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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 239 out of 8,753

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VAERS ID: 1765614 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 11-21 / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Headache, Limb discomfort, Night sweats, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: At 12:57 am on 10/6/21 I woke up with pain in my legs. My limbs felt heavy and my chest had pressure. I was shivering profusely at room temperature. At 2:00 am I woke again with sweats and sharp pain in my chest. The chest pains have been on and off since. I had a terrible headache ranging from 12:57 am-2:30 pm.


VAERS ID: 1765620 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Dry skin, Erythema, Extra dose administered, Peripheral coldness, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Headache and mild flu like symptoms with second dose, fatigue, no fever
Other Medications: Vitamin D, Vitamin C, Zink, Viotin, T3 Thyroid medication
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, tremors, dizzyness skin cold/pink/dry Vaccine given at 1600 and symptoms started at 1605 Diphenhydramine was given orally to patient at 1617. Patient states that the symptoms are getting better 1628. Doctor gave patient Tylenol at 1643


VAERS ID: 1765640 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045AZ1A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthritis, Blood test normal, Chest X-ray normal, Dyspnoea, Electrocardiogram normal, Headache, Myalgia, Pyrexia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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: Alfuzosin HCL, Calcium, Dustasteride, Famotidine, Flonase, Magnesium, Multivitamin, Myrbetriq, Pataday, B12, C, D3.
Current Illness: none
Preexisting Conditions: BPH
Allergies: Azithromycin, clarithromycin, phenylbutozine, moxifloxacin
Diagnostic Lab Data: Covid test was negative. chest x-ray, ekg, and blood work were normal. All were received on 3/18/21.
CDC Split Type:

Write-up: Event lasted 5 days. Symptoms were fever, headache, inflamed joints, sore muscles, perceived breathing difficulty. I was examined in the ER on 3/19/21. I received covid test, chest x-ray, ekg, and blood work. The doc told me to go home and rejoice that I was having a robust reaction to the vaccine and did not have covid.


VAERS ID: 1765642 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Uterine haemorrhage
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Uterine shedding the morning following first dose of vaccine (~24 hours later). Was not menstruating or expecting menstruation for another 2 weeks


VAERS ID: 1765675 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Dizziness, Pruritus, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient complaint of dizziness 15 mins after vaccine. He was given fluids. Vitals: B/P 133/93, HR 108, temp 97.3, resp 20 and SpO2 100%. Patient rested in chair for another 15 mins, feeling dizzy. After further questioning, he complained of itching and throat tightness. Patient seemed anxious, but otherwise breathing unlabored. No sign of rash and SpO2 100% on vital recheck. Ambulance called at 1651 and arrived at 1700. Patient taken to nearest hospital for evaluation and monitoring.


VAERS ID: 1765676 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 RA / IM

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

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

Write-up: Syncope


VAERS ID: 1765679 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Pruritus, Sensation of foreign body, Throat clearing, Throat irritation, Urticaria, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Moderna 3/4/21 throat irritation
Other Medications: Losarten, Trazadone, Bupropion
Current Illness:
Preexisting Conditions:
Allergies: Amox, banana, sesame, Moderna covid vac
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt said throat felt irritated "like a ball stuck in there." Sx progressed to thrat and inner ears feeling itchy, throat felt tight, seeing "star flies", few hives noted on neck and continuously clearing throat. )2 2 L initiated and Epipen 0.3 mg adiministered and within 1 min pt states she was feel better. Pt transported for observation.


VAERS ID: 1765692 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF25E7 / 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: Moderna given as the first dose on 09/01/2021. Pfizer given as the second 10/06/2021.


VAERS ID: 1765699 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 001A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Hyperhidrosis, Interchange of vaccine products, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (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: Moderna COVID Vax Age 72 on 3/5/2021. "On Friday I had the first with in an hour felt like my throat was closing up and tongue
Other Medications:
Current Illness:
Preexisting Conditions: Extensive medical history. Includes Atrial tachycardia, Atherosclerosis of aorta, IBS, Anxiety,
Allergies: Flagyl, Kenalog, Prednisone, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a J&J shot around 11 am. She was in the observation area for a 1 hour observation per patient request due to her reaction to the Moderna vaccine in March (patient reported shortness of breath and throat swelling but did not seek emergency care). After about 40 minutes, she complained of dizziness and appeared pale and diaphoretic. She was lowered to the ground and legs were propped up on a chair. She did not lose consciousness. Patient was then assisted to a wheelchair and then over to the gurney. She complained of chest tightness that began when she was lying on the ground. Patient was advised to go to the ER for a workup due to cardiac history and chest tightness. She wanted to wait a while to see how she felt. She rested for another 20 minutes and said her chest tightness subsided a little but was still present and had moved to the left side of her chest. She agreed to go to the ER and was transported via wheelchair. VS: 142/78 HR 75 99% on RA.


VAERS ID: 1765702 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yasmin Aldactone Prozac Albuterol Inhaler Flonase nasal spray
Current Illness: NA
Preexisting Conditions: Achondroplasia depression reactive airway disease without complication
Allergies: Dog and Cat dander
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient received a Covid Pfizer vaccine but was originally given Moderna (2 doses) and should not have received Pfizer dose


VAERS ID: 1765704 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E54A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 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: Moderna given as first shot 09/01/2021. Pfizer given as second shot 10/06/2021.


VAERS ID: 1765716 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: Patient arrived at vaccine site at approximately 1520 reporting that she had received dose 1 of the AstraZeneca COVID vaccine (lot 77673) in Mexico on 7/23/2021. She requested to receive the Pfizer COVID vaccine. PHN called PHN supervisor and the medical team. Dr from the medical team approved Pfizer vaccine series for the patient. Patient received dose 1 of the Pfizer COVID vaccine (lot 30145BA) at 1530. Patient waited in observation area, no report of adverse symptoms. Patient left walking at approximately 1548 with steady gait.


VAERS ID: 1765724 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

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

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

Write-up: none


VAERS ID: 1765734 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3128 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Cold sweat, Condition aggravated, Dizziness, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: associate stated gets dizzy and has spells. fainting history. She stated she has discussed with PMD.
Allergies: unknown
Diagnostic Lab Data: Vital Signs done, cool compress, elevated lower extremities.
CDC Split Type:

Write-up: Associate felt dizzy and weak after vaccination, BP was elevated. clammy skin. HR elevated. Monitored closely for 60 minutes. Associate felt better after about 48 minutes post vaccine. Closely monitored. Did not drive home after vaccine.


VAERS ID: 1765741 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No adverse event(s) experienced or reported by patient. Reporting to VAERS due to patient being 16 years of age and Moderna only currently approved for 18+ years old.


VAERS ID: 1765885 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

Administered by: Public       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? 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: Second dose of Pfizer was given 12 days after initial dose. Vital signs normal. No adverse events after administration and 30 minute observation period.


VAERS ID: 1765901 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-08
Onset:2021-10-06
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 9269 / 1 LA / IM

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

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

Write-up: Outpatient MAB infusion and admission to the hospital with worsening SOB


VAERS ID: 1765904 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Heart rate increased, Injection site rash, Oropharyngeal pain
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), 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: Pfizer 4/2/2021
Other Medications: Letrozole, metformin, atorvastatin, melatonin, vit d
Current Illness: None
Preexisting Conditions: Prior BrCA (2019)
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2.5 hours post jab= rash on under upper arm of jab arm; increase of heart rate (resting) barely sore throat @ 10.5 hours post jab; heart rate almost slowed to normal resting rate


VAERS ID: 1765910 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Pruritus, Vaccine positive rechallenge
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: high blood pressure med, unable to recall name
Current Illness:
Preexisting Conditions: hypertension
Allergies: aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client reported to EMT feeling "itchiness on her hands" after 30 mins in observation. EMT contacted RN and PHN for assistance. Upon arrival at 1350 client sitting upright in anti-gravity chair. Client alert and oriented x4. Client reported having rash a few hours after first Pfizer Covid vaccine and self medicated at home. Client reported with her own medication and cream symptoms resolved that time. Per client, today''s symptoms "feel just like last time." Client denied shortness of breath or feeling throat close. Vitals at 1355: blood pressure 135/70, pulse 63, oxygen sat 97%. Client reported history of hypertension, unable to recall medication, and allergy to aspirin. PHN asked client to remove mask and assess for swelling, no swelling noted on face, neck, or tongue. Client stated only itchiness to both hands right now. PHN observed redness on hands, unable to tell if rash as client had been scratching. No other redness noted. PHN offered client Benadryl at 1356 and explained possible side effects. Client declined, stated she drove herself, and she would take her own medication at home. PHN discussed with client importance of following up with medical provider, when to seek medical help, and ER precautions. Client left against medical advise at 1358 with steady gait.


VAERS ID: 1765911 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 RA / 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: UNKNOWN
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Patient''s first covid vaccine was Pfizer and received Moderna for her 2nd dose


VAERS ID: 1766117 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Anaphylactic reaction, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

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

Write-up: Anaphylaxis, onset immediately after vaccine was given.


VAERS ID: 1766118 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-22
Onset:2021-10-06
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Product administered to patient of inappropriate age
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow)

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

Write-up: 16 year old pt given Moderna vaccine. Pt is pregnant and due 11/08/2021. Pt did not report any adverse reactions for vaccine given.


VAERS ID: 1766125 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Warm tender rash going up and down arm.


VAERS ID: 1766132 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Pain in extremity
SMQs:, 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: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes in armpit on side of body where got the shot. Sore arm


VAERS ID: 1766137 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Hypertension, Hypoaesthesia oral
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: no
Preexisting Conditions: essential hypertension, hyperlipidemia
Allergies: Lisinopril, hydrocodone Bitartrate, Vicodine, Hydrochlorthiazide, amlodipine Besylate, Terfenadine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: tongue numbness, hypertensive


VAERS ID: 1766140 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphonia, Dysphonia, Fatigue, Hyperhidrosis, Productive cough, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

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

Write-up: 1 hour in a half later started sneezing and having a runny nose and flem in my chest and throat and now voice is completely gone if I speak I sound like I''m trying to bark. Constant slight fever up to 100.7. Sweating and feeling tired.


VAERS ID: 1766145 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (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: Moderna COVID first dose
Other Medications: Wellbutrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, vomiting, dizziness, diarrhea, extreme body aches


VAERS ID: 1766169 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

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

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

Write-up: Patient fainted for a few seconds within a few minutes of vaccination. Within 5 seconds he was talking but still had loss of color. Removed sweatshirt. Immediately gave ice packs and stuck ammonia inhalant under his nose to help. His color improved after 5 minutes. Patient stayed in pharmacy area for thirty minutes. He then played in a soccer game a few hours later and was continuing to do fine.


VAERS ID: 1766170 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR U5764AB / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Vaccination site haemorrhage, Vaccination site mass
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)

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

Write-up: Patient received the Pfizer third dose first on right arm without incident. Patient received Fluzone HD in the left arm and immediately started bleeding. A small lump was seen coming from the vaccination site. It was not hard. Pressure was applied and the bleeding ceased. Patient was asked to wait for 15 minutes and was okay. Pharmacist called approximately four hours later and left message with patient.


VAERS ID: 1766313 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Chest X-ray, Computerised tomogram head, Condition aggravated, Foaming at mouth, Generalised tonic-clonic seizure, Laboratory test, Lethargy, Musculoskeletal stiffness, Pain, Seizure, Unresponsive to stimuli, Urinary incontinence, Urine analysis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Pt with history of grand mal seizures since the age of 6 years old. Condition medically managed with prescription Lamictal and has not had a seizure in 2 years. Within an hour of receiving the Johnson & Johnson vaccine, pt suffered a grand mal seizure lasting approx 20mins. Symptoms included convulsions, foaming of the mouth, stiff muscles, urinary incontinence and unresponsiveness/nonverbal. Treated with Versed and Ativan. Typical post-ictal state: lethargy, body aches


VAERS ID: 1766316 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

Administered by: Private       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: Women?s multi vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Delayed urticaria on head and upper body.


VAERS ID: 1766331 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: One hour after injection started developing numbness and tingling on left side of face, arm, and leg. No other symptoms aside from fatigue from first two vaccines.


VAERS ID: 1766335 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BR8737 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Blood test normal, Chest discomfort, Chest pain, Full blood count normal, Lymphatic disorder, Metabolic function test normal, Nerve injury, Tenderness, Ultrasound scan normal
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 5/18/21 Primary care physician visit, complete metabolic panel (normal), complete blood count (normal), physical exam (normal except isolate pain under arm and on side) 5/21/21 Primary care physician visit for follow up to tests and referral to surgeon for ultrasound and exam 5/24/21 General surgeon exam and portable ultrasound exam (normal), referral to imaging for full ultrasound which was determined normal 5/28/21 Primary physician follow up, review of results. Sharp pain persists under left side, all ultrasound and blood work came back normal, suspected nerve damage and/or lymphatic system damage related to vaccine
CDC Split Type:

Write-up: The evening of the shot (4/3/21), about 6 hours after, I felt very sharp pain under my left armpit that can only be described as if somebody stabbed my side with a knife. Also experienced tightness/soreness across the left side of my chest and an isolate sharp pain on my left side if touched. The pain continued for a month and did not go away when I finally sought treatment. Pain continues to current day of this filing (10/6/2021)


VAERS ID: 1766445 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNSURE / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthma, Chills, Condition aggravated, Pain in extremity, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (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: covid vaccine only
Other Medications: Sudafed, Premarin, Zyrtec, vitamin D, zinc, albuterol inhaler, doxycycline,Acidophilus
Current Illness: None
Preexisting Conditions: Asthma, endometriosis, pituitary micro add a noma
Allergies: Augmentin Bactrim Phenergan morphine sensitivity demerol and bees
Diagnostic Lab Data:
CDC Split Type:

Write-up: slight wheezing, asthma flare up a initially.. premedicated as directed with pepcid and albuterol then by late afternoon/ early evening significant chills but no fever and very sore left arm.


VAERS ID: 1766455 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: General physical condition abnormal, Loss of consciousness, Malaise
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: ALBUTEROL MDI, PRAZOSIN, LIDOCAIN SOL, VISTARIL, BACLOFEN,
Current Illness: UNKNOWN
Preexisting Conditions: ANXIETY, INSOMNIA
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 10-15 min after receiving the shot, pt got up to pay for a prescription and during the transaction, kneeled down and rolled onto her back and appears to have lost consciousness for approximately 10 seconds after which she sat up for a few minutes then a chair was brought to her to sit. Pt did not want to stay longer despite my recommendation and said she wants to have her mom drive her to the hospital because she is not feeling well. An associate walked with her out to her car. Will followup with pt tomorrow.


VAERS ID: 1766461 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-18
Onset:2021-10-06
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 RA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Arrhythmia, Aspiration, Cardiac disorder, Facial paralysis, Feeding tube user, Monoplegia, Neurological symptom, Vomiting
SMQs:, Acute pancreatitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 96 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Oxcarbazepine, sertraline, buspirone, risperdal, atorvastatin, metformin, glimepride, pioglitazone, levothyroxine, vitamin D3, dasetta, multivitamins,
Current Illness: Diabetes, hypothyroidism, depression, bipolar,hyperlipidemia,Psychotic disorder
Preexisting Conditions:
Allergies: Sulfa, depakote
Diagnostic Lab Data: Full hospitalization from June 24, 2021 until present day
CDC Split Type:

Write-up: Patient began to vomit uncontrollably. She then aspirated. She had a droopy face on the left side. She was hospitalized. While there they said she had a new heart problem and arrhythmia. She''s now on a permanent feeding tube. She can no longer use her legs. There is undetermined neurological damage.


VAERS ID: 1767102 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (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: PFizer COVID 19 dose 1 on 12/21/2020; age 29 headache
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10/5/21 at 10pm-sore arm at injection site 10/6/21 at 2:30am-shivering 10/6/21 at ~8am- headache, muscle aches and low grade fever -took Tylenol 650mg at 8am which seemed to help for a few hrs but muscle aches and headache never went away. -too ibuprofen 400mg at 4pm which also helped but muscle aches and headache never went away.


VAERS ID: 1767104 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain
SMQs:, 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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest Pain


VAERS ID: 1767106 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain lower, Back pain, Bradykinesia, Chest discomfort, Chest pain, Condition aggravated, Dizziness, Facial spasm, Fatigue, Feeling cold, Feeling hot, Feeling of body temperature change, Hyperhidrosis, Hypoaesthesia, Hypoaesthesia oral, Migraine, Musculoskeletal stiffness, Myalgia, Nausea, Nipple pain, Oropharyngeal pain, Pain, Pain in extremity, Palpitations, Peripheral coldness, Piloerection, Pyrexia, Rhinorrhoea, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazadone 100 mg at night. Bupropion 300 mg in morning Seroquil 50 mg at night Phentermine 25 mg in morning Albuterol PRN
Current Illness: Asthma Depression Viral infection
Preexisting Conditions: Kikuchis disease Chronic osteo myelitis Chronic Bronchitis Eating disorder
Allergies: Amitryptaline Sertraline Iodine topical
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: *Migraine *Numbing, tingly and achy leg on same side as injection followed by body pain and aches in muscles And limbs overcoming the whole body after several hours. *feelings of being very cold while sweating * feeling of being really hot with goose bumps cold fingers *cold feeling and pain in nipples Lower left abdomin/ and lower left back area shooting pains *extreme increase of pain in previous injury (lumbar spine) Dizzy, nausea, lightheadedness, very tired, moving slowly, stiff, achy, runny nose Pain in feet toes and fingers, fever, hot/cold flashes, sleepy, occasional spasm of face muscles around mouth causing numbness of lips and causing lips to not shut for short periods, palpitations, chest pain that comes and goes, sore throat, chest tightness


VAERS ID: 1767111 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid 19 Pfizer-sore arm
Other Medications: Hydrocodone/APAP 5/325mg, Clopidogrel 75mg, Hydrochlorothiazide 12.5mg, Omeprazole 40mg, Pravastatin 10mg, Amlodipine 5mg, Carvedilolol 6.25mg,
Current Illness: Unknown
Preexisting Conditions: Bone Fracture, Chronic Ischemic heart disease
Allergies: Benciar, Erythromycin, Labetalol, Latex, Levaquin, Lexapro, Macrobid, Omega 3,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given Covid 19 shot instead of the flu shot. Patient had already received 3 doses of the Covid 19 with the last dose given on 10/01/2021


VAERS ID: 1767113 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-29
Onset:2021-10-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness transient, Blood test, Cerebrovascular accident, Cranial nerve palsies multiple, Diplopia, Drug screen negative, Echocardiogram, Electrocardiogram, Magnetic resonance imaging, Scan with contrast
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Low dose birth control
Current Illness: None
Preexisting Conditions: Mild asthma
Allergies: None
Diagnostic Lab Data: MRI with and without contrast10/2/21 MRA 10/2/21 Echocardiogram 10/2/21 EKG 10/2/21 Copious blood work 10/2/21 and 10/3/21 Urine drug screen 10/2/21 negative Hospital stay 10/2/21-10/3/21
CDC Split Type:

Write-up: 10 hours after my vaccine I developed double vision. I was told it was a cranial nerve palsy the next day when i went to an optho doctor. The next day I temporarily lost vision in the left eye. I then went to the ER the following day and was diagnosed with a midbrain stroke. I am a healthy 36 YO physician. I have been on low dose birth control for $g15 years. I forgot to mention I am also on a low dose of phentermine which I have been taking for a month without any issues. I have also been on it before. I have no history of strokes nor do I have any history of DVT etc.


VAERS ID: 1767116 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Injection site swelling, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin XL, Viibryd, Belsomra, Silenor, Propranolol, Melatonin, Vitamin D & K, Vitamin C, Zinc, Fish Oil, Multivitamin/Mineral, Magnesium, Lithothyronine, Biest cream, testosterone cream, Progesterone
Current Illness: n/a
Preexisting Conditions: Major depressive disorder, Generalized anxiety disorder
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lumpy, painful/itchy, rash near the injection site


VAERS ID: 1767123 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (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: Sharp lower back pain


VAERS ID: 1767139 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-01
Onset:2021-10-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Vertigo
SMQs:, Anticholinergic syndrome (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: Dairy enzyme supplement
Current Illness: None
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Dizzy even when lying down. Intermittent vertigo sensations.


VAERS ID: 1767630 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax, Dyspnoea, Fibrin D dimer increased, Full blood count, Hypoaesthesia, Metabolic function test, N-terminal prohormone brain natriuretic peptide, Troponin
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: losarten, Metoprolol, Viagra, glucotrol, jardiance, prilosec, lasix, asa, lipitor, glucophage,
Current Illness: No acute illness.
Preexisting Conditions: DM, Hyperlipidemia, Obesity, CAD, OSA, Chronic hepatitis C, chronic systolic heart disease, stage 3 CKD, ocular hypertension
Allergies: terfenadine
Diagnostic Lab Data: elevated Ddimer. Other tests stable cbc, cmp, troponin and pro bnp. CTA of the chest done - results pending
CDC Split Type:

Write-up: SOB, bilateral hands and feet numbness.


VAERS ID: 1767782 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 EWO198 / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, metoprolol, bupropion, ibuprofen, acetaminophen
Current Illness: None
Preexisting Conditions: Hypertension, asthma
Allergies: Penicillin, mint
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Lymph node swelling left armpit.


VAERS ID: 1767783 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Lymphadenopathy, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer, dose 1 extreme fatigue, dose 2, nausea
Other Medications: Zoloft, Trazadone, vitamin d, and multi-vitamin
Current Illness:
Preexisting Conditions: Anxiety and depression
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes and nausea


VAERS ID: 1767784 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Hot flush, Injection site pain, Migraine, Sleep disorder
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: Patient was 18, experiencing headaches and nausea.
Other Medications: Hydroxyzine, birth control shot
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within the first day I experienced an extreme migraine, and had experienced hot flashes and bad injection site pain. By the second day the symptoms were less mild, however were still there and even in the early morning were keeping me up. The symptoms would be extreme and then mild out during the day and then become extreme again.


VAERS ID: 1767943 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 30155BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Injection site pain, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (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: Prenatal vitamins CQ10 Vitamin D & E Glucosamine Biotin B12 Fish Oil Acne - Topical Clyndamycin Gel 1% Acne - Topical Dapson Gel
Current Illness: None
Preexisting Conditions: Moderate Obesity - BMI 33
Allergies: G6pd - Quinine group of drugs Fava/Soy/White Beans Pitted Fruits (Cherries, Peachers) Kiwis
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Soreness at the injection site Swollen Lymph nodes under arm Throbing headache


VAERS ID: 1767959 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol, ipratropium, amlodipine, ampicillin, aspirin, atorvastatin, ceftriaxone, citalopram, docusate, enoxaparin, famotidine, iron, Breo, melatonin, multivitamin, metoprolol, silver sulfadiazine cream, lidocaine patch, wa
Current Illness: endocarditis, pyelonephritis
Preexisting Conditions: hypertension, COPD, CHF
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was removed from refrigerator and initially punctured at 12:00pm on 10/5/21. Dose was administered to the patient at 8:30am on 10/6/21, which was 20.5 hours after initial puncture at room temperature.


VAERS ID: 1767974 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-10-06
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dyspnoea, Headache, Myalgia, Nausea, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: Rapid test collected and resulted positive on 10-6-2021
CDC Split Type:

Write-up: Fever, muscle aches, cough, shortness of breath, nausea, vomiting, headache, loss of taste and smell, congestion


VAERS ID: 1767975 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 FF2589 / 3 RA / IM

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

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

Write-up: Patient was accidentally given 2 covid vaccines by nurse inted of one covid vaccine and 1 flu shot


VAERS ID: 1767976 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Genvoya Levetiracetam Sulfamethoxazole/Trimeth
Current Illness:
Preexisting Conditions: HIV Epilepsy Osteoarthrosis
Allergies: No Known Allergies
Diagnostic Lab Data: None indicated
CDC Split Type:

Write-up: Patient previously received the Pfizer Vaccine (does #1) at previous institution. That vaccine is not offered at this facility. Patient meets the criteria to receive the 3rd dose of the vaccine. It was not realized until after administration that he had previously received the Pfizer brand. He has no adverse reactions at the current time.


VAERS ID: 1767986 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-14
Onset:2021-10-06
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Janssen on 9/14. Positive on 9/28


VAERS ID: 1767997 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

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

Write-up: I had a mild fever and minor headache and had mild chills when I went to bed. I feel fine this morning with no issues.


VAERS ID: 1768042 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-30
Onset:2021-10-06
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

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

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

Write-up: COVID positive result upon hospital admission


VAERS ID: 1768047 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 FF2587 / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DIABETES, HYPOTHYRODISM, PUMONARY FIBROSIS, SCHIZOPHRENIA, DEMENTIA, IRON DEFICIENCY ANEMIA, OSTEOARTHRITIS, GERD, CERB INFRC D/T EMBOLISM OF RIGHT CERBERAL ATRERY
Allergies: VITAMIN A&D G RX, CARBAPENEMS, BETALACTAMS, COMPAZINE, PHENOTHIAZINES, PENICILLINS, CEPHALOSPORINS
Diagnostic Lab Data:
CDC Split Type:

Write-up: RESIDENT WAS INADVERTENTLY ADMINISTERED HER BOOSTER DOSE OF PFIZER, BUT HAD PREVIOUSLY RECEIVED HER 3RD DOSE (IMMUNOCOMPROMISED). DATES OF PFIZER ADMINISTRATION: 1/12/21, 2/2/21, 8/26/21, 10/6/21.


VAERS ID: 1768059 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Condition aggravated, Fatigue, Headache, Menstruation irregular, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Fertility disorders (broad), Arthritis (broad), Tendinopathies and ligament 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: COVID vaccine 2nd dose 1/26/21
Other Medications: Kariva, multivitamin
Current Illness: none
Preexisting Conditions: migraine
Allergies: Shrimp (FPIES)
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Similar to 2nd dose, joint/muscle aches (especially hips/lower back, but also general muscle aches), headache, extreme fatigue, chills New: initiation of period, though I''m on week 1 of my cycle, and take birth control to control menses (skip active weeks)


VAERS ID: 1768068 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 / SYR

Administered by: Unknown       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: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1768069 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 FF2587 / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, MORBID OBESE, DIABETS, HTN, MULTIPLE SCLEROSIS, HX TIA AND CEREB INFARC
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: RESIDENT INADVERTENTLY ADMINISTERED BOOSTER DOSE AFTER RECEIVING THE 3RD DOSE (IMMUNOCOMPROMISED) ON 8/26/21. DATES OF PFIZER VACCINE ADMINISTERED: 1/12/21, 2/2/21, 8/26/21, 10/6/21.


VAERS ID: 1768070 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-10-06
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series
CDC Split Type:

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1768071 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 301458A / UNK LA / SYR

Administered by: Unknown       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: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1768073 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 EWO179 / UNK - / -

Administered by: Unknown       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: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1768074 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR 5X755 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Malaise, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament 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: Covid 19 first injection , fever, chills, fatigue, generalized malaise, joint pain, fatigue, Pfizer on 2/22/21, age 69
Other Medications: Lisinopril, omeparzole, apixiban, atorvastatin, Tylenol, levothyroxine
Current Illness: None
Preexisting Conditions: AFib,
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Right arm pain, nausea, generalized malaise, aching all over, joint pain, fatigue. All have resolved except slight arm pain.


VAERS ID: 1768076 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 RA / SYR

Administered by: Unknown       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: Administration error: Mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1768077 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid mediciation, blood pressure medicine, birth control, fish oil, calcium
Current Illness:
Preexisting Conditions: hypothyrodism, high blood pressuer
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node in my right armpit area that is still present, headache and chills


VAERS ID: 1768080 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 EW0179 / UNK - / -

Administered by: Unknown       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: Administration error: Mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1768083 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 301458A / UNK LA / SYR

Administered by: Unknown       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: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1768085 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 RA / SYR

Administered by: Unknown       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: Administration error: Mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1768086 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 EWO179 / UNK - / -

Administered by: Unknown       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: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1768097 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Back pain, Breast pain, Breast swelling, Fatigue, Oedema peripheral, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (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: Zoloft
Current Illness: none
Preexisting Conditions: none
Allergies: Sulfa Medications Morphine Bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10/6/21, noted pain and swelling in the axilla, generalized fatigue. On 10/7/21 I reported to my Occupational Health due to increased pain and swelling in the axilla, right breast and back.


VAERS ID: 1768098 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-10-06
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Breakthrough COVID-19 case.


VAERS ID: 1768099 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-12
Onset:2021-10-06
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR test collected 10-6-2021, resulted positive on 10-7-2021
CDC Split Type:

Write-up: unknown


VAERS ID: 1768102 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified the 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768103 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Condition aggravated, Extra dose administered, Fatigue, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Phizer 01/08/2021 (symptoms of chills, body ache, fever) lasting 24hrs
Other Medications: Benafalacien, Cixcinda, Levathoroxien
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Arithamicine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd dose of Booster Phizer 10/05/2021, started experiencing symptoms 10/06/2021 of chills, body aches, fatigue, headaches, and muscle aches. Self-treating with Tylenol and improving. No noted Primary visit.


VAERS ID: 1768104 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-10-06
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Fall, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 325 Mg Oral Tab Atorvastatin (Lipitor) 10 Mg Oral Tab Calcium Carb/Vit D3/Minerals (Calcium-vitamin D Oral) Carbidopa 25 Mg/Levodopa 100 Mg (Sinemet) 25-100 Mg Oral Tab Cyclosporine Modified (Neoral) 25 M
Current Illness:
Preexisting Conditions: Anemia Atrial fibrillation Cardiomyopathy, s/p LVAD and heart transplant CKD stage 3 Hypertension Hyperparathyroidism Lumbar spinal stenosis Osteopenia Parkinson''s diease Seizure Sleep apnea Tinnitus Tremor
Allergies: Morphine
Diagnostic Lab Data: POSITIVE COVID TEST 10/6/21
CDC Split Type:

Write-up: FREQUENT FALLS AND ACUTE CONFUSION.


VAERS ID: 1768105 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 FF8839 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5AJ3B / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL HFA) 90 mcg/actuation inhaler benzoyl peroxide 10 % cream busPIRone (BUSPAR) 10 MG tablet clotrimazole (LOTRIMIN) 1 % cream fluconazole (DIFLUCAN) 150 MG tablet fluticasone propionate (FLONASE) 50 mcg/actuation nasal sp
Current Illness: N/A
Preexisting Conditions: Benign essential hypertension Type 2 diabetes mellitus without complication, without long-term current use of insulin (HCC) Asthma Abnormal uterine bleeding Anxiety Conductive hearing loss, bilateral Obesity (BMI 35.0-39.9 without comorbidity) Sensorineural hearing loss (SNHL) of both ears
Allergies: Aspirin Miconazole Nitrate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was in clinic for a flu shot, nurse got flu shot out and laid shot on computer. after verifying name and DOB picked up a covid shot off of table where covid shots held and gave covid vaccine. nurse explained to pt that wrong shot was given. Flu shot given in opposite arm. Nurse asked pt if it has been six months since last covid shot , and she said yes. nurse asked for shot record. Pt stated she got her covid shots at a pharmacy and did not have card. nurse asked pt if she had Pfizer or moderna. she stated moderna. nurse filled out the vaccine card with lot number and told pt to keep both cards and let pharmacy know she has had a Pfizer booster. Pt verbalized that she understands.


VAERS ID: 1768116 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768119 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-10-06
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, 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? 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: Breakthrough COVID case.


VAERS ID: 1768126 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses administered 0.3mL doses instead of 0.5mL. Patient notified 10/06/2021 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768133 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768141 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered wrong dose Patient was notified 10/06/21 and offered to received the additional mL to receive the full dose.


VAERS ID: 1768148 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768159 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768161 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 - / 3 LA / SYR

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

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

Write-up: Experienced fatigue at 09:30PM on 06OCT2021, then hot flashes, chills and 100.6F fever at 1:35AM on 07OCT2021. Headache and fatigue experienced at 8:00AM 07OCT2021. Symptoms relieved by 9:30AM on 07OCT2021.


VAERS ID: 1768164 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768170 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 30135BA / 3 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Hypotension, Pupillary reflex impaired, Skin discolouration, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: placed on comfort measures relted to sigmoid colon cancer
Preexisting Conditions: COPD,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 10/6/2021 at approximately 2:00 PM- Pt became sick to his stomach- vomited; unresponsive; pupils sluggish; legs discolored-more on let side that right; blood pressure barely audible. .5 mg of epinephrine administered by RN; resident started to arouse. Blood pressure low 60/40; attempting to speak; some discoloration remained present on the left side but much better; IM zofran and IV fluids started. Today, 10/7/21- eating some, able to respond to questions.


VAERS ID: 1768174 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered wrong dosage. Patient was notified 10/06/21 and offered to received the additional mL to receive the full dose.


VAERS ID: 1768180 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-10-06
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic 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: Patient Covid + on 10/06/2021 and hospitalized Per Ed Note: 89-year-old male past medical history significant for HTN, A. fib, BPH is presenting to the emergency department from ECF via EMS for Covid positive x2. Patient was found to be Covid positive at the ECF and they are not able to care for him at the care facility if he is Covid positive. Patient has no symptoms including shortness of breath, chest pain, productive cough, rhinorrhea or other URI symptoms. Patient denies any abdominal pain, vomiting, focal paresthesias or weakness, headache, dizziness, fevers or chills, change in bowel or bladder habits, leg pain or edema or history of blood clots, or changes in medications. He denies any other modifying precipitating or relieving factors. PMH: HTN, A. fib, BPH


VAERS ID: 1768191 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768193 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2021-10-06
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Constipation, Cough, Dehydration, Diarrhoea, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram normal, Extrasystoles, Fatigue, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (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 + on 10/06/2021 and vaccinated. Patient hospitalized Per Ed Note: 98-year-old male with past medical history of hypertension, hyperlipidemia, hypothyroidism, and anemia presented to the emergency department with complaint of weakness. He describes the weakness as a lack of energy and generalized fatigue. He states he saw his cardiologist 2 weeks ago because he had an abnormal EKG, stating he was told he had a "missed beat." He states he had a follow-up appointment on Thursday, 9/30/2021 with his cardiologist. He was told that his EKG is normal and that there is nothing to worry about. During that appointment he noticed that he was having some constipation. He was told to take magnesium citrate, and he did take that. He states over the next 2 days he had multiple episodes of loose stool, and feels as if he may be dehydrated. He now complains of some myalgias as well as some lightheadedness. He states he does have a cough, this is nonproductive. He also states some shortness of breath. He denies any associated headache, vision changes, neck pain, back pain, chest pain, palpitations, syncope, abdominal pain, nausea, vomiting, dysuria, hematuria, extremity numbness or tingling, or focal weakness. Patient''s daughter was at the bedside and also stated that she believes he could be dehydrated because he has had similar issues when using laxatives; when he is been hydrated in the past he is presented similarly and has required IV hydration eventually goes home.


VAERS ID: 1768195 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768198 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768201 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 FF8839 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse event, Condition aggravated, Cystitis, Fatigue, Headache, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IUD, Zinc/Vitamin C
Current Illness: Sick (heavy cold?) prior to first dosage
Preexisting Conditions: Interstitial Cystitis
Allergies: Sulfa, Shell Fish
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: common reactions such as head ache, sore arm, tired, etc. Additional adverse event/reason for reporting is flare up of cystitis that has otherwise been under control.


VAERS ID: 1768203 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768204 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-26
Onset:2021-10-06
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, COVID-19, Chills, Productive cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient vaccinated and Covid + on 10/06/2021. Patient hospitalized Per ED Note: The patient is a 59-year-old male past medical history significant for insulin-dependent diabetes, HTN, HLD, COPD who is presenting to the emergency department with chief complaint of elevated blood pressure. Patient is non-English speaking and interpreter was offered through the Martti system however patient''s brother is at bedside and patient would prefer his brother to translate. Went to his primary care physician because he was having subjective fevers and chills patient states that he was sent in by his primary care physician after being seen in clinic for elevated blood pressure. Patient states that he and a productive cough for approximately 24 hours prior to arrival in the emergency department. Patient states that he got a dose of his metoprolol at the clinic which she had not taken earlier in the day. Patient states that he is overall feeling feverish and "weak." Patient did receive his Covid vaccinations approximately 3 months prior to arrival in the emergency department. Patient denies any sick contacts. Patient denies any other acute complaints at this time. Patient denies any chest pain, abdominal pain, vomiting, focal paresthesias, headache, blurred vision, decrease in urine output, dizziness, change in bowel or bladder habits, leg pain or edema or history of blood clots, or changes in medications. He denies any other modifying precipitating or relieving factors.


VAERS ID: 1768206 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

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

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768208 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   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 30135BA / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Burning sensation, Dyspnoea, Erythema, Paraesthesia oral, Skin warm, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Nothing was done
CDC Split Type:

Write-up: I developed facial swelling and hives all over my body. My body felt like it was on fire. My skin was red and hot. I begin to have SOB and my tongue was tingling


VAERS ID: 1768209 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768217 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose. Alert about age was bypassed, patient was 15 years old.


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