is expected.


VAERS ID: 1760989 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8288 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dizziness, Electrocardiogram, Headache, Hypoglycaemia, Lip oedema, Tachycardia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to molds; Anal stenosis; Grass allergy; Specific allergy (drug)
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: Electrocardiogram; Result Unstructured Data: Test Result:not provided
CDC Split Type: ITPFIZER INC202101228837

Write-up: Throat constriction; Hypoglycaemia; Tachycardia; Headache; Shivers; Dizziness; Oedema lip; regulatory authority This is a Non-Interventional Study report from the observational study from a contactable pharmacist from the regulatory authority-WEB, regulatory authority number IT-MINISAL02-786327. A 16-year-old female patient received bnt162b2 (COMIRNATY), dose 1 intramuscular on 09Sep2021 (Lot Number: FF8288) at age of 16-year-old as single dose for covid-19 immunization. Medical history included anal stenosis unknown if ongoing, Specific allergy (drug) unknown if ongoing, Allergic to Grasses, Allergic to Molds. The patient''s concomitant medications were not reported. The patient experienced throat constriction, hypoglycaemia, tachycardia, headache, shivers, dizziness, oedema lip all serious as hospitalization, on 09Sep2021 with outcome of recovered on 09Sep2021. The patient underwent lab tests and procedures which included electrocardiogram: not provided on 09Sep2021. Actions taken was Flebocortid 500 MG intravenous infusion Admitted to Emergency Department. Initial sinus tachycardia non-specific intraventricular conduction period. Reporter comment: Attached Emergency Room Report on Anamnesis: Allergic to Grasses, Molds The reporter''s assessment of the causal relationship of the events with the suspect product was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. No follow up attempts are possible. No further information is expected.; Reporter''s Comments: Attached Emergency Room Report on Anamnesis: Allergic to Grasses, Molds; Sender''s Comments: A possibly contributory role of bnt162b2 (COMIRNATY) in triggering the onset of throat constriction, hypoglycaemia, tachycardia, headache, shivers, dizziness, oedema lip cannot be fully excluded, considering the close temporal relationship and known adverse event profile of the suspect vaccine. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate


VAERS ID: 1761099 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-21
Onset:2021-09-09
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Fibrin D dimer, Myocarditis, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: Fibrin D dimer; Result Unstructured Data: Test Result:Fibrin D dimer
CDC Split Type: AUPFIZER INC202101242567

Write-up: Myocarditis; Fibrin D dimer; Palpitations; This is a spontaneous report from a contactable healthcare professional via the Regulatory Authority. The regulatory authority report number is 622868. A 55-year-old female patient received BNT162B2 (COMIRNATY, Lot unknown, unknown if first or second dose) solution for injection intramuscular on 21Aug2021 as a single dose for COVID-19 vaccination. Medical history and concomitant medications were not reported. On 09Sep2021, the patient experienced fibrin D dimer; myocarditis; palpitations. The outcome of the events fibrin D dimer; myocarditis; palpitations was recovering. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1761110 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-09
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Fatigue, Loss of consciousness, Neck pain, Pain in extremity, Palpitations, Paraesthesia, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AUPFIZER INC202101242892

Write-up: Loss of consciousness; chest pain; Dyspnoea; Fatigue; Neck pain; Pain in extremity; Palpitations; Paraesthesia; Visual impairment; This is a spontaneous report from a contactable other health professional via the Regulatory Authority. Regulatory authority report number is 623902. A 39-year-old male patient received bnt162b2 (COMIRNATY, formulation: Solution for injection, Batch/Lot Number was not reported) via an unspecified route of administration on an unknown date as DOSE NUMBER UNKNOWN, SINGLE for COVID-19 immunisation. The patient medical history and concomitant medication were not reported. It was reported that, on 09Sep2021, the patient experienced chest pain, dyspnoea, fatigue, loss of consciousness, neck pain, pain in extremity, palpitations, paraesthesia and visual impairment. Onset latency of events was reported as 14 days. The outcome of the events was recovering. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information was expected.


VAERS ID: 1763717 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-09
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Concomitant elements: good
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: SARS-CoV-2 RT-PCR test; Result Unstructured Data: Positive Iu international unit(s)
CDC Split Type: PTJNJFOC20211001796

Write-up: Vaccination failure; COVID-19; This spontaneous report received from a physician by a Regulatory Authority (regulatory authority, PT-INFARMED-B202109-1359) on 01-OCT-2021 and concerned a 35-year-old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Concomitant elements: good. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 21C13-01 and expiry: unknown) 0.5 ml, 1 total administered on 02-AUG-2021 for covid-19 immunisation. No concomitant medications were reported. On 09-SEP-2021, the patient experienced vaccination failure and covid-19. Laboratory data included: SARS-CoV-2 RT-PCR test (Polymerase Chain Reaction) Positive Iu international unit (s). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from covid-19 on 14-SEP-2021, and the outcome of vaccination failure was not reported. This report was serious (Other Medically Important Condition).


VAERS ID: 1766666 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG7372 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Blood pressure increased, Blood pressure measurement, Erythema, Heart rate, Heart rate increased, Hemiparesis, Loss of consciousness, Oxygen saturation, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hemiparesis (a similar incident 1 year earlier)
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: Blood pressure; Result Unstructured Data: Test Result:145/90 mmHg; Test Date: 20210909; Test Name: Pulse rate; Result Unstructured Data: Test Result:120; Comments: Units:/min; Test Date: 20210909; Test Name: Oxygen saturation; Test Result: 100 %
CDC Split Type: NOPFIZER INC202101256861

Write-up: Left side hemiparesis; SYNCOPE; Rubor on chest; he felt tingling in his left upper and lower extremity; lost consciousness; lacked the ability to speak; Pulse was 120 (min); blood pressure was 145/90 (mmHg); This is a spontaneous report from a contactable health care professional downloaded from the regulatory authority-WEB NO-NOMAADVRE-FHI-2021-Um2ym4. A 16-year-old male patient received bnt162b2 (COMIRNATY), intramuscular, administered in left arm on 09Sep2021 11:00 (Batch/Lot Number: FG7372) (at the age of 16 years old) as dose 1, single for COVID-19 immunisation. Medical history included hemiparesis in 2020 (a similar incident 1 year earlier). The patient''s concomitant medications were not reported. On 09Sep2021, the patient experienced left side hemiparesis, syncope and rubor on chest. The patient received the received the first dose of the COVID-19 vaccine Comirnaty at school. Immediately he felt tingling in his left upper and lower extremity. He did not tell anyone about this and went to the classroom. He lost consciousness while sitting at the desk in the classroom . A doctor, physiotherapist, teacher and principal were present. An ambulance was called (35 minutes after vaccination). There was ruberous skin on the chest. 0.5 ml of adrenaline was given by the doctor. No contact achieved with the patient by pinching or jerking on the sternum. Patient breathed regularly. Pulse was 120 (min), SpO2 was 100 % and Blood pressure was 145/90 (mmHg). Paramedics arrived after 15 min. No longer unconscious, but he lacked the ability to speak. He communicated in writing. There was a hemiparesis left side. The patient''s mother arrived and informed about a similar incident 1 year earlier. He was then examined without clear findings, but spontaneous improvement after 2 days. The patient went home from school with his mother. To contact doctor/ambulance in case of deterioration. The regulatory authority assessed the causal relationship between bnt162b2 (COMIRNATY) and all the reported events as Possible. Stop date for hemiparesis, syncope and erythema was reported on 09Sep2021. The patient underwent lab tests and procedures which included blood pressure measurement: 145/90 mmhg on 09Sep2021, heart rate: 120/min on 09Sep2021 and oxygen saturation: 100 % on 09Sep2021. The outcome of the events left side hemiparesis, syncope, rubor on chest and lost consciousness was recovered on 09Sep2021 while recovering from the other events.


VAERS ID: 1767656 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-09
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: COAPROVEL
Current Illness: Hypertension arterial
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRJNJFOC20211008878

Write-up: EMBOLISM PULMONARY; This spontaneous report received from a physician via a Regulatory authority (regulatory authority, FR-AFSSAPS-TO20218270) on 05-OCT-2021 and concerned a 55 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: hypertension arterial. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number was not reported) 1 dosage forms, 1 total administered on 31-AUG-2021 for covid-19 vaccination. The duration of administration was 1 days. The drug start period and drug last period was 10 days. The batch number was not reported. Per procedure, no follow-up will be requested for this case. Concomitant medications included hydrochlorothiazide/irbesartan for hypertension arterial. On 09-SEP-2021, the patient experienced embolism pulmonary, and was hospitalized (date unspecified). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from embolism pulmonary. This report was serious (Hospitalization Caused / Prolonged).


VAERS ID: 1769521 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Exposure during pregnancy, Haematoma, Haemorrhage, Placental disorder, SARS-CoV-2 test, Uterine contractions during pregnancy
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210914; Test Name: SARS-CoV-2 test; Test Result: Negative ; Comments: Nasal Swab; Test Date: 20210922; Test Name: SARS-CoV-2 test; Test Result: Negative ; Comments: Nasal Swab
CDC Split Type: FRPFIZER INC202101272161

Write-up: Placenta detachment / hematoma = discovered because bleeding and contraction; Placenta detachment / hematoma = discovered because bleeding and contraction; Placenta detachment / hematoma = discovered because bleeding and contraction; Placenta detachment / hematoma = discovered because bleeding and contraction; vaccine exposure during pregnancy; This is a spontaneous report from a contactable consumer or other non hcp (patient) downloaded from the Regulatory Agency (RA)-WEB, from Regulatory Authority Portal. This consumer or other non hcp reported information for both mother and foetus/baby. This is a maternal report. A 36-years-old pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), via an unspecified route of administration, administered in Arm Left on 09Sep2021 at 15:15 (Batch/Lot Number: Unknown) (at the age of 36-Years-old) as dose number unknown, single for covid-19 immunisation at hospital. The patient medical history and concomitant medications were not reported. Patient took diet complement for pregnancy. Patient was not diagnosed with COVID-19 prior to vaccination. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 09Sep2021at 15:15, patient had vaccine exposure during pregnancy. On 12Sep2021 at 05:00, the patient experienced placenta detachment / hematoma discovered because of bleeding and contraction. The mother reported she became pregnant while taking bnt162b2. The mother was 12 Weeks pregnant at the onset of the event. The mother was due to deliver on 21Mar2022. The patient underwent lab tests and procedures which included sars-cov-2 test which was negative on 14Sep2021 through Nasal Swab, sars-cov-2 test which was negative on 22Sep2021 through Nasal Swab. Therapeutic measures were not taken with respect to events. At the time of this report, the outcome of events was not recovered. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1769828 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-09
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Sinus tachycardia
SMQs:, Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GRJNJFOC20211012218

Write-up: PRECORDIAL PAIN; SINUS TACHYCARDIA; This spontaneous report received from a physician by a Regulatory Authority (GR-GREOF-20217887) was received on 07-OCT-2021 and concerned a 45 year old male of unspecified race and ethnicity. The patient''s weight was 75 kilograms, and height was 175 centimeters. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number was not reported) dose was not reported,1 total administered on 01-SEP-2021 for an unspecified indication. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 09-SEP-2021, the patient experienced precordial pain and sinus tachycardia. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from precordial pain, and sinus tachycardia. This report was serious (Other Medically Important Condition).


VAERS ID: 1773285 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-09
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Pyrexia, SARS-CoV-2 test, Therapy non-responder
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210915; Test Name: SARS-CoV-2 RT-PCR test; Result Unstructured Data: Positive
CDC Split Type: PHJNJFOC20211012563

Write-up: CONFIRMED CLINICAL VACCINATION FAILURE; COVID-19 PCR TEST; COVID-19; COUGH; CHILLS; FEVER; This spontaneous report received from a health care professional via a Regulatory Authority [regulatory authority, PH-PHFDA-300108093] concerned a female of an unspecified age. The patient''s height and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A, expiry: unknown) dose was not reported, frequency time 1 total administered on 26-JUL-2021 for drug used for unknown indication. No concomitant medications were reported. On 09-SEP-2021, the patient had covid-19 polymerase chain reaction (pcr) test, covid-19, cough, chills and fever. On 15-SEP-2021, she underwent laboratory test included: Severe acute respiratory syndrome coronavirus 2 reverse transcription?polymerase chain reaction (SARS-CoV-2 RT-PCR) test (NR: not provided). Result came as positive (confirmed clinical vaccination failure). The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from covid-19 polymerase chain reaction (pcr) test, covid-19, fever, cough and chills, and the outcome of confirmed clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint (PQC).; Sender''s Comments: V0: 20211012563-covid-19 vaccine ad26.cov2.s-confirmed clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1779988 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG4686 / 1 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Exposure during pregnancy, Skin lesion, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergic rhinoconjunctivitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC202101236891

Write-up: Nettle rash/Generalized urticaria; pruritic lesions in perineum/erythematous lesions; Drug exposure during pregnancy; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Agency (RA)-WEB, regulatory authority number ES-AEMPS-999630. A pregnant 23-years-old female patient received bnt162b2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported), dose 1 via an unspecified route of administration, administered in Arm Right on 08Sep2021 as DOSE 1, SINGLE for covid-19 immunization. The patient medical history was not reported. The patient''s concomitant medications were not reported. On 09Sep2021, it was reported that a pregnant patient of 13 + 6 weeks who comes for generalized pruritus/ nettle rash and pruritic lesions in perineum. Yesterday, the patient went to general emergencies prescribing Cetirizine and topical cream. No vomiting or jaundice. First dose of Covid vaccine 48 hours ago. Denies dyspnea or odynophagia. In a generalized way, the patient had raised erythematous lesions that disappeared to the pressure very pruritic without signs of over infection. Polaramine and Urbason 20 mg intravenously are administered in emergencies, improving symptoms. Pregnancy due date is on 13Mar2022. The outcome of the events was recovering. No follow-up attempts are possible, information about lot/batch number cannot be obtained. Follow-up (28Sep2021): New information reported from a contactable consumer downloaded from the Regulatory Agency (RA)-WEB, regulatory authority number ES-AEMPS-999630 includes: reaction data (added events Skin lesion and drug exposure during pregnancy), updated outcome of the event urticaria and patient pregnancy details provided. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1780444 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Write-up: The day after getting my first shot, I just suddenly notice the rashes on my body.


VAERS ID: 1782181 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD6840 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure measurement, Communication disorder, Dysphonia, Dyspnoea, Heart rate, Oxygen saturation, Presyncope, Rash, Stridor, Vertigo
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PIRACETAM AL; ASENTRA; RIVOTRIL; NEURONTIN; TEBOKAN
Current Illness: Allergy (casein, ginger); Allergy to antibiotic (Klacid); Aortic valve prolapse; Epilepsy; Fruit allergy (citrus); Mitral valve prolapse; Penicillin allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Scarlet fever
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: Blood pressure; Result Unstructured Data: Test Result:106/70 mmHg; Test Date: 20210909; Test Name: Blood pressure; Result Unstructured Data: Test Result:103/67 mmHg; Test Date: 20210909; Test Name: Pulse rate; Result Unstructured Data: Test Result:69; Test Date: 20210909; Test Name: Pulse rate; Result Unstructured Data: Test Result:77; Test Date: 20210909; Test Name: Oxygen saturation; Result Unstructured Data: Test Result:97-100 %
CDC Split Type: CZPFIZER INC202101298561

Write-up: communication disorder; mild vertigo; pre-collapse state; stridor; Anaphylaxis; respiratory distress; rash on the neck with extension to the chest; hoarseness; This is a spontaneous report from a contactable physician downloaded from a regulatory authority-WEB, regulatory authority number CZ-CZSUKL-21010890. Sender''s (Case) Safety Report CZ-CZSUKL-21010890. An 18-years-old female patient received bnt162b2 (COMIRNATY, Solution for injection, Batch/Lot Number: FD6840) via intramuscularly on 09Sep2021 (at the age of 18 years) as DOSE 2, SINGLE for COVID-19 immunisation. Medical history included drug allergy to antibiotic Klacid (ongoing), mitral valve prolapse (ongoing), allergy to casein, ginger (ongoing), epilepsy (ongoing), aortic valve prolapse (ongoing), scarlet fever, fruit allergy citrus (ongoing), penicillin allergy (ongoing). Concomitant medications included piracetam (PIRACETAM AL); sertraline hydrochloride (ASENTRA); clonazepam (RIVOTRIL); gabapentin (NEURONTIN); ginkgo biloba extract (TEBOKAN); all via orally. Patient had previously received first dose of received bnt162b2 (COMIRNATY, Solution for injection, Batch/Lot Number: not reported) via unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation. On 09Sep2021 (same day of vaccination), the patient experienced respiratory distress (after 5 minutes of vaccination), rash on the neck with extension to the chest, hoarseness, communication disorder, pre-collapse state, had mild vertigo, stridor, anaphylaxis (after 15 minutes of vaccination). The patient was hospitalized from 09Sep2021 for 2 days. Treatment received for respiratory distress, rash on the neck with extension to the chest, hoarseness, stridor, anaphylaxis was: 2 breaths salbutamol (VENTOLIN) inhalator, vertical position, 0.2 ml adrenaline intramuscularly, 50 ml saline intravenously, 0.5 ml bisulepin hydrochloride (DITHIADEN) and dexamethasone sodium phosphate (DEXAMED) 8mg. As reported, 5 min after the application of the second dose, respiratory distress began to develop, which did not subside, in the 15th minute stridor, hoarseness, mild vertigo. Self-administration 2 breaths salbutamol (VENTOLIN) inhalator, blood pressure 103/67mmHg, pulse 69/min, reclining subjectively mild remission of respiratory distress, however, development of pre-collapse state, deterioration of contact, without complete loss of consciousness. Called rescue service. Development of rash on the neck with gradual spread to the chest. Application of 0.2 ml of adrenaline intramuscularly, peripheral venous access provided, 50 ml of saline administered intravenously. Retreat of the rash, alleviation of respiratory distress. Upon arrival of the rescue service application 0.5 ml of bisulepin hydrochloride (DITHIADEN) and dexamethasone sodium phosphate (DEXAMED) 8mg. Lab test on 09Sep2021, included blood pressure measurement: 106/70 mmHg and 103/67 mmHg, oxygen saturation: 97-100 % and pulse rate: 69 and 77 min before the arrival of the rescue service. The outcome of all events was resolved on 09Sep2021. No follow up attempts possible. No further information is expected.


VAERS ID: 1783386 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-09
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chest X-ray, Dyspnoea, Nasal congestion, Pyrexia, SARS-CoV-2 test, Vaccination failure
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Dyslipidaemia; Hypertension arterial; Type II diabetes mellitus
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive; Test Date: 20210910; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive; Test Date: 20210914; Test Name: Thorax X-ray; Result Unstructured Data: bilateral interstitial infiltrate
CDC Split Type: ESJNJFOC20211022876

Write-up: COVID-19 PNEUMONIA; DYSPNEA; VACCINATION FAILURE; FEVER; NOSE CONGESTION; This spontaneous report received from a pharmacist by a Regulatory Authority (regulatory authority, ES-AEMPS-1004167) was received on 12-OCT-2021 and concerned a 54 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included dyslipidaemia, hypertension arterial, and type 2 diabetes mellitus. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 21C16-04 expiry: UNKNOWN) dose was not reported, 1 total administered to non-dominant arm on 17-JUN-2021 for covid-19 vaccination. The drug start period and drug last period was 90 days and duration of vaccination was 1 days. No concomitant medications were reported. On 09-SEP-2021, the patient experienced nose congestion, and was hospitalized (date unspecified). Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. On 10-SEP-2021, the patient experienced fever. Laboratory data included: COVID-19 PCR test (NR: not provided) Positive. On 14-SEP-2021, the patient experienced covid-19 pneumonia, dyspnea, vaccination failure. Laboratory data included: Thorax X-ray (NR: not provided) bilateral interstitial infiltrate. Other relevant diagnostics included: bilateral interstitial infiltrate with areas of pulmonary condensation. The number of days of hospitalization was not reported and it was unsure the patient discharged from the hospital. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from fever, dyspnea, and nose congestion, and was recovering from covid-19 pneumonia, and vaccination failure. This report was serious (Hospitalization Caused / Prolonged, and Other Medically Important Condition).


VAERS ID: 1681244 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Burning sensation, Dizziness, Dry eye, Nausea, Pain in extremity, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Vestibular disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Tendinopathies and ligament 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: one a day women''s multivitamin IUD
Current Illness: no
Preexisting Conditions: no
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got J&J vaccine @ 5:30 PM in R Arm. within 20 minutes felt sympathetic pain in my L arm @ same spot on L arm as R arm injection. Went to bed at 10:30pm. woke @ 3AM feeling like I needed to move - got up for a drink and became aware of feeling like I spread over my entire body - not exactly the same as chills and/or fever - literally felt like pepperminty cool burn/tingle all over whole body. Felt faintness w/waves of nausea - had to squat twice like when you feel like you are about to faint/brown or black out so you feel the need to get close to the floor. Had waves of abdominal cramps that felt like strong period cramps. eyes feel dry - irritatingly dry - and I have not been wearing contacts.


VAERS ID: 1682414 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-09-08
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysstasia, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

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

Write-up: On day 20 after 2nd dose I began to experience dizziness at 2PM that turned extreme being unable to stand or move without support followed by violent vomiting every 20 minutes for the next two hours. The dizziness was in the form of visual spinning of all things in sight and/or the sense of body spinning with eyes closed. Breathing remained full and thinking was not impaired. Symptoms began to subside after 2-1/2 hours and normal feeling returned after 5-6 hours. These events followed a modest lunch; however, for the sake of elimination I had the same lunch ingredients 2 days later with no adverse reactions.


VAERS ID: 1682460 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-09
Onset:2021-09-08
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LF3180 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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: 54, 8/19/21, left arm injection, Pfizer
Other Medications: none
Current Illness: none
Preexisting Conditions: none - I don''t know if this was related to the initial or followup dose. The information listed is from the initial vaccination. If you need the second instead, please let me know.
Allergies: none
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: Today I woke up and found NOT bright red blood in my stool. I understand bright is usually a hemorrhoid, but this was darker. It''s been 5 hours and I''m still pooping blood, and not feeling like I''m completely vacated.


VAERS ID: 1682509 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Patient uncooperative, Underdose
SMQs:, Medication errors (broad)

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

Write-up: 60% of dose given. Patient has a developemental delay and was unable to tolerate vaccine process. First attempt was made and 0.3mL of 0.5mL dose was given. Distraction and redirection techniques were attempted by patient?s care giver and staff members. Second attempt was made but again, patient was unable to tolerate and care giver advised vaccine adminsitrator to stop.


VAERS ID: 1682526 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

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

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

Write-up: Pt. awoke this am with whelps on arms and chest . Non itchy whelps


VAERS ID: 1682554 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The patient did NOT experience any adverse reactions. The vaccine was given after the beyond-use-date. The medicine was contained in the original vial in the refrigerator (~41''F). The vaccine was drawn and administered immediately after. The manufacturer recommends the diluted vaccine is good for up to 6 hours after dilution. After detailed conversation with the Pfizer manufacturer and CDC, it was determined that the vaccine within the vial has maintained physical stability within the parameters mentioned and the patient would not need to repeat the dose.


VAERS ID: 1682572 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-27
Onset:2021-09-08
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: The patient was vaccinated by the RN. At approximately 14:10, the patient was dismissed without any complaints. As the mother was driving away she called out "help". The RN approached the vehicle and found the patient awake and alert. His color was pale. Skin was warm and dry. The patient''s BP was 92/60. The patient''s mother stated that she witnessed the patient briefly "passed out". EMS was called. The patent was given water and was able to answer questions. The patient was assessed by EMS. The patient declined transport to the hospital. When the patient left this clinic, he was alert and talking. Follow up with Mom phone call. She stated that she contacted the patient''s PCP. Further questioning with the patient revealed that the patient did not have any fluids since the day before. No further medical attention was recommended from the patient''s PCP.


VAERS ID: 1682579 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-04
Onset:2021-09-08
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Breakthrough case. Covid positive results on 9/8/2021 by PCR test


VAERS ID: 1682589 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013SBA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HIV
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was vaccinated with first dose in another place and then came here for the second dose, patient received the first dose of MODERNA in another place and the PFIZER vaccine was administered by mistake.


VAERS ID: 1682638 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Electrocardiogram, Fatigue
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: 14-15 days post covid
Preexisting Conditions: none
Allergies: Bee stings
Diagnostic Lab Data: EKG and VS 9/8/2021
CDC Split Type:

Write-up: reports feeling real tired post vaccination


VAERS ID: 1682647 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-26
Onset:2021-09-08
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray normal, Cough, Dyspnoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, ASA, atorvastatin, calcium w/ vit D, coreg, vit D, dulaglutide, fluoxetine, gabapentin, hydrocodone/APAP, humalog, senne-docusate, trazodone
Current Illness: no
Preexisting Conditions: Depression, DM, HTN, ITP, Obesity, OSA
Allergies: nkda
Diagnostic Lab Data: PCR + 9.7.2021, CXR: clear
CDC Split Type:

Write-up: breakthrough case Covid + 9.7.2021, symptoms, SOB, cough, weakness, CXR: clear


VAERS ID: 1682656 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-25
Onset:2021-09-08
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, zyrtec
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sonogram confirmed no heartbeat and dated pregnancy one week behind.
CDC Split Type:

Write-up: Miscarriage confirmed 9/8/21 at routine appointment Due : 4/2022 Pregnancy history- 3 pregnancies 1 termination 1 full term birth 1 miscarriage


VAERS ID: 1682699 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Flushing, Lethargy, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 20mg, Ativan 0.5mg, Trileptal 150mg , Albuterol sulfate 108MCG/act
Current Illness: N/A
Preexisting Conditions: Asthma Other acne Mild intellectual disability Anxiety Depression Back pain GERD (gastroesophageal reflux disease) Rosacea Epigastric pain Hematemesis ETOH abuse Marijuana abuse Seasonal allergies History of abnormal cervical Papanicolaou smear History of sexual violence Insomnia Migraine History of absence seizures
Allergies: Amoxicillin, Ceftin, Clonidine, Depakote, Penicillin G Benzathine, Serraline
Diagnostic Lab Data: All vitals with-in normal limits
CDC Split Type:

Write-up: Approximately 10 minutes after injection patient''s face became flushed, she then complained of being very tired. Patient acting lethargic. Patient after juice and laying down unable to keep awake .


VAERS ID: 1682742 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-25
Onset:2021-09-08
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient Covid+ at Hospital on 09/08/2021. Patient was fully vaccinated with Pfizer vaccine, 1st dose on 05/04/2021 and 2nd dose 05/25/2021 per ED Note: Patient is a 66-year-old male with past medical history of hypertension and hyperlipidemia who presents to the emergency department today after testing Covid positive yesterday and complaining of diarrhea. Patient states that he has been having diarrhea 3-4 times per day and it has been completely liquid. This is been going on for 4 days and not getting better. Patient is also complaining of dry cough but denies any chest pain or shortness of breath. Patient is requesting that we check his electrolytes to see if they are off secondary to the diarrhea and is also requesting IV fluids. Patient denies any abdominal pain and nausea and vomiting


VAERS ID: 1682745 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013U8A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain
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: Soreness around injection site


VAERS ID: 1682769 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Patient called the pharmacy the day after the vaccination and reported break through bleeding in her menstrual cycle. She usually is very regular and shouldn''t cycle until the 26th of the month. Patient will continue to monitor.


VAERS ID: 1682778 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-01
Onset:2021-09-08
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / UNK - / -

Administered by: Senior Living       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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization with COVID-19. Positive test on 09/02/2021


VAERS ID: 1682793 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hypoacusis, Paraesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hearing impairment (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: None at this time- patient refused to go to hospital.
CDC Split Type:

Write-up: Patient stated had difficulty hearing, tingling of lower lip, dizziness. Code white called (get members of management to area) as well as 911. Spoke with patient and she felt hot and dizzy. Patient felt OK sitting down and did not want to move. Father left to get a short sleeve shirt as she was wearing a sweatshirt. Kept patient talking while waiting for EMS to arrive. Patient was coherent and answered questions accurately. Was asked by management if she was thirsty but I would not let her get water in the event she passed out. EMS arrived and spoke to patient and father and she declined to go to the hospital and within 5 minutes of them arriving they left and patient left with father to go home. Spoke to office @ 1:06pm and reported adverse reaction.


VAERS ID: 1682801 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bystolic 5 mg 1/day Lexapro 20 mg 1/day multi vitamin magnesium 250 mg 1/day
Current Illness: none
Preexisting Conditions: supraventricular tachycardia
Allergies: allergic to sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have had an unusual amount of itchingaround my face and neck


VAERS ID: 1682810 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Retin-A Naproxyn
Current Illness: None
Preexisting Conditions: Asthma, Anxiety
Allergies: Multiple Food Allergies, stated over 100. Anaphylaxis to Reglan Hypertension with Ativan
Diagnostic Lab Data: None, Observation and Vital Signs only
CDC Split Type:

Write-up: Pt stated dizzy, lightheaded, flushed, clammy after receiving 2nd dose of Pfizer (EW0191).


VAERS ID: 1682826 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Unknown  
Location: Maryland  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: NKDA
Diagnostic Lab Data: patient''s vital signs were obtained and the patient was given an ice pack, and EMS was called, the patient refused EMS transportation to the local ER.
CDC Split Type:

Write-up: Patient received the vaccine, shortly after receiving the vaccine (1-2 minutes), the patient begin to feel dizzy and started hearing a ringing sound in her ears.


VAERS ID: 1682866 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Mild, Additional Details: experienced mild nausea/sweating/dizziness- monitor blood pressure- over the course of 30 mins- felt better after 45 mins- gave water- asked to sit for 10 more minutes


VAERS ID: 1682881 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Work       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: Dose of Moderna given after receiving Johnson and Johnson vaccine at a different facility


VAERS ID: 1682883 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1682887 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose, Electrocardiogram, Exposure during pregnancy, Palpitations, Uterine contractions during pregnancy
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)

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

Write-up: 34 year old female, 34 weeks gestation here for 2nd Pfizer dose of Covid 19 vaccine. Vaccine administered at 1023. 15 minutes post administration, patient began to report a sensation of palpitations. VS checked and are as follow. BP 121/79 HR 87 RR 16 Saturation of 98% on RA. Patient reported sensation of "Braxton Hicks" contraction without and pain. MD STAT called for further evaluation. Per MD order, EKG and blood glucose checked. Disposition to OB clinic for further evaluation.


VAERS ID: 1682889 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache
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: Vitamin D3, Quercetin, Vitamin B, Vitamin K, Elderberry extract, Nascent Iodine, Magnesium, Selenium, Probiotics, Zinc, Apple Pectin, Beet Root Capsules, Omega 3, EGCg Green Tea extract
Current Illness: None,
Preexisting Conditions: High blood pressure
Allergies: None,
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: About one day from first injection, I am having headaches I would describe as mildly sharp intermittent pains in right temple. I may add more information to VAERS to the extent that I exhibit further adverse effects. I am self reporting for the purpose of accurately memorializing adverse effects.


VAERS ID: 1682890 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

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

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

Write-up: Dosing Interval Deviation. Patient received their 1st dose of Moderna on 08/18/2021. They self-scheduled themself for an appointment 3 weeks from the 1st dose instead of the recommended 4 week interval. Patient was vaccinated by a 4th year pharmacy student who did not catch the early administration even though the patient wrote on the consent form the date of their 1st dose. We consulted the CDC "Covid-19 Vaccine Administration Errors and Deviations" guideline and the interim recommendation is for a 2nd dose administered fewer that 24 days (Moderna) after the 1st dose, We do not need to repeat the dose. Staff and interns have been verbally retrained on the recommended dosing intervals and the need to thoroughly review the consent forms PRIOR to administration.


VAERS ID: 1682900 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-09-08
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Patient received Moderna Dose #1 on 3/2/2021 and then received Pfizer dose on 8/1/2021. Patient returned 8/27/2021 to receive second dose of Pfizer vaccine and was disqualified and advised she is considered fully vaccinated.


VAERS ID: 1682902 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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? 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: Covid positive due to spouse testing positive


VAERS ID: 1682913 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / UNK - / -

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? 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: Covid positive unknown contact


VAERS ID: 1682914 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Work       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: Moderna vaccine administered after one dose of Johnson and Johnson was given at another facility


VAERS ID: 1682921 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incomplete course of vaccination, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Patient was administered Moderna vaccine on 8/11/2021. Patient was then administered Pfizer vaccine on 9/8/2021. Reporting that patient did not complete a series of Moderna (dose 1), because Pfizer was given as dose 2.


VAERS ID: 1682927 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Work       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: Vaccine given after Johnson and Johnson vaccine given at another facility


VAERS ID: 1682941 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Oropharyngeal pain, Rash, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: naproxen, 250 MG, TABLET, ORAL TAKE ONE doxycycline
Current Illness: Covid-19 10AUG2021
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Rash on face, sore throat, and tachycardic


VAERS ID: 1682953 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mom brought patient in for Pfizer vaccine at local outreach vaccine clinic. She lied about the patient''s DOB. I asked mom and patient "you are 12, right?" and they both said yes. Vaccine was given. Patient doesn''t turn 12, until 2021. Health Care will call mom and notify her.


VAERS ID: 1682958 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-06
Onset:2021-09-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Tachycardia, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: wbc 13.
CDC Split Type:

Write-up: Chest pain, tachycardia


VAERS ID: 1682965 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt blood pressure dropped and pt felt faint. Had pt lie on floor and took blood pressure at 1:20 was 112/73 and pulse of 49. monitored pt and rechecked blood pressure at 1:25 was 117/86 and pulse of 61, at 1:30 was 91/53 pulse of 52. gave pt salty potato chips and pt was drinking a dr pepper. blood pressure at 1:35 was 126/82 and pulse of 58. pt felt fine and sat in break room for another couple minutes then said he was fine.


VAERS ID: 1682977 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse 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: Cell Well-being phase 2 supplements and digestive enzymes
Current Illness: Cold 2 to 3 weeks ago
Preexisting Conditions: None
Allergies: Avocado
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: No sign or symptoms at this time


VAERS ID: 1682990 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb mass
SMQs:

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

Write-up: Patient received second dose of Pfizer on 9/7/2021 and called on 9/8/2021 to report a "golf-ball sized lump" under her right armpit.


VAERS ID: 1682998 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 UN / IM

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

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

Write-up: Situation: Name of Reactive drug/vaccine: Pfizer COVID vaccine Time of Immunization Administration: 1330 Time of Reaction: 1340 Subjective symptoms reported by patient: C/O being "light headed" Objective symptoms/nursing assessment: Color normal for skin type, no SOB, BP 120/78 HR 76 PO2 97 Immediate nursing interventions: Gave orange juice Observed x 30 minutes Was the Emergency Protocol for Anaphylaxis Initiated? no Patient response to interventions and additional details: Patient states no longer feels lightheaded. Left ambulatory @ 1400 with instructions to hydrate


VAERS ID: 1682999 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3182 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Neck pain, Pain in extremity, Pyrexia, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient report that at midnight after the vaccine she started having Fast heartbeat & body vibrations , also she had soreness on the back of her neck and fever and sore arm...


VAERS ID: 1683003 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FC3183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Dehydration (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: Ortho-Tri-Cyclen
Current Illness: Covid infection
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: BP: 123/83 P:101 O2:97%
CDC Split Type:

Write-up: Palpitations starting 10 minutes after injection and elevated pulse up to 101. Pulse went down to 85 after 20 minutes.


VAERS ID: 1683016 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-06
Onset:2021-09-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bisoprolol/HCTZ 5/6.25 mg
Current Illness:
Preexisting Conditions:
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports "chest pain" that started the morning of 9/8/21 as well as, pain in the lower back.


VAERS ID: 1683039 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-09-08
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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? 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: Covid positive unknown source


VAERS ID: 1683051 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: After receiving the Pfizer Covid-19 Vaccine patient during 15 minute observation started to say he wasn''t feeling very well and was feeling dizzy. After stating this he started to lean in his chair and starting making sounds with his throat..gargling sounds like he couldn''t breathe and then began to lose consciousness. He was brought down to the floor from the chair and an Epi-pen was administered and shortly after he came through. Paramedics arrived afterwards and they took him to the local hospital.


VAERS ID: 1683071 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown last seen in office 2020
Current Illness: unknown
Preexisting Conditions: ischemic cardiomyopathy, prostatic enlargement, hyperlipidemia, thyroid dysfunction, GERD, neuropathy, vitamin D deficiency, hypertension, COPD, history of DVT, CHF, ventricular tachycardia.
Allergies: Lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: No known adverse reaction at this time (9/8/2021 @1535) after an offsite Covid vaccine clinic while documenting in system our office found that patient has already received two doses of Pfizer Covid vaccine in February 2021. Patient had filled out the covid vaccine registration form prior to the Moderna vaccine given 9/8/2021. Patient did not mention he had any other Covid vaccines in the past. I did try to call the patient to update him that a report would be filled out and to gather anymore information that he may have, patient did not answer. A voicemail was left to call our office.


VAERS ID: 1683077 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Feeling hot, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazol, prenatal vitamins, escitalopram, metformin and depo
Current Illness:
Preexisting Conditions: anemia, anxiety, asthma
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt fine entering the office. 15 minutes after receiving her vaccine she started to feel fatigue, nauseas and a warm sensation in her arm. She spoke with provider and discussed with him that she did feel okay thinks it may have been her anxiety and was informed to go to the ER if any of her symptoms worsened


VAERS ID: 1683080 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Nausea, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: patient refers not taking any medications
Current Illness: Patient refers not having any disease at the time of vaccination.
Preexisting Conditions: Epilepsy
Allergies: Penicillin, Aspirin, Toradol, and Decadron
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient got vaccinated, by the time she sat in the area of observation, she refers having head pain, blurry vision, nausea and immediately vomits. We proceed to take her vitals BP 120/70, P:115, and sat.o2 99 and we call the ambulance and she is taken to the hospital area.


VAERS ID: 1683085 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Multi Vitamin, Vitamin C, Potassium, Magnesium Glycinate, Zinc
Current Illness: Covid 19
Preexisting Conditions: Thyroid
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had blood in my urine upon waking.


VAERS ID: 1683092 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Heart rate 85 Oxygen 100% Blood pressure 102/71
CDC Split Type:

Write-up: Pain at injection sight and chest pain.


VAERS ID: 1683099 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

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

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

Write-up: Administered second dose of COVID -19 Vaccine in error Pfizer should''ve been Moderna


VAERS ID: 1683120 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Hyperhidrosis, Musculoskeletal chest pain
SMQs:, Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: G6PD deficient, R Knee Pain, Hyperlipidemia
Allergies: ASA
Diagnostic Lab Data: EKG, vitals, sent to ER via ambulance for eval
CDC Split Type:

Write-up: Member was getting up after 15 minutes post vaccine and felt left sided chest/lower rib pain radiating to back with diaphoresis.


VAERS ID: 1683126 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

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

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

Write-up: patient slumped in chair after 5 minutes of receiving the vaccine. I shook patient and he woke up and had some orange juice. he then was resting for about 10 minutes when he passed out again and was more unresponsive than the first episode so we called 911. he was awake before paramedics arrived but very pale. he was checked out by paramedics and a family member came to pick him up


VAERS ID: 1683135 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Disorientation, Loss of consciousness, Malaise, Seizure, Symptom recurrence
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), Dementia (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), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving the vaccination, the patient stated she wasn''t feeling well. She had a history of fainting after giving blood. She asked for juice or gatorade so I went to grab her a drink. When I came back, she had passed out and was convulsing. After a few seconds she came to and was briefly disoriented. She quickly realized what happened and said the same thing happened before. She felt fine other than rubbing her head but didn''t report any pain. I sat with her for about 45 minutes total. She denied an ambulance/further care, and her boyfriend came to get her. When she was leaving, she said she felt completely normal and had no concerns.


VAERS ID: 1683156 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 - / IM

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

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

Write-up: Situation: Name of Reactive drug/vaccine: Covid Pfizer Time of Immunization Administration: 14;50 Time of Reaction: 15:05 Subjective symptoms reported by patient: Complaints of dizziness Objective symptoms/nursing Assessment Diaphoretic Anaphylaxis: Immediate nursing interventions Placed in supine position. Cool compress to forehead,fluids offered. BP taken. 104/68 supine Repeated at 15:30 110/68 Skin warm and dry. Was the Emergency Protocol for Anaphylaxis Initiated? no Patient response to interventions and additional details: Skin warm and dry. Left accompanied by co worker at 15:40 Background: Allergies: Allergies Allergen Reactions ? Aspirin Nausea And Vomiting ? Gluten Protein GI Distress ? Nuts (Other) Dizziness, Headache, Nausea And Vomiting and Respiratory Difficulty PMH: social anxiety Assessment: Influenza Vaccine Reaction. *** Recommendation/Plan: Rest as needed


VAERS ID: 1683157 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Ear discomfort, Feeling hot, Feeling jittery, Headache, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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: Pt almost immediately began to feel warm all over. Her face, ears burning and warm. Spreading to her chest. No c/o SOB or tongue swelling. Pulse ox 99-100%. HR 88 BP elevated at 176/104. She c/o of feeling jittery. Pt given 50 of Benedryl. Rash spread to upper arms. No rash on back or abdomen or legs. After 30 minutes, flushing less severe, Jitteriness gone, has developed a headache, still c/o some burning in her face. BP 156/93 and HR 88 PO 99%.


VAERS ID: 1683167 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pharyngeal paraesthesia, Throat irritation, Tongue disorder
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Itchy throat, tingly, thick tongue


VAERS ID: 1683186 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

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

Write-up: Shortly after receiving the J&J Covid 19 vaccine the patient sat in the waiting area for the required 15 minute observation period. About three minutes in she stood up and stated "I don''t feel so good". She was told to sit down immediately. Before she could sit she fainted and fell. She went into convulsions for a period of about 10 seconds on the ground and she slowly stopped and came to. 911 was called and EMS came to evaluate. She left with the ambulance.


VAERS ID: 1683206 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: Patient stated they were nervous getting and following the vaccine. Vomiting following shortly after vaccination. Vitals were taken, fluid (water) was given and continued observation for thirty minutes. Patient felt immediately better after vomiting.


VAERS ID: 1683267 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Full blood count, Loss of consciousness, Malaise, Muscle contracture, Myocardial necrosis marker, Tremor, 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), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none reported
Preexisting Conditions: unknown/none reported
Allergies: reported no allergies to medications, food or other products
Diagnostic Lab Data: 9/8/2021 CBC and electrolytes ,Cardiac isoenzymes, temp/pulse/respiratory, blood pressures, pain assessment
CDC Split Type:

Write-up: Patient reported not feeling well then lost consciousness. Hands and jaw were clenched and body was shaking. Patient was none responsive. Epipen given and patient regained consciousness and asked what happened. Since pharmacy is in the hospital patient was taken to the emergency room for further evaluation.


VAERS ID: 1683277 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Vision blurred
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), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: At 1105, patient stood up and reported he "feels like I''m going to pass out" to RN. Patient advised to sit down. Patient reported history of panic attacks. Patient reported feeling "sweaty" and having "blurred vision". EMT sat down with patient. Patient closed eyes and started to slump in chair. EMT assisted patient to lay down on the floor. Patient opened eyes after approximately 5 seconds. Patient elevated legs on a chair. At 1111 RN assessed patient vital signs: blood pressure 118/76 mmHg and pulse 99 beats/minute. Patient reported no chronic conditions, no current medications, and no known allergies. At 1121, RN reassessed patient: blood pressure 122/78 mmHg, pulse 56 beats/minute, and SpO2 100%. At 1125, patient was able to stand up and sit in chair. Patient denied dizziness. Patient given water and gatorade. Patient able to drink water and gatorade. At 1131, RN reassessed patient vital signs: 130/100 mmHg, pulse 70 beats/minute and SpO2 100%. Patient denied dizziness and stated he was "feeling fine". RN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider, and to sign up on v-safe. At 1135, patient left facility with unlabored respirations and steady gait.


VAERS ID: 1683279 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Heart rate irregular, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Pale, Fluctuating heart rate, fainted


VAERS ID: 1683280 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Pt was vaccinated at 3:36pm; 3:42pm pt. stated "My head is hurting, and I feel hot". Patient got vaccinated on left arm. RN assessed patient , vitals : BP 125/75, Temp 98.1, HR 77, Resp 20, Spo2 99%. on room air. Pulses noted on both arms strong and regular. Hearts sounds present. No respiratory distress, breathing through her nostrils mouth closed. Skin warm and dry. Patient denies any other symptoms. Patient waited additional 15 minutes. RN reassessed and patient states, ? I feel fine now. I no longer have a headache, or feel hot?. Vitals: BP 117/75, Temp 98.1, HR 74, Resp 20, Spo2 99% on room air, Patient cleared by clinical staff. Clinical staff explained to pt and the family member should she have any other reaction she may want to seek medical attention at a clinic. 4:10pm patient ambulated out of the clinic; no distress gait steady and regular. Family member with her and family member drove her home. Cleared by Clinical Staff.


VAERS ID: 1683283 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Incident due to needle malfunction with retractable needle/syringe. After nurse injected 0.2 mls, needle hub became loose within syringe and began leaking from hub for remainder of dose. Needle was unable to be retracted. Patients mother refused revaccination. Syringe was discarded.


VAERS ID: 1683288 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-01
Onset:2021-09-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, COVID-19, Ear congestion, Facial pain, Fatigue, Headache, Malaise, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Sinus pain, Sinusitis, Throat irritation
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Azelastine HCI
Current Illness:
Preexisting Conditions:
Allergies: cefuroxime
Diagnostic Lab Data: August 4th positive test for COVID.
CDC Split Type:

Write-up: I was fully vaccinated in February 2021. I was exposed to COVID on July 30, and developed symptoms two days later. I tested positive for COVID on August 4. It started off as an itchy throat and slight sinus pain. Within a couple days it had progressed to fever, extreme sinus/facial pain, loss of taste and smell, throbbing headache, sever congestions, plugged ears, and extreme fatigue. I was really sick for 8 days and developed a bad sinus infection after. Three weeks after becoming sick, I went in to the doctor about my sinus pain and found out I also had a sinus infection. It looks about 4 weeks to start to feel better, despite being fully vaccinated. A little over a month out, and I still tired and having an elevated heart rate when exercising that never existed before.


VAERS ID: 1683294 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

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: Insulin and lisinopril.
Current Illness:
Preexisting Conditions: Type 1 diabetes
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Metallic-foul taste in mouth. Happened within 1 minute of injection. Still ongoing.


VAERS ID: 1683303 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acoustic stimulation tests, Amnesia, Axillary pain, Blood albumin, Blood test, Chest pain, Chills, Confusional state, Disturbance in attention, Dysgeusia, Ear discomfort, Feeling abnormal, Hypoaesthesia, Limb discomfort, Lymphadenopathy, Magnetic resonance imaging, Musculoskeletal chest pain, Neck pain, Pain in extremity, Palpitations, Paraesthesia, Paraesthesia ear, Peripheral coldness, Tinnitus
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (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: Bystolic 5mg multi vitamin vitamin b, d, c fish oil
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: erythromycin
Diagnostic Lab Data: mir neck and back on June 1 and June 2nd blood tests 5/12/21 anti dna ss 31 positive albumin 5.0 ast 47 alt63 memory test aug 17 21 hearing test 6/2 June 3rd ast 34 alt 50 albumin 4.6
CDC Split Type:

Write-up: right after injection had a indescribable feeling going through rt. arm kind of felt like circulation was off. next day had a taste of metal, sore arm and sharp pain in chest behind rt. breast, that continued on and off for weeks. about 2 weeks after shot, woke up with tingling in shoulders arms and hands for a few days. tingling pinching and burning sensation in rt. ear, tingling and numbness on rt. side of face from lips to ears. ringing in both ears pain in back of neck with tingling running down back of neck head and shoulders. strange feeling in rt. arm like it had a rubber band on it.sharp stabbing pain in rt. arm pit lasted one day then would happen occasionally. mild swelling in arm pit sharp stabbing pains under rib cage ,hands and feet . tingling legs hands and feet. rt. foot very cold had to use heating pad nothing else worked.heart palpitations about he same time in evening for several days in a row. chills on and off for a few days confusion, brain fog and hard to concentrate and remember things.


VAERS ID: 1683307 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 RA / IM

Administered by: Pharmacy       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ---
Current Illness: Covid + but she did not tell us
Preexisting Conditions: Mental issues per MD office
Allergies: ---
Diagnostic Lab Data: We called her dr and the hospital so confirm and watched her for 30 mins. She left and call 911 later at her home and I called and checked on her 30 mins ago and she was doing well.
CDC Split Type:

Write-up: She came in wanting the covid vaccine and 2 techs and myself asked her the questions. She did not have a fever or ever say she had covid after getting the vaccine she stated she was in the hospital last week with covid and had the monoclonal antibodies treatment.


VAERS ID: 1683309 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, 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: Patient''s husband said that syncope has happened before
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: ambien, crestor, ibuprofen
Diagnostic Lab Data: NA
CDC Split Type: NA

Write-up: Patient experienced syncope after getting her first Pfizer Covid shot - patient''s husband was present and said that this had happened before after receiving a shot.


VAERS ID: 1683310 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Fall, Pallor
SMQs:, Accidents and injuries (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: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At 1028, patient fell from chair to the floor. RN arrived on scene. Patient''s eyes were closed for approximately 3 seconds. RN shook patient''s shoulders and called out to patient. Patient opened eyes. Patient sat up. Patient was alert and oriented to person, place, time and situation. Patient reported he wanted to lay down on the ground. EMT elevated patient''s feet on a chair. EMT assessed patient. EMT noted skin was clammy and pallor of the face. Patient denied hitting head. Patient denied pain, tenderness, redness on head and on left and right knees. Patient reported no history of fainting with vaccinations. Patient reported no chronic conditions, no current medications, and no known allergies. At 1032, assessed patient vital signs: 116/70 mmHg, pulse 88 beats/minute and SpO2 100%. At 1037, EMT reassessed patient vital signs: blood pressure 122/76 mmHg, pulse 78 beats/minute, and SpO2 99%. At 1042, EMT reassessed patient vital signs: blood pressure 120/ 78 mmHg, pulse 76 beats/minute, and SpO2 98%. At 1045, patient was able to stand and sit in chair. Patient denied dizziness and lightheadedness. Patient given water. Patient able to drink water. At 1050, EMT reassessed patient vital signs: blood pressure 118/76 mmHg, pulse 78 beats/minute, and SpO2 98%. EMT educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider, and to sign up on v-safe. Patient reported he "feels fine". At 1058, patient left facility with unlabored respirations and steady gait.


VAERS ID: 1683316 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7319NA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Rph monitored the patient for 15 minutes No adverse reaction or event reported..
CDC Split Type:

Write-up: pt was waiting for Flu vaccine. Rph gave him Covid -19 ( PFIZER ) vaccine instead of flu..Pt. got 1st and 2nd dose of covid-19 vaccine ( MODERNA) 7 months ago. ( Rphs had 4 people waiting for covid shots and 1 for flu.so by mistake gave the last customer covid-19 shot)


VAERS ID: 1683318 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-09-08
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Confusional state, Dizziness, Fatigue, Injection site pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: PT STATES ONCE SHE MADE IT HOME WITHIN AN HOUR AFTER RECEIVING THE VACCINE SHE WAS CONFUSED AND LIGHTHEADED. SHE ALSO REPORTED DIZZINESS AND FATIGUE. SHE STATES SHE ALSO HAD SORENESS AT THE SIGHT AS WELL AS MEMORY LOSS.


VAERS ID: 1683327 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

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

Write-up: Swelling and tingling of vaccinated arm, light headed, dizzy.


VAERS ID: 1683331 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: Bupropion
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Resting heart rate increased (130''s) for a few hours, approximately 24 hours after the vaccine.


VAERS ID: 1683336 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO176 / 1 LA / IM

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

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

Write-up: Pt presented to clinic for 1st dose of Pfizer Covid-19 vaccination. Pt and Mother stated pt''s birth date was 9/2/2009 and received a 1st dose of Pfizer covid-19 vaccine. Upon entering data into state registry, we discovered pt''s birthdate is 9/20/2009. Mother confirmed birthdate was 9/20/2009 and stated she had lied on the paperwork. She was informed that her child will not receive a second dose until child was 12 years old.


VAERS ID: 1683337 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), 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: Levofloxacin Other (see comments) Not Specified 5/19/2004 Mold Hives Not Specified 3/7/2017 Monosodium Glutamate Hives Not Specified 3/7/2017 Penicillins
Current Illness:
Preexisting Conditions: asthma
Allergies: Allergies Nucala [Mepolizumab] Anaphylaxis High 11/25/2020 Amoxicillin Other (see comments) Not Specified 5/19/2004 unknown Aspirin Other (see comments) Not Specified 5/19/2004 Azithromycin Other (see comments) Not Specified 2/18/2005 Bee Sting [Bee Venom Protein (Honey Bee)] Anaphylaxis Not Specified 5/19/2004 Cat Dander Other (see comments) Not Specified 11/26/2019 itching Erythromycin Base Other (see comments) Not Specified 5/19/2004 Levofloxacin Other (see comments) Not Specified 5/19/2004 Mold Hives Not Specified 3/7/2017 Monosodium Glutamate Hives Not Specified 3/7/2017 Penicillins Other (see comments) Not Specified 5/19/2004 Polysorbate 80 Anaphylaxis Not Specified 4/15/2021 Red Dye Hives Not Specified 3/7/2017 Sodium Phosphate,dibasic Heptahydrate Anaphylaxis Not Specified 4/15/2021 Sucrose Anaphylaxis Not Specified 4/15/2021 Sulfamethoxazole-trimethoprim Anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Pfizer vaccine after allergy testing and was cleared to receive vaccine. Approximately 30 minutes after dose given she started wheezing, having difficulty breathing, and had satts of 70%. She was given Epinephrine. Benadryl, and IV was started and she was given steroids. She was then transported to the ER.


VAERS ID: 1683342 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-05
Onset:2021-09-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Pain, Pain in extremity, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I take to many medications to list I have a full list with pharmacy or I can send you copies of my list.
Current Illness: Multiple Sclerosis
Preexisting Conditions: Multiple Sclerosis
Allergies: Morphine, nickel, dye from 30 yr old CD scan.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 09/06 took Tylenol after the vaccine 09/07 Am. Increased temp., 99.9 I took Tylenol again. By about 12:00 the cough started I started to feel achy in my arms and legs. By about 6:00 Pm the chills started but went away after I went to bed. Slept through the night when I woke up my temp was 100.2 my usual temperature is 97.4 ish. The aches started non stop I slept all day 3:37 and I took Tylenol half hour ago still high temp. I take GALYNIA for my MS .


VAERS ID: 1683344 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-22
Onset:2021-09-08
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retinal disorders (broad)

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

Write-up: Busted blood vessel in lower left eye. There is a bright red spot under pupil.


VAERS ID: 1683356 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 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: Patient received Moderna Vaccine on 04/13/2021 and received Janssen Vaccine today 09/08/2021.


VAERS ID: 1683366 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: COVID 19-Pfizer was mixed with only 0.8ml of saline instead of 1.8ml. Pt was given 0.3ml of mixed vaccine


VAERS ID: 1683368 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 OT / IM

Administered by: Private       Purchased by: ?
Symptoms: Oropharyngeal discomfort, Peripheral swelling, Pyrexia, Swelling face, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Patient notified at the time of urgent care visit that she had reaction to 1st dose of Pfizer-flushing, numbness to right arm however did not report at the time prior to the second dose
Preexisting Conditions: Multiple drug allergies, knee pain, allergy to influenza vaccine, knee pain, heavy periods
Allergies: Amoxicillin, Azithromycin, Diphenhydramine, Doxycycline, Eggs, Latex, Penicillins, Sulfa antibiotics
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient had 2nd dose of COVID PFIZER vaccine at 0900, being monitored for 15 minutes, left the clinic without any adverse reactions. Patient returned the urgent care clinic around 1230 with swollen face, arms, vomited before arrived to the clinic, felt feverish, denied tightened on throat. Inserted peripheral IV on right antecubital, administered Solumedrol 40 mg, IV NS 1000 ml. Patient stated that she felt better after the treatment. Patient recalled that her throat felt heavy before solumedrol dose. Patient started complained of her throat feeling heavy and bothering her, administered EPI 0.5 mg IM. Monitored patient closely, VS taken every 30 mins. Called ambulance to transfer patient to ER for higher level of care


Result pages: prev   136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=235&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166