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

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



Case Details (Reverse Sorted by Onset Date)

This is page 24 out of 5,069

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VAERS ID: 1467214 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, estrogen, Glimepiride, Onglyza, Omeprazole, Naproxen, Alvesco, Albuterol, Meloxicam, Solifenacin, Lidocaine, Acetaminophen
Current Illness: None
Preexisting Conditions: DM 2 DM 2 W HYPERLIPIDEMIA HYPERLIPIDEMIA GERD (GASTROESOPHAGEAL REFLUX DISEASE) HTN (HYPERTENSION) MIGRAINE ATHEROSCLEROSIS OF AORTA RIGHT SHOULDER JOINT PAIN VARICOSE VEINS HX OF BACK SURGERY BILAT HEARING LOSS HX OF APPENDECTOMY HX OF TOTAL HYSTERECTOMY ALLERGIC RHINITIS BILAT TINNITUS STRESS SCIATICA, LEFT SIDE CHRONIC NECK PAIN $g 3 MONTHS LEFT HIP JOINT PAIN LEFT CENTRAL PERFORATION OF EARDRUM CERVICAL SPONDYLOSIS OSTEOARTHRITIS OF LEFT HIP MEDICATION THERAPY MANAGEMENT PROGRAM 2018 TREADMILL STRESS TEST NEGATIVE FOR ANGINA PECTORIS CHRONIC LOW BACK PAIN LUMBAR SPONDYLOSIS HEARING PROBLEM RIGHT KNEE JOINT PAIN OSTEOARTHRITIS OF BILAT KNEES MIXED URINARY INCONTINENCE CHRONIC GASTRITIS URINARY INCONTINENCE OSTEOARTHRITIS OF RIGHT SHOULDER CORONAVIRUS COVID-19 DISEASE CORONAVIRUS COVID-19 PNEUMONIA
Allergies: Atorvastatin, Bactrim, Glipizide, Metformin, Pravastatin, Simvastatin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: @1135 Pt''s granddaughter called out because pt felt dizziness upon getting up. Pt is 30 mins post vaccination, Pfizer 1st dose. C/O dizziness and tingling sensation to L hand. @1135 VS sitting 128/69 (103) 74 with dizziness @1136 VS standing 151/82 (109) 82 with increased dizziness, wobbly upon getting up. Needs to be supported by nurse and granddaughter. Water provided. Encouraged patient to finish bottle of water. Daughter arrived, was able to translate better. Per pt, she has pressure to R eye and was feeling dizzy post vaccination. Pt didn''t tell granddaughter and nurse these symptoms. Tried standing patient up, complained of dizziness and nausea. Was gagging. Nonpharmacologic interventions provided, effective. Pt stated that her nausea is better. @ 1153 VS sitting 68 98%RA 122/74 (94) @ 1154 VS standing 120/84 (96) 76HR 100% Denies any dizziness. C/O very mild nausea. Pt refused to stay longer, wants to go to get some food. Daughter agreed to patient''s plan and is confident to take pt home. Instructed to have pt follow up to her PMD and to go to the ER if symptoms worse or new symptoms arise. Encourage increased fluid intake as tolerated. Pt, daughter verbalized understanding.


VAERS ID: 1467218 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None given
Current Illness: None given
Preexisting Conditions: None given
Allergies: None given
Diagnostic Lab Data: Blood pressure taken 115/78 on 7/13/2021
CDC Split Type:

Write-up: Patient became dizzy, weak and woozy/nauseous. He reported that he may have passed out for a quick moment.


VAERS ID: 1467251 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: On July 7th it was discovered that when the Pfizer vaccination was taken out of the fridge and mixed it was dated with the incorrect date. It was dated as the 7th however was actually supposed to be the 6th. It was also discovered that the staff had not thrown the Pfizer vaccination away when they left on the 6th. This resulted in a patient receiving the Pfizer vaccination that had set out all night. Pfizer vaccination had actually been taken out of fridge at 8:54am and then mixed at 9:01am then drawn into syringes and was dated the 7th however was actually the 6th. One vaccination was given that day then the next day the 7th a staff member looked at the dates and times and then gave the injection to a patient. When I discovered the error I contacted Pfizer to see what next steps need to be done.


VAERS ID: 1467259 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pfizer vaccine dose 1, 6/22/2021
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: BP and HR 12:20pm 99/60 - 63 12:25pm 100/63 -59 12:30pm 101/62 - 71
CDC Split Type:

Write-up: pt reported dizziness and nausea after 15 mins at 12:20pm getting his 2nd dose of pfizer covid vaccine. Pt had similar episode of nausea/dizziness when getting his 1st shot 3 weeks ago. Pt was instructed to lay down and drink some Gatorade. Pharmacist on duty started measuring his BP every 5 mins with reading as below 99/60, HR:63 (12;20pm), 100/63, HR 59 (12:25pm), 101/62 Hr 71(12:30am). Pt ''s nausea and dizziness was gone after 10 mins laying down at 12:20pm. Pt recovered completely without other complication and left the pharmacy at 12:40pm


VAERS ID: 1467270 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cooling therapy, Feeling hot, Pallor
SMQs:, Hypotonic-hyporesponsive episode (broad)

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

Write-up: WITHIN A FEW SECONDS AFTER RECIEVING THEIR VACCINE, THE CLINE T TURNED WHITE AND SAID SHE FELT HOT. AFTER SITTING IN THE CHAIR FOR A COUPLE MINUTES, THE CLIENT WAS HELPED TO THE FLOOR AND FEET ELEVATED. WITHIN A MINUTE THE CLIENT FELT BETTER AND WAS ABLE TO SIT. SHORTLY AFTER, THE CLIENT THEN WAS ABLE TO WALK. WET COMPRESS AND A FAN HELPED CLIENT COOL. NO OTHER ISSUES OR CONCERNS.


VAERS ID: 1467280 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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 had a seizure about 5 to 10minutes after vaccine was administered. Full body seizure and patient slide down to the floor from the chair he was sitting. Seizure lasted about 30 seconds. We had the patient lie on the ground until ambulance arrived. Patient was able to answer questions and said he felt calm after seizure was over. Patient was able to walk and fully alert when ambulance arrived. Patient was taken to hospital by ambulance.


VAERS ID: 1467283 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Hyperhidrosis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: dizziness, sweating, headache, numbness in arms. given 25mg diphenhydramine liquid and water. he did not pass out but felt as if he might. he rested in the waiting area until he felt he could leave safely on his own (about 30 minutes).


VAERS ID: 1467291 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: PATIENT APPEARED VERY PALE, FELT NAUSEOUS, DIZZY, AND SWEATING. NO BREATHING PROBLEM, NO SWELLING OF LIPS OR THROAT. ACCOMPANYING FRIEND SAID PATIENT DID NOT HAVE ANY BREAKFAST BEFORE VACCINATION. PHARMACY STAFF HELP ALLEVIATE PATIENT''S LEGS AND ENSURED ADEQUATE VENTILATION.


VAERS ID: 1467301 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

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

Write-up: patient felt light headed and paramedics came and said she was fine and she refused going to hospital


VAERS ID: 1467312 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-01-25
Onset:2021-07-13
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, COVID-19, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glyb uride/metformin, Atorvastatin, Gabapentin, Pioglitazone, omeprazole, Vit D3, Famotidine, lisinopril, Aspirin 81 mg. Calcium
Current Illness: None
Preexisting Conditions: Peripheeral sensory nnewuopathy, DM type 2, GERD''s, Coronary Arteriosclerosis, hx of MI, Osteoporosis
Allergies: Bee venom, Tylenol, tomato, banana, oranges, Benoxinate/fluorescein
Diagnostic Lab Data: Jul 13, 2021@13:29:08 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Loss of taste


VAERS ID: 1467314 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: influenza
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: cipro,dilaudid,morphine,oxycodone,oxycontin,penicillin,percocet,rocephin,sulfa,tylenol-codeine. prior history of reaction to flu vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented red itchy rash from face down to legs, pt took 50 mg of benadryl prior to coming to clinic. pt was given in clinic 125 mg solu-medrol and 20 mg of pepcid, symptoms resolved pt sent home


VAERS ID: 1467328 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 RA / IM

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

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

Write-up: PT ARRIVED AT STORE 7/13/2021 AND MODERNA VACCINE WAS ADMINISTERED. PT CLAIMED TO HAVE NEVER RECEIVED COVID VACCINE. VACCINE REGISTRY WAS REVIEWED LATER AND FOUND THAT PT HAD RECEIVED: 3/26/2021 - MODERNA (DOSE 1) 4/29/2021 - MODERNA (DOSE 2) 5/28/2021 - JANSSEN (DOSE 1) *7/13/2021 - MODERNA (DOSE 3)*


VAERS ID: 1467513 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-09
Onset:2021-07-13
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Breast feeding, Contusion, Exposure via breast milk, Immune thrombocytopenia, Immunoglobulin therapy, Injection site haemorrhage, Platelet count decreased, Red blood cell count normal, White blood cell count normal
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Neonatal exposures via breast milk (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: They think he was experiencing ITP or Immune Thrombocytopenic Purpura. His platelet count was 5 and should be between 159-350 His body thinks he has a virus and is attacking his platelets. They treated him with immunoglobulins. Update on Alek. A normal platelet count should be between 159-350. Alek?s was 5.
CDC Split Type:

Write-up: The adverse reaction was with my son who is breast fed not with my wife. On June 28th we took our son to the doctors for a normal 6 month visit and showed them some of the bruises he had on his arms caused by our daughter grabbing his arms. They asked normal questions about any bleeding he may have had from circumcision or past shots and we told them none. They said the bruising is okay but to be careful with how our daughter plays with him. He got his 6 month shots and we went home. My wife noticed that he was bleeding through the bandaids and his shorts so we went back to the doctors office. They were now concerned and sent us to Hospital. Hospital did extensive blood work and ruled out things like Leukemia and things like lupus for now since his red and white blood cell count was normal. However his Platelet Count is extremely low. They think he was experiencing ITP or Immune Thrombocytopenic Purpura. His platelet count was 5 and should be between 159-350 His body thinks he has a virus and is attacking his platelets. They treated him with immunoglobulins. Update on Alek. A normal platelet count should be between 159-350 was 5. The infusion of immunoglobulins he got last night worked. He got his results back and they were good news. He increase to 132 and then 218. The hope is that he will maintain or increase the platelet count from here on out. He?s had a few blood tests last week and his count is very high and hopefully will level out. My concern is this: My wife had her 2nd Pfizer shot on June 9th. We started noticing the bruising on or around the 12th or 13th. I?ve asked at least a dozen doctors and nurses if the virus that my son?s immune system was fighting could have been caused by my wife?s 2nd Pfizer vaccine since she breast feeds. No one can give me an answer nor will they do any testing. Not to mention my son is a COVID baby. My wife and I both had COVID while she was pregnant with him. If anything you would think someone would care enough to at least test him for COVID or the antibodies. But no. Everyone just blows me off. Maybe what happened to him and his case could save another little babies life. If it wasn?t for the bruising on his arms caused by my daughter who knows what could have happened. Some doctors say he could have had a brain bleed and died.


VAERS ID: 1467518 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

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

Write-up: I''m reporting a possible error regarding the administration of a Pfizer vaccine. When administering a vaccine to a patient I''m not sure if 0.3 mL or 0.5 mL was drawn up. I realized as I was administering the subsequent shot that I was unsure of the dose, and that I used a syringe normally designated for Moderna/JJ doses for a Pfizer dose. The vial itself was not short any doses, but I am reporting out of an abundance of caution.


VAERS ID: 1467523 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Private       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: yes 1st pfizer vaccine she passed out. please see above
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient fainted in her chair about 10 mins after vaccine was administered. Patient did not hit her head. Patient was given water, asked to lie down, and monitored for an additional 15 minutes until she felt better


VAERS ID: 1467528 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular 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:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was anxious about getting a shot before but she was ok during administration, and after waiting 15 minutes. Store staff reported that she was lying on the ground at parking lot. Main symptoms were muscle weakness and dizziness so she couldn''t stand up. EMT came in but pt refused to take ambulance. Per patient, she will go to hospital with her husband.


VAERS ID: 1467532 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: The patient received the pfizer vaccine to the patient for the first dose. About 5 minutes after the vaccine the patient experienced adverse effects and could not breathe. Due to this we administered a epipen to the patient and the patient was able to breath afterwards. We also called the EMT who examined the patient. The EMT said the patient was okay and did not have to take the patient to the ER.


VAERS ID: 1467533 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Head discomfort, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 was administed the Pfizer Covid vaccination. She was waiting in the waiting room for 15 minutes. After 7 to 10 minutes she notified staff that her arm was swelling and she did not feel right. Pharmacist went to talk with patient. Her arm was swelling and her head did not feel right. She reported she was dizzy and felt faint. 911 was called immediately. Theyresponded and after examination patient was transported to hospital.


VAERS ID: 1467534 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Eye movement disorder, Feeling hot, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient experienced dizziness with first dose of Pfizer vaccine
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: AMOXICILLIN
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient came into pharmacy to receive 2nd COVID-19 Vaccine dose. I screened patient and there was no contraindications. Patient mentioned she was dizzy after the first dose and it resolved quickly and gets dizzy with most vaccines and lab-work. Patient stated she ate food and drank a lot of water prior to coming as she had not eaten last time. I recommended patient just stay still in chair for few minutes after administration to avoid dizziness. I administered vaccine at 9:36 am and patient was fine, and verbally speaking for couple minutes and then stated she wanted water and was feeling dizzy and hot. I called the patients husband from the waiting area and at that moment the patients eyes went inwards and it seemed like she was passing out. Patient was conscious, and kept talking but looked very pale and clammy. I dialed 911 and EMT responded after few minutes. Patients blood pressure was 93/67 and pulse was 75 bpm according to EMTs. Patient declined to go to hospital and patient and husband sat in the waiting area for a bit and left pharmacy at 10:30 am.


VAERS ID: 1467548 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007021A / 1 LA / IM

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

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

Write-up: I administered a moderna vaccine to a 17 year old. No adverse reaction.


VAERS ID: 1467549 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-09
Onset:2021-07-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site infection, Skin infection
SMQs:

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

Write-up: PATIENT REPORTED ON 7/13/21 THAT SHE HAD TO GO TO AN URGENT CARE AND SHE WAS PRESCRIBED ANTIBIOTICS DUE TO SKIN INFECTION AT INJECTION SITE


VAERS ID: 1467550 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: The patient reported to pharmacy around 6:45pm with pain near his pectoral muscle that had begun around 6:30 pm. The pain was mostly in his armpit and was severe enough that he couldn''t lift his arm without pain increasing. His vaccine occurred around 4:20pm and he then returned to work stocking shelves.


VAERS ID: 1467745 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: propanolo er capsules, methylphenidate er osm tablet
Current Illness: None known.
Preexisting Conditions: Acne, ADHD, anxiety
Allergies: No known allergies.
Diagnostic Lab Data: EMTs took EKG, heart rate, and blood pressure. All were within normal ranges.
CDC Split Type:

Write-up: Patient received vaccine at seemed ok initially. No history of adverse reaction to vaccines previously and felt ok after injection, so went to pick up prescriptions and was asked to stay in store for monitoring for 15 minutes. While checking out at counter after approximately 3 to 5 minutes, patient tensed up and passed out, falling backward and hitting her head on the floor. Patient came to within 15 to 30 seconds, but complained of being hot, slightly nauseated, and was very pale. Patient was brought back into private health room with her mother and monitored by pharmacist and RXOM, and ambulance was called. Patient showed improvement and after EMT vitals came back normal, patient declined ambulance ride but was advised by pharmacy staff to contact PCP in regards to her reaction. Patient chose to leave after a few more minutes saying she felt ok.


VAERS ID: 1467746 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Hypotonia, Loss of consciousness, Muscular weakness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient has passed out with every vaccine and blood draw
Other Medications: Not available
Current Illness: Not available
Preexisting Conditions: Anemia (past condition)
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately after receiving the injection, the patient passed out. She was already in the proper sitting position, and I ( immunizer) saw that she was passing out. I had just placed the syringe in the sharps container and was about to place her bandage on, when her head went slack and I saw her eyes roll. I immediately leaned one arm over her to keep her from falling out of the chair, while using my other hand to steady her neck and head. The patients mother was in the room with us, and was talking to her daughter, trying to revive her. I informed the patients mother that I would be unable to leave her daughter, and gave her the name of my pharmacist on duty and asked her to step out and go to the consult window and have him come back to the immunization room. Pharmacist and the patients mother returned in short order and pharmacist verified what I had already checked that she was showing signs of breathing, chest was rising and falling. He helped support her head and asked the mother to gently rub her face to try to wake the patient back up. He stepped out briefly while I was continuing to support the patient and came back with some wet paper towels to place on the back of the patients neck and forehead. After approx. 10 minutes the patient came to and was able to stand and walk under her own power. She sat in the waiting room for an additional 15 minutes before leaving.


VAERS ID: 1467751 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

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

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

Write-up: patient stated that she was itching in both arms/wrists/hands - she was given 5ml of bendaryl 15 minutes later - pt stated that she felt fine but still had the itching feeling. no sign of difficulty of breathing - I called the patient later tonight to check on her and she was doing fine


VAERS ID: 1467754 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK LA / IM

Administered by: Pharmacy       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: n/a
Current Illness:
Preexisting Conditions:
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came in and asked to get covid vaccine. He said he hasn''t received it and also checked "not received" on consent form. Later on same day, his daughter called and told us Pt received both Pfizer vaccine at different location on Feb 2021. She said his father just don''t remember that he received already. She understands that he received 3rd dose of Pfizer and let us know if there is any other concern.


VAERS ID: 1467756 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Dyspnoea, Loss of consciousness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: within about 30seconds to 1min after administering Pfizer covid vaccine, 12 year old patient passed out....went from talking, laughing to sagging off his chair, I grabbed him and slowly lowered him to the floor....he was having difficulty breathing, focusing , etc.....talked to him, focus him on breathing, gave him water to drink, wet cloth to forehead, face and neck...he came out of it and said he felt ok....he got up and walked to the waiting area with his mom...appeared to be fine, was talking and laughing again, when all of a sudden he was just sitting there, eyes wide open, but not aware. Another customer was there and she noticed him and immediately got him to focus, breathe, popped an ammonia inhalant, applied instant ice pack to his back and neck which brought him out of it.....asked mom and we called 911, EMT''s responded and transported Patient to the hospital to be checked.


VAERS ID: 1467762 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None that we were made aware of.
Current Illness: None reported.
Preexisting Conditions: None reported. He stated after the incident that he has fainted in the past when getting bloodwork done and during a tattoo, but only stated this after the incident.
Allergies: No allergies he is aware of.
Diagnostic Lab Data: EMT''s checked his blood pressure and heart rate and did an EKG. (07/13/21)
CDC Split Type:

Write-up: Patient fainted while sitting in a chair in our waiting area. He slowly fell forward, lightly hit his head of the blood pressure machine, and went to the ground. He was out for only 5-10 seconds and able to speak with me right after waking up. We called 911, he stated he felt light headed until the EMT''s arrived and they did an EKG and blood pressure/heart rate reading and decided to take him to the hospital just to be safe.


VAERS ID: 1467765 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-07
Onset:2021-07-13
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysmenorrhoea, Fatigue, Heavy menstrual bleeding, Menstruation delayed, Ovarian cyst, Pain, Polymenorrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Heavier period, earlier period, ?nstense cramps that won?t go away with pain killers or heating pads. Pfizer Vaccine. 1st dose -
Other Medications: Ibuprofen 600mg X2 gel form for period cramps
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: The yellow tide breaks me out in hives
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Nothing was wrong with me after my first dose, my period came a day late which is normal for me to get it later and it was like any other period I had this year. I then got the second dose of the Pfizer vaccine on 06/28/2021 meaning in 07/12/2021 I would be deemed fully vaccinated. Just a day after, today 07/13/2021 I got my period 3 days earlier when that has NEVER happened to me in my 10 years of having a period, its always like I said a day to a week (max) late. My period came in like a fully opened faucet, making me change my pads every hour, my cramps are so intense I feel dizzy, fatigued, on the verge of passing out from the pain and if I could afford a hospital bill I would?ve been there hours ago getting help. I can?t even stand or move too much without breaking down in pain. These cramps are NO joke. I took 2 ibuprofen 600 mg an hour apart from each other and it?s been 4 hours singed and I have no improvement. I do have ovarian cysts in both ovaries and usually have bad periods with stronger cramps than what other healthy women experience but this is completely different. I?m listening to my body and it?s telling me something is wrong.


VAERS ID: 1467779 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-13
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWU202 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Headache, Migraine, Retinal migraine, Vision blurred, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flixotide (Long term treatment for Asthma. It is authorized in )
Current Illness: NA
Preexisting Conditions: Asthma
Allergies: Aspirin
Diagnostic Lab Data: Self reporting of the symptom
CDC Split Type:

Write-up: I have got a retinal migraine this day. It started by some difficulty to see and focus the vision (15-30 min). Then I got the headache. It was moderate for 1 hr and then relatively low the next hours. I have not had any migraine in the last 3 years. But I got some before in other countries (on or two max per year).


VAERS ID: 1467964 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dizziness, Headache, Nausea, Pain in jaw, Paraesthesia, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Osteonecrosis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B12
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms within 24 hours after injection: headache, nausea, jaw pain, chills, tightness in chest Symptoms between 24-48 hours after injection: tingling in left hand, blurry vision, light-headed


VAERS ID: 1467973 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / 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: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted after the shot, but quickly became responsive.


VAERS ID: 1467980 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT CURRENTLY TAKING ANY MEDICATION
Current Illness: PERSON WITH HER MENTIONED SHE WAS MENSTRATING BUT NO OTHER ILLNESSES OR HEALTH RELATED ISSUES
Preexisting Conditions: NO OTHER HEALTH CONDITIONS
Allergies: NO ALLERGIES
Diagnostic Lab Data: no tests
CDC Split Type:

Write-up: pt started to faint and was nauseous. She never lost full consciousness -- she closed eyes but with cold compress and touching her face she regained consciousness. We did call EMS jus in case but pt regained full consciousness and was able to stand on her own before they arrived and did not want to wait.


VAERS ID: 1467987 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-31
Onset:2021-07-13
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Headache, Musculoskeletal stiffness, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Physician; 07/16/2021
CDC Split Type:

Write-up: Frequent Body Stiffness , neck stiffness , back pain and leg pain, headache


VAERS ID: 1468202 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Father called for help and I ran out to see the patient in his father''s arms I helped ease him on the floor. He was able to speak but not clearly. 911 was activated and they arrived. The patient and the father left with them.


VAERS ID: 1468214 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-09
Onset:2021-07-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Corneal oedema, Dry eye, Ocular hyperaemia, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Corneal disorders (narrow), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamins Mag O7 Probiotics
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Coconut Lactose
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Itching, dryness, eye redness and swelling of cornea in the left eye.


VAERS ID: 1468354 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM

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

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

Write-up: gave ot pt under 18 y/o


VAERS ID: 1468360 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-06
Onset:2021-07-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol 500mg, Naprosyn off and on, multi vitamin gummy, vitamin C gummy.
Current Illness: None
Preexisting Conditions: Bipolar, skin cancer from moles, past recreational drug and persctiption abuse with over ten years off them, Marijuana use daily, former cigarette smoker.
Allergies: Latex and natural rubber products, grass, lilacs, cypress, malt.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red, swelling, itching, warm to touch, raised and textured injection site seven days after injection.


VAERS ID: 1468371 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

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

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

Write-up: While completing paperwork in immunization room, patient''s mother stated she thought her daughter was starting to react to the vaccine. It appeared patient was starting to pass out so pharmacist and mother lowered her down from the chair to the floor to prevent injury. Patient''s pulse was very faint to the touch and patient was difficult to arouse. Pharmacist delegated pharmacy technician to obtain AED. Patient''s mother stated patient was beginning to shake and was becoming very hot and sweaty. 911 was dialed. No health conditions or medications were noted that would cause this reaction. Pharmacist was beginning to take BP when EMS arrived. EMS continued taking vitals. BP 100/65, HR 84, SPO2 96%. Patient started to become alert again as vitals were being taken.


VAERS ID: 1468382 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-05
Onset:2021-07-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Injection site induration, Injection site mass, Injection site pain, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (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: Vitamens
Current Illness: Staph infection for the first time ever in my life on my face. Had to go to emergency room & given strong antibiotic Rx.
Preexisting Conditions: None.
Allergies: Yes ? allergies to basically everything that grows. Trees, grass, pollen, cats, weeds, certain chemicals, cosmetics & make up products, hygiene items, latex, etc etc. No allergies to any medications that I am aware of.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm with tender big hard ball lump at site of injection. Also tingling & burning in my back shoulder blade area to back of upper arm randomly.


VAERS ID: 1468385 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-30
Onset:2021-07-13
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

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

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

Write-up: COVID arm - large, red circle around vaccine area. Itchy and rash like.


VAERS ID: 1469907 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fear of 104. Muscle pain. Severe headache


VAERS ID: 1469913 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1469919 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Additional Details: Pt stated she was nervous getting shot before shot was given due to side effects. while being observed,she said she felt hot and dizzy. gave apple juice and told her to sit and be observed as long as she felt comfortable. left after feeling better. tried calling to follow up but # not valid.


VAERS ID: 1469924 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Pain in extremity
SMQs:, 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:
Other Medications: N/Q
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fatigue, soreness of arm, lost of appetite, 12 hours later 8am


VAERS ID: 1469925 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Chest discomfort, Chest pain, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypertension, Lethargy, Nausea, Paraesthesia, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypertension (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Hypertension-Mild, Systemic: Nausea-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Visual Changes/Disturbances-Mild, Additional Details: Patient felt dizzy and asked to lay down. Had patient lay down on the ground and monitored patient. Asked if she needed EMT/911, patient declined. Patient then asked pharmacy to call 911. Patient was taken to ER and tests were ran. Physician said patient had an adverse reaction, but would not call it an allergic reaction. Patient had no anaphylaxis. Patient showed up back to pharmacy to pick-up card and finish report.


VAERS ID: 1469928 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Nervousness, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Nausea-Severe, Systemic: Vomiting-Severe, Additional Details: projectile vomiting, we gave him water helped him clean himself... he stated after the incident that he was super nervous, he gets like this with vaccine


VAERS ID: 1469931 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Flushing, Hyperhidrosis, Hypotension, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Mild, Systemic: Nausea-Mild, Systemic: Weakness-Mild, Additional Details: After administering the immunization, the patient proceeded to the lobby where she sat down. She began to feel nauseous and rose from her seat. She then passed out. I ran out to the lobby and tried to get her to her seat, where she then fainted again. A this time we had a nurse come over and check her blood pressure that was approximately 90/50. After about 5 minutes her blood pressure normalized to approx. 120/80. After 15-30 minutes, her mother picked her up and took her home. No complications


VAERS ID: 1469933 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypertension, Immediate post-injection reaction, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Hypertension-Medium, Systemic: Shakiness-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Patient compained of shakiness immediately after receiving immunization. Had patient sit for 10 minutes. CHecked blood pressure and was elevated (156/80) and patient reports usual BP around 110/80. Had patient sit for awhile longer and symptoms continued to worsen. After another 15 minutes BP was up to 158/84 with a pulse of 98. Adminstered benadryl 25mg and had patient sit for additional 20 minutes. No change in blood pressure and pateint continued to have shakiness, but no worsening symptoms.


VAERS ID: 1469934 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / IM

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

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

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


VAERS ID: 1469939 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry mouth, Dysphagia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), 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 (broad), Hypersensitivity (broad), Dehydration (broad)

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

Write-up: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Additional Details: very dry mouth


VAERS ID: 1469940 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry mouth, Dysphagia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), 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 (broad), Hypersensitivity (broad), Dehydration (broad)

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

Write-up: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Additional Details: very dry mouth


VAERS ID: 1469942 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Disturbance in attention, Fatigue, Headache, Influenza like illness, Injection site erythema, Injection site inflammation, Injection site pain
SMQs:, Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control Quartette, OTC pain relievers, ibuprofen 600mg, docusate sodium, Claritin, nitrofurantoin mono 100mg
Current Illness: UTI
Preexisting Conditions: Depression, pleurisy
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Began overnight after injection. Bodily fatigue, flu like symptoms, soreness and pain at injection site, headache, loss of focus, inflammation and red filled circle about 1inch diameter at injection site. Have been taking ibuprofen 600mg as treatment.


VAERS ID: 1469943 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

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

Write-up: Site: Bruising at Injection Site-Mild, Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: VOMITING ONCE-Mild, Systemic: Nausea-Mild, Systemic: Vomiting-Mild


VAERS ID: 1469945 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Seizure-Severe, Additional Details: Patient was given COVID shot in the shot administration room and then walked back to the pharmacy. He then fell/began having a seizure which was around a minute after administration. The pharmacist turned him on his side and held his head. The seizure lasted around 5 -10 seconds. 911 was called and first responders assessed patient. Patient reported that this has happened multiple times before after recieving vaccinations. After their assessment, he was able to walk out of the pharmacy.


VAERS ID: 1469949 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Flushing, Hyperhidrosis, Nausea, Syncope, Tremor, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Severe, Systemic: Shakiness-Severe, Systemic: Vomiting-Severe, Systemic: Weakness-Severe, Additional Details: Patient approached pharmacy and appeared normal/healthy. Vaccine was mixed/prepared/given proper protocol. Patient sat down after vaccination and within 5-10 minutes he fainted face forward from a seated position. He regained consciousness within 30 seconds of fainting. He then vomited within minutes after he sat up after fainting. A nurse practitioner was in store shopping and stopped by to read his blood pressure (135/76) then the EMT arrived within a minute of the blood pressure reading.


VAERS ID: 1470105 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Feeling abnormal, Paraesthesia, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient experienced rash 3 days post COVID19 Pfizer dose 1
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported after receiving vaccine that she felt tingly. Mom noticed faint red rash to her anterior neck. Patient reported that she felt "weird." No angioedema, SOB, wheezing or stridor noted. Patient had taken benadryl prior to arrival due to history of developing a rash 3 days after her previous Pfizer dose. Patient admits that she is very anxious. Due to rash, we administered solu-medrol 125mg IM and pepcid 40mg PO. VS were BP 144/90 HR 120 RR 24 Spo2. Patient very anxious appearing. Approx 10 minutes after receiving meds, patient reporting feeling slightly better. Rash appears fainter. No SOB, angioedema, stridor. Patient in no distress. Continued to monitor patient for at least 30 more minutes. Patient reports feeling much better. Symptoms continuing to improve. Prior to arrival, rash noted to be gone. No further development of symptoms. BP 133/83. HR 106. RR 18 Spo2 100%. Patient has been eating goldfish and drinking water. Reports that she feels much better. Mom feels comfortable continuing to monitor at home. If there is any concern for needing a booster dose, would advise allergy consult.


VAERS ID: 1470115 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0710 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red, swollen, hot to touch


VAERS ID: 1470127 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 3 RA / IM

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

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

Write-up: Patient is currently in the nursing home for rehabilitation. Patient was mistakenly given a 3rd dose of the Covid-19 Moderna vaccine. Patient received a Covid-19 Moderna vaccine on 1/18/21, 2/18/21, and 7/13/21.


VAERS ID: 1470133 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Dysgeusia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol clonazepam, methylphenidate, gabapentin metformin, omeprazole, oxycodone and sertraline
Current Illness: breast cancer
Preexisting Conditions:
Allergies: contrast dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient feel burning in left arem bad taste in mouth and trouble breathing


VAERS ID: 1470134 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erectile dysfunction, Fatigue, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Erectile Dysfunction; Fatigue; Extreme Arm pain


VAERS ID: 1470150 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-10
Onset:2021-07-13
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 RNA increased
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, obesity OSA
Allergies:
Diagnostic Lab Data: COVID-19 RNA DETECTION on 7/13/2021
CDC Split Type:

Write-up: pt currently has Covid 19


VAERS ID: 1470163 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-16
Onset:2021-07-13
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Herpes zoster, Vaccination complication
SMQs:, Opportunistic infections (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: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patients caregiver reported via phone call that patient developed shingles after receiving his first dose of the Moderna vaccine. She also reported that after speaking with his primary care physician, she determined the outbreak to be an adverse reaction of the Moderna vaccine based on her asssessment of patients symptoms and review of his medical history


VAERS ID: 1470178 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 RA / IM

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

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

Write-up: Patient remained on site for 25 minutes and insisted on going home to take Benadryl, similar to what she does when she experiences these symptoms when she eats food that has shellfish or has touched shellfish. She has an EpiPen at home and I followed up to make sure she made it home okay since she did not want to remain on site. I called ~11:30 and she had made it home and just taken Benadryl. I advised to seek EMS if she has trouble breathing or continued to worsen. I called again that evening at around 6:30pm to follow up but had to leave a voicemail.


VAERS ID: 1470188 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise
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: dtap
Other Medications: Alprazolam 0.5 mg, Desvenlafaxine Er 50 mg, Divalproex ER 250 and 500 mg , Quetiapine 100 mg , Trazodone 50 mg
Current Illness: Seizure disorder
Preexisting Conditions: seizure
Allergies: allergic reaction to Dtap vaccine as child
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient heard troubling news right before immunization so already anxious and worried . While getting immunization , Rph tried to calm her down so immunization went well . She was instructed to wait 30 minutes for observation. After 15 minutes , she approached pharmacist that she is not feeling well and about to seize . She was taken to immunization room where she sat on the floor shaking for few seconds. She was coherent and alert responding to pharmacist questions . Pharmacist asked if she had taken her Depakote for that day and she responded No ,and if she could take a dose . Rph brought her Depakote ER 750 mg (3 tabs of 250 ) along with water . she took medication and was observed for 20 minutes . Her son came to take her home . She was ok while leaving the pharmacy


VAERS ID: 1470210 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Loss of consciousness, Malaise, Musculoskeletal stiffness, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: unknown
Current Illness: none at time of vaccination and unknown up to one month prior
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine dose at 4:43pm. At approximately 4:48pm, she stood up to tell staff that she was feeling ok and wanted to pick up an item in the store. A staff member saw that she looked unwell and asked if she was ok and she said no. She passed out at that moment. She was unconscious for approximately 5-10 seconds. Her body became stiff and her shoulder/arm trembled during that time frame of being unconscious. She refused an ambulance. She remained in the pharmacy for 30 minutes until she no longer felt light-headed. During the 30 minutes, she felt light-headed, hot and was sweating. She said she felt fine after the 30 minute wait.


VAERS ID: 1470256 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Musculoskeletal stiffness, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, baby aspirin, atenelol, Fexofenadine, folic acid, gabapentin, hydrocodon-acetaminophin, hydroxychloroquine, losarten poNorvasc, norvasc, phentermine, simvastatin, sulfasalazine, tizanidin, xarelto, mutivitamin
Current Illness:
Preexisting Conditions: Rheumatoid Arthritis
Allergies: Indocin, methotrexate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore, stiff right arm, sore muscles and joints, especially right knee


VAERS ID: 1470258 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

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

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

Write-up: Patient was administered 0.6ml No symptoms


VAERS ID: 1470265 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was administered 0.6ml No symptoms


VAERS ID: 1470267 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049CZ1A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Fatigue, Hypoaesthesia, Nausea, Pain, Pain in extremity, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: 1st dose Moderna Covid-19
Other Medications: None
Current Illness:
Preexisting Conditions: Fibromyalgia
Allergies: None
Diagnostic Lab Data: Just an oscillation of movement to discard paralysis
CDC Split Type:

Write-up: Exhaustion, generalized pain, 101.3 fever. Numbness and tingling with pain on whole right arm (vaccine was administered on left). Nausea. Went to urgent care. Dr. Stated that paresthesia can be a side effect.


VAERS ID: 1470286 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-09
Onset:2021-07-13
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No allergies
Diagnostic Lab Data: Jul 13, 2021@14:00:43 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Covid 19 screening, contact to a positive covid.


VAERS ID: 1470301 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 RA / IM

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

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

Write-up: patient presented to clinic 7/12/2021 at 2:00pm for 2nd COVID vaccine. Patient completed the COVID 19 vaccine screening and consent form and said she was here for her 2nd dose. Nurse, RN asked her if her first dose had been Moderna and the patient said yes. Nurse administered the Moderna vaccine and then the client presented the nurse with her vaccine card which listed Pfizer as the first dose Lot #ER2613 administered by mobile vaccination bus on 5/22/2021 . Nurse informed patient of this. Patient had no adverse reactions and left after 15 min monitoring time.


VAERS ID: 1470324 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Dysstasia, Myalgia, Pain in extremity, Pyrexia, Toothache
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? 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: Could not make it to a doctor
CDC Split Type:

Write-up: High fever 24 hours, weakness 24 hours- couldn''t sit or stand, chills, arm pain, muscle pain, tooth pain lasting days preventing eating and drinking


VAERS ID: 1470327 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-01-28
Onset:2021-07-13
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Chills, Dyspnoea, Ear pain, Influenza A virus test negative, Influenza B virus test, Oropharyngeal pain, Productive cough, Respiratory syncytial virus test positive, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Aspirin, Atorvastatin, CalciumCyclobenzaprine HCL, Estrogens cream, Guaifenesin/DM, Ibuprofen, Lisinopril, Loratadine, Metformin hcl, mULTIVITAMIN, Naproxen,Semaglutide ,
Current Illness: None
Preexisting Conditions: Smoker, Obesity, hearing loss, DM type 2, Arthritis of knee, tricompartmental degeneration
Allergies: Vancomycin
Diagnostic Lab Data: Jul 13, 2021@14:10:07 FLU A NEGATIVE, FLU B NEGATIVE, RSV NEGATIVE _COVID-19 POSITIVE*
CDC Split Type:

Write-up: complains of sore throat, left ear ache, chills, painful knees, stomach ache, productive cough, and shortness of breath.


VAERS ID: 1470328 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. 1659422 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS AMVA568A / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 4F99G / 1 LA / IM

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

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

Write-up: After administering vaccines patient stated he felt dizzy and started to become pale. Applied a cool compress to back of neck and laid patient down. Patient never lost consciousness. Gave him some water and notified provider. VS taken and WNL Gave him some trail mix and had him sip on water. He stated he started to feel better. Had patient wait in office for 15min and patient was able to stand up and color came back and stated he felt better.


VAERS ID: 1470331 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Cyanosis, Discomfort, Ear discomfort, Hypotonia, Malaise, Pallor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

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

Write-up: After we left pharmacy and was in the car at a stoplight, my daughter starting feeling very uncomfortable. She complained that she did not feel well, she could not see and that her ears were "foggy". When I looked over at her, her face was pale as can be and her lips had bluish tinge to them and she looked limp laying in the passenger seat of the car. It came on very quickly and lasted about a minute or so and was extremely scary. It took close to 30 minutes for her to regain her color. We sat in a parking lot for thirty minutes to make sure she was stable and gave her water. Went home and gave her benadryl. She slept through the night fine and this morning so far is ok.


VAERS ID: 1470345 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient started to feel sweaty around 15 minutes after the vaccine was given, no other complaints of discomfort expressed by patient. Patient was observed and Vital were taken, first set was hr 72, bp 190/100, resp 18, and 98% saturation. Water and a cookie was given and consumed, Patient states that he''s diabetic and has a history of hypertension and did not take his morning medication. Patient stated was feeling fine and skin warm and dry. Second set of vital taken hr 79, bp 160/100, resp 20 and saturation is 97%. Nurse educated patient on adverse reaction symptoms and when to seek medical assistance, patient gave understanding.


VAERS ID: 1470367 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lymphadenopathy, Tenderness
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: Daily multi vitamin
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 2nd dose of Pfizer Covid vaccine on 07-12-21 at 0930. Presented to Health Dept on 07-13-21 and reported that he noticed his left axcillary area was swollen around 0830 on the morning of 07-13-21 approximately 24 hours after receiving 2nd dose of Covid vaccine. Nurse noted that left axcillary area was swollen on the inner area closest to chest and directly in the arm pit area. No erythema present on 07-13-21, was slightly tender to touch. Encouraged to use anti-inflammatory meds, watch area, and to seek medical attention if symptoms persisted or becomes worse.


VAERS ID: 1470374 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-07-13
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL92261 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cough, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ProAir, Symbicort, Lasix, Toprol XL, Aldactone, Flomax, Warfarin.
Current Illness:
Preexisting Conditions: COPD; Chronic Kidney Disease; Atrial Fib; CHF; Obesity.
Allergies: Contrast Dye.
Diagnostic Lab Data: COVID-19 PCR test done at Lab.
CDC Split Type:

Write-up: No increase in cough noted by staff. Daughter felt like he was coughing more so brought him to ED.


VAERS ID: 1470375 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 OT / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity, Skin tightness
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: tightness to touch, left arm pain. Evaluated by EMS-Refusal to transport.


VAERS ID: 1470395 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Foaming at mouth, Gaze palsy, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood pressure 100/58
CDC Split Type:

Write-up: Patient lost consciousness for approximately 30 seconds immediately after receiving the vaccination. Her eyes and head rolled back, and there was a small amount of foam coming from the mouth. The patient did not enter anaphylaxis or stop breathing at any point. A pharmacy technician called 911 while the pharmacist moved the patient to the ground to lay down and monitor for further reaction. The patient was provided with food and water. EMS arrived on the scene approximately 10 minutes later. They took the patient''s pulse and blood pressure, which was slightly low (100/58 - I believe). The paramedics determined that the patient experienced syncope and there was no need for further evaluation at the facility. The patient remained in the pharmacy for about an hour until she felt strong enough to go home.


VAERS ID: 1470396 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-02
Onset:2021-07-13
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Polymerase chain reaction, Polymerase chain reaction positive
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: NO
Current Illness: hx of A-fib
Preexisting Conditions: CAD, A-fib, HTN, DM, former smoker
Allergies: NO
Diagnostic Lab Data: PCR
CDC Split Type:

Write-up: PCR positive 07/13/2021


VAERS ID: 1470410 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-05
Onset:2021-07-13
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mfetformin HCL, Pioglitazone, Aspirin, Lisinopril, Ibuprofen, Simvastatin, Tylenol,
Current Illness: None
Preexisting Conditions: DM type 2, HTN, Diabetic Dyslipidemia, Diabetic retinopathy
Allergies: Codeine
Diagnostic Lab Data: Jul 13, 2021@15:17:53 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE , RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Covid screening. no complaints


VAERS ID: 1470416 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Electrocardiogram, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benedryl. Zoloft
Current Illness:
Preexisting Conditions: Epilepsy. Last seizure was 14 years ago
Allergies: Sulfa
Diagnostic Lab Data: Ekg. We have neurology appt soon
CDC Split Type:

Write-up: Seizure within 5 minutes


VAERS ID: 1470430 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-05
Onset:2021-07-13
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SARS-CoV-2 N gene Resp Ql NAA+probe~SARS-COV-2 (COVID-19) CLINIC COLLECT KIT OR EXTERNAL KIT performed on 7/13/2021 at 11:29. Test came back positive. Based on case investigation documentation, client is asymptomatic and reports no chronic health conditions.


VAERS ID: 1470436 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Incorrect product formulation administered, Nervousness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Pt presented to the pharmacy to get his first dose of Shingrix. This vaccine was processed correctly, however when the immunizing tech saw the VAR form on the counter, she assumed that pt was here for the COVID vaccine and administered Pfizer COVID shot. After pt received his COVID vaccine-card, he realized that he was given incorrect vaccine. Per pt he already completed two doses of Pfizer in the past (04/13/21. 05/04/21). He mentioned he had been fasting from last night for his blood work up this morning. He stated he was feeling little shaky and dizzy. Pt stayed at the waiting area for about 20 mins and he did not complain any further symptoms.


VAERS ID: 1470441 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2020-12-21
Onset:2021-07-13
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated and tested positive for Covid-19.


VAERS ID: 1470461 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: Pt was administered Janssen vaccine 0:50 minutes after the open vial time expired. Vial was punctured at 8:55am and vaccine was given at 3:45pm. Was realized the morning after (7/14/21) by another staff member.


VAERS ID: 1470470 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetrizine, allegra, provera 10 mg, meloxicam 15 mg, singulair 10 mg, Imitrex 50 mg
Current Illness: adverse reaction to first covid vaccine (widespread itching)
Preexisting Conditions: patent foramen ovale closure, allergic rhinitis, osteoarthritis of both knees, history of stroke, migraine, vasomotor symptoms d/t menopause
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient reports wide spread itching 10 min after vaccine administered. Noted to be clearing throat frequently. Treated with 50 mg IM benadryl


VAERS ID: 1470486 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product substitution
SMQs:

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

Write-up: We noticed the patient was vaccinated with Moderna yesterday but had previously been vaccinated with Janssen on 3/6/21 (obtained through ImmuNet). It appears the person was pre-registered for the clinic via our MS system and answered ?Yes? to the question, Is this your first vaccine dose? Our staff ask the questions on the yellow screening form as well that ask as similar question if they have ever received a Covid vaccine. This is a vaccination administration error.


VAERS ID: 1470497 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Lymphadenopathy, Pain in extremity, Sensitive skin
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pain in arm, joint pain, swollen gland in armpit (very painful and large), sensitive skin, fatigue


VAERS ID: 1470498 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Hawaii  
Vaccinated:0000-00-00
Onset:2021-07-13
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, Nucleic acid test, 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: Contains abnormal data SARS-COV-2, QUALITATIVE, NAA (COVID-19), LAB Status: Final result Visible to patient: Yes (kp.org) Next appt: Today at 10:10 AM in Internal Medicine Dx: SCREENING FOR CORONAVIRUS COVID-19 DI... Specimen Information: NASOPHARYNGEAL SWAB Ref Range & Units 7/13/21 12:39 PM SARS-COV-2 NAA (COVID-19) Detected Abnormal Comment: Test performed by polymerase chain reaction (PCR). This is a Nucleic Acid Amplification Test (NAAT) which is a molecular assay also known as PCR, RT-PCR, or TMA. Disclaimer: This test has not been cleared or approved. This test has been authorized under an Emergency Use Authorization (EUA) for use by authorized laboratories. Please see fact sheet for healthcare providers & fact sheet for patients posted on the Lab website.
CDC Split Type:

Write-up: Patient received 6/8/2021 Given 0.5 mL Lt deltoid IM MOD 034C21A Moderna COVID-19 Vaccine (EUA) History 5/4/2021 Given 0.5 mL L Deltoid IM MOD 002C21A Moderna COVID-19 Vaccine (EUA) completed full vaccination for COVID with moderna and tested positive for COVID-19 on 7/13/21 with mild COVID symptoms. His other family members also tested positive for COVID


VAERS ID: 1470502 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-29
Onset:2021-07-13
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: SARS-CoV-2 RdRp Resp Ql NAA+probe~COVID-19 rapid diagnostic test (nucleic acid amplification test NAAT) performed on 7/13/2021. Test came back positive. Case investigation interview with patient has not been conducted as of time of this note.


VAERS ID: 1470515 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM

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

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

Write-up: HAS RASH TO RT ARMPIT, NECK, CHEST AND LT WRIST. DENIES ANY DIFFICULTY BREATHING OR SWALLOWING. ADVISED TO USE COOL PACK AND BENADRYL FOR COMFORT AND CALL PCP TO SEE IF CORTISONE SHOT OR OTHER TX NEEDED. GO TO ER IF SX WORSEN/JAW


VAERS ID: 1470517 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-02
Onset:2021-07-13
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: SARS-CoV-2 RdRp Resp Ql NAA+probe~COVID-19 rapid diagnostic test (nucleic acid amplification test NAAT) performed on 7/13/2021 at a pharmacy. Case investigation interview with patient has not be conducted as of the time of this note.


VAERS ID: 1470536 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

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

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

Write-up: Patient, aged 17, was inappropriately given Moderna COVID19 vaccine, not recommended under the age of 18. Pharmacy attempted to contact patient immediately upon realization, roughly 3 hours after vaccination. Pharmacy finally reached patient''s mother the next morning, and she was informed of the error. Patient''s mother will monitor patient, and in accordance with CDC recommendation, the pharmacy will plan to administer the second dose of Moderna to the patient at the appropriate time. Patient''s mother agrees with this plan. At the time of contact, patient had only developed mild soreness at the injection site.


VAERS ID: 1470538 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-04-08
Onset:2021-07-13
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anosmia, COVID-19, Fatigue, Headache, Influenza A virus test negative, Influenza B virus test, Nausea, Respiratory syncytial virus test negative, Respiratory tract congestion, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medroxyprogesterone, Multivitamins
Current Illness: URI 4 days prior, Covid 19 test negative.
Preexisting Conditions: GERD''s, Migraines Depression, Asthma, Anxeity, Panic disorder, Obesity,
Allergies: HAY DUST, PINEAPPLES, BANANAS, MELOXICAM, TREE NUTS, KIWI FRUIT, SPINACH, MELONS
Diagnostic Lab Data: Jul 13, 2021@17:38:07 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: vomited x1 yesterday and has been having nausea all day today. Patient c/o headache, congestion, loss of smell, and fatigue.


VAERS ID: 1470562 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EE0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Disturbance in attention, Fatigue, Influenza like illness, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Had bad flu like symptoms - chills, muscle aches, joint aches, nauseous, fatigue, difficulty concentrating Took ibuprofen Most symptoms subsided after 24 hours but still having some muscle and joint aches


VAERS ID: 1470563 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Cold sweat, Dizziness, Dyskinesia, Electrocardiogram normal, Fall, Full blood count normal, Head injury, Headache, Loss of consciousness, Metabolic function test, Musculoskeletal stiffness, Pallor, Troponin I normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Denies taking any medications
Current Illness: None reported
Preexisting Conditions: After incident occurred pt stated he had a seizure about 10 years ago and has also fainted in the past.
Allergies: NKA
Diagnostic Lab Data: While at hospital pt had an EKG which was normal. CBC, CMP and Troponin I was drawn - all normal.
CDC Split Type:

Write-up: Pt received 2nd Moderna vaccine at 10:07am. Within 2 minutes of injection pt stated he felt dizzy and put his head down and then he jerked to his right, fell out of his chair and hit the right side of his head on the floor; his head bounced hard off the floor and he was lying face down unconcious. Attempted to break pt''s fall but this nurse ended up falling too. Was able to turn pt over onto his back being very careful with his head and neck. At that point pt''s entire body went stiff and he "woke up" and gasped and had a "post-icteric" stare. Placed pt on his back in an attempt to wake him up more. 10:10am: BP: 118/70, Pulse 47, pulse ox 98%. He became more coherent. Stated the side of his head was hurting ("5-7" on pain scale). No active bleeding or swelling observed. PERLLA. Pt very pale and clammy. 911 called for eval and transport to Emergency Room. Vitals taken every few minutes which remained fairly stable (BP at it''s lowest was 94/62, and pulse ranged from 47-64. EMS arrived and transported pt to UMPC.


VAERS ID: 1470567 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Contusion, Erythema, Skin haemorrhage, Skin warm, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: Tetanus. information unknown
Other Medications: Aspirin
Current Illness:
Preexisting Conditions:
Allergies: Opiates
Diagnostic Lab Data: Ultrasound of area to rule out blood clot. Was given cephalexin antibiotic for cellulitis.
CDC Split Type:

Write-up: After administration, patient bled down her arm. The bandage was replaced and pressure applied. The following day the patient reported warmth, redness and bruising and went to the Emergency Department.


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