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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 241 out of 5,069

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VAERS ID: 1416227 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5829 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Dehydration, Gait disturbance, Hypophagia, Stress, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Dehydration (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: Test Date: 20210603; Test Name: Body temperature; Result Unstructured Data: Test Result:36.6 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC2021658871

Write-up: stress; Vomiting; poor oral intake; Difficulty in walking; Dehydration; This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is v21111912. A 80-year-old female patient received the second dose of BNT162B2 (COMIRNATY; lot number: FA5829; expiry: 31Aug2021), via an unspecified route of administration on 03Jun2021 14:30 (at the age of 80-years-old) as 2nd dose, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient had no family history. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status). The patient''s body temperature before vaccination was 36.6 degrees Centigrade. On 03Jun2021 at 14:30 (the day of vaccination), the patient received the second dose of BNT162B2. On 04Jun2021 at 07:00, the patient experienced Dehydration, Vomiting and Difficulty in walking. On 05Jun2021, the outcome of the events was recovered. The course of the event was as follows: At 14:30 on 03Jun2021, the patient was vaccinated. From the morning of 04Jun2021 07:00, vomiting began to appear, and poor oral intake. The patient had no symptom of pyrexia and had symptom of Difficulty in walking. The patient was transported to a hospital via GA (gurney and ambulance). Diagnosed as Dehydration, after treatment, the patient recovered and went home on the same day. The reporting physician classified the event as non-serious and the causality between the event and BNT162B2 as unassessable. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: The patient has symptoms of vomiting and dehydration due to stress. The outcome of stress was unknown; while for the other events was recovered on 05Jun2021.


VAERS ID: 1416229 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0779 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Dysstasia, Hypoaesthesia, Palpitations
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Caffeine allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: body temperature; Result Unstructured Data: Test Result:36.2 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC2021658903

Write-up: Difficulty in standing; Hand and foot numbness; Palpitations; This is a spontaneous report from a contactable physician received from the The regulatory authority; report number is v21111925. The patient was a 37-year-old female. The patient was allergy to the local anesthetics and caffeine. Body temperature before the vaccination was 36.2 degrees Centigrade. On the 03Jun2021 at 9:10 A.M. (the day of the vaccination) the patient received BNT162B2(COMIRNATY, Solution for injection, Lot number: EY0779, Expiration date: 31Aug2021) via an unspecified route of administration, as 1st dose, single for COVID-19 immunization. The course of the event was as follows: The event onset date was as reported as 04Jun2021 (the day after the vaccination). At 15:00 of 04Jun2021, the patient developed hand and foot numbness, palpitations, and difficulty in standing. At the request of the patient''s family, the patient was rushed to the hospital. The outcome of the events was recovering at 04Jun2021. The reporter classified the events as serious (can lead to disability) and assessed that that the causality between the BNT162B2 was not provided. The reporting physician commented as follows: It was contacted the patient that night and learned that the patient''s symptoms had improved, returned home.


VAERS ID: 1416240 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY5420 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Blood pressure measurement, Body temperature, Heart rate, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210605; Test Name: Blood pressure; Result Unstructured Data: Test Result:130/80; Test Date: 20210603; Test Name: body temperature; Result Unstructured Data: Test Result:36.9 Centigrade; Comments: before vaccination; Test Date: 20210604; Test Name: body temperature; Result Unstructured Data: Test Result:37.5 Centigrade; Test Date: 20210605; Test Name: body temperature; Result Unstructured Data: Test Result:37.5 Centigrade; Test Date: 20210605; Test Name: Pulse rate; Result Unstructured Data: Test Result:88; Comments: beats/min
CDC Split Type: JPPFIZER INC2021659437

Write-up: blood pressure 130/80; Pyrexia 37.5 degrees centigrade; Vomiting; Queasy; This is a spontaneous report from a contactable nurse received from the Regulatory Authority. Regulatory authority report number is v21111928. The patient was a 55-year and 8-month-old male. Body temperature before vaccination was 36.9 degrees Centigrade. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status). On 03Jun2021 at 14:00, the patient received the second dose of BNT162B2 (COMIRNATY, Solution for injection, Lot number EY5420, Expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 04Jun2021 at 16:00, the patient experienced adverse events. The course of the event was as follows: On 04Jun2021 around 16:00 (1 day after the vaccination), the patient experienced Pyrexia 37.5 degrees centigrade, Queasy and Vomiting. On 05Jun2021 (2 days after the vaccination), the patient had Physician Office Visit. Pyrexia 37.5 degrees centigrade, pulse rate 88 beats/min, blood pressure 130/80. SOLDEM 3A 500ml 1 bottle; PP) CALONAL Prescription. On 04Jun2021 (1 day after the vaccination), the outcome of the event was not recovered. The reporting physician classified the event as non-serious and assessed that the event was related to BNT162B2. There was no other possible cause of the event such as any other diseases.


VAERS ID: 1416259 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pharyngeal stenosis, Rhinorrhoea
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: JPPFIZER INC2021666095

Write-up: Pharyngeal stenosis; Nasal discharge; This is a spontaneous report received from a contactable other health care professional via Pfizer sales representative. The patient was a 45-year-old female. It was unknown whether the patient had other medical history. On 04Jun2021 (the day of vaccination), the patient received the single dose of BNT162B2 (COMIRNATY, Solution for injection, Lot number unknown) for COVID-19 immunization. On 04Jun2021, the patient experienced Pharyngeal stenosis and nasal discharge. The outcome of the event was recovered on 04Jun2021. The details of the reaction were reported as follow: on 04Jun2021, after vaccination with medical staff, there was a feeling of pharyngeal stenosis and nasal discharge. Both symptoms recovered during the day. Reporter considered that the event was non-serious and the causality between the BNT162B2 and event was probably related. Information on the lot/batch number has been requested.; Sender''s Comments: Based on the information currently available, a causal association between the reported event pharyngeal stenosis and BNT162B2 cannot be fully excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RAs, Ethics Committees, and investigators, as appropriate.


VAERS ID: 1416314 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0932 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Amnesia, Asthenia, Blood test, Computerised tomogram, Headache, Influenza like illness, Loss of consciousness, Myalgia, Nausea, SARS-CoV-2 test, Specialist consultation, Vaccination site pain, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN D [COLECALCIFEROL]; PANTOPRAZOLE; ACIDUM FOLICUM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy; Spherocytosis
Allergies:
Diagnostic Lab Data: Test Date: 20210605; Test Name: Blood test; Result Unstructured Data: Test Result:nothing was found; Test Date: 20210605; Test Name: CT; Result Unstructured Data: Test Result:nothing was found; Test Date: 20210605; Test Name: Nasal Swab; Test Result: Negative ; Test Date: 20210605; Test Name: Consultation with a neurologist; Result Unstructured Data: Test Result:nothing was found
CDC Split Type: PLPFIZER INC2021657043

Write-up: unconscious fainted on the floor; nausea; Went to the bathroom to vomit; no memory of the moment; Headache started at the night; strong pain on the local of injection; flu like symptoms; pain at the muscles; Feeling very weak; This is a spontaneous report from a contactable consumer (patient) received from COVAES. A 44-year-old female patient received BNT162B2 (COMIRNATY, solution for injection), dose 2 via an unspecified route of administration, administered in Arm Left on 04Jun2021 18:15 (at the age of 44 years old) (Lot Number: FD0932) as second dose, single for COVID-19 immunisation. Medical history included spherocytic anaemia and allergy to penicillin. Prior to the vaccination, patient was not diagnosed with COVID-19. The patient was not pregnant at the time of vaccination. The patient took her first dose of BNT162B2 on 30Apr2021 18:15 (lot number: EY3014 , Anatomical Location: Arm Left) for COVID-19 immunisation and experienced pain in the local of injection and some weakness on the day after. Concomitant medications included colecalciferol (VITAMIN D), pantoprazole and acidum folicum; all taken for an unspecified indication, start and stop date were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 04Jun2021 22:00, patient experienced headache that started at the night, strong pain on the local of injection, flu like symptoms, pain at the muscles. Patient was feeling very weak. After lunch on 05Jun2021, she started to feel very bad with a lot of nausea. Patient went to the bathroom to vomit and her husband came to help her after hearing her screaming. When he entered the bathroom, he found patient unconscious fainted on the floor, moving the legs and arms. Patient woke up after 30s or 1 minute, screaming again. She had no memory of the moment when screamed and lost consciousness. An ambulance was called and patient went to the hospital where she was examined with a CT, blood test and consultation with a neurologist and nothing was found. On the next day of the events, patient was feeling weak, but better. The events resulted in Emergency room/department or urgent care. Patient received treatment of Consultation at the ER (Emergency Room), CT (computerised tomography), blood test, IV (intravenous) drip. Since the vaccination, the patient been tested for COVID-19. On 05Jun2021, patient''s COVID-19 Nasal swab result was negative. The outcome of the events was recovering at the time of report.


VAERS ID: 1417887 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Excessive eye blinking, Headache, Sleep disorder, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad)

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

Write-up: Received in right arm/shoulder at 15:39. Later when lying in bed my teeth started clattering and I got the chills which lasted around 20 mins. When this passed I got a bad headache, location was forehead, top of my head and each temple. Took painkillers which didn''t clear it fully but enough to get some sleep. Woke in the middle of the night, headache was back, took painkillers and went back to sleep. For the next three days I had a low grade headache in the same areas, I took mild painkillers and managed to sleep through the night. The part of the headache at each temple also feels like there''s a rod going from temple, behind my eyes, to my other temple. I need to blink more often and my right eye is experiencing slight blurriness in the center of my vision. It''s been 18 days and I still have the headache and eye issue.


VAERS ID: 1418691 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Cold sweat, Dizziness, Fatigue, Feeling hot, Headache, Maternal exposure during pregnancy, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASPIRIN [ACETYLSALICYLIC ACID]; FOLIC ACID
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Suspected COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021663652

Write-up: Headache; Clammy; Bloating; Feeling hot; Nausea; Heart racing; Tiredness; Dizziness/Felt faint; Maternal exposure during pregnancy/Patient was exposed to the medicine second-trimester (13-28 weeks); This is a spontaneous report from a contactable consumer received from a regulatory authority. The regulatory authority report number is GB-MHRA-APPCOVID-202106060922142550-AIHYG. A 32-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number unknown), via an unspecified route of administration on 04Jun2021 (at the age of 32-year-old) as DOSE 1, SINGLE for COVID-19 immunization. Medical history included suspected COVID-19 from 21Mar2020 to 10Apr2020 and was not ongoing. Not had a COVID-19 test. Patient is not enrolled in clinical trial. Patient is not currently breastfeeding. Concomitant medication included aspirin [acetylsalicylic acid] taken for pregnancy from 01Mar2021; folic acid taken for vitamin supplementation. On 04Jun2021, the patient experienced maternal exposure during pregnancy/patient was exposed to the medicine second-trimester (13-28 weeks), dizziness/felt faint, and tiredness. On 05Jun2021, the patient experienced nausea, heart racing, headache, clammy, bloating, and feeling hot. The events were medically significant. Patient has not tested positive for COVID-19 since having the vaccine. Outcome of the headache was recovered on 05Jun2021, of the dizziness/felt faint and feeling hot was recovered on 06Jun2021, of the nausea, heart racing, tiredness, and clammy was recovering, and of the bloating was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1418770 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Hot flush, Malaise
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Clinical trial participant
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021663788

Write-up: Flush hot; Generally unwell; Headache; This is a spontaneous report from a contactable consumer received from the Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202106061044065090-1Z6HT, Safety Report Unique Identifier is GB-MHRA-ADR 25426993. An 85-year-old male patient received second dose of BNT162B2 (COVID-19 MRNA VACCINE BIONTECH), via an unspecified route of administration on 03Jun2021 as single dose for COVID-19 immunisation. Co-suspect drug SARS-COV-2 VIRUS was reported. Medical history included clinical trial participant. He has not had symptoms associated with COVID-19 and not had a COVID-19 test. The patient''s concomitant medications were not reported. The patient experienced flush hot, generally unwell, and headache on 04Jun2021. He has not tested positive for COVID-19 since having the vaccine. The patient was recovering from flush hot while outcome of other events was not recovered. Case was reported as serious by health authority (hospitalization). No follow-up attempts are needed, information about batch number cannot be obtained. No further information is expected.


VAERS ID: 1418882 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Fatigue, Feeling hot, Hangover, Headache, Hyperaesthesia teeth, Joint stiffness, Paraesthesia oral, Swollen tongue, Throat irritation, Toothache
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021671717

Write-up: chest pain; tooth sensitivity; Tooth pain; Stiff joint; Itchy throat; Feeling hot; Lip tingling; Swollen tongue; Headache; Pain chest; Hangover; Tiredness; This is a spontaneous report from a contactable consumer received from the Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202106061942326550-PMXDX. Safety Report Unique Identifier GB-MHRA-ADR 25427736. A female patient of an unspecified age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on 04Jun2021 (Batch/Lot number was not reported) as single dose for COVID-19 immunization. The patient medical history was not reported. The patient''s concomitant medications were not reported. On 04Jun2021, patient experienced lips began tingling within a few hours or jab. This was followed by tongue feeling swollen. Patient treated it with antihistamine. She felt a hungover feeling and was hot but did not have a fever. In the evening, patient felt tired and had chest pain and a headache. The headache came and went throughout the day and was treated with paracetamol. The following day (on 05Jun2021) patient had stiff joints and developed a scratchy throat, treated with paracetamol and this did not develop any further. On the third day (06Jun2021) patient developed tooth pain and sensitivity. Patient has not tested positive for COVID-19 since having the vaccine. Outcome of events tooth pain, tooth sensitivity and chest pain was not recovered, of other events was recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1424838 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-09
Onset:2021-06-04
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, B12, certrizine hydrochloride
Current Illness:
Preexisting Conditions:
Allergies: Avocado
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spotting 1 week prior to start of menstruation


VAERS ID: 1425749 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (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: ROJNJFOC20210646691

Write-up: ANAPHYLAXIS; This spontaneous report received from a physician via a Regulatory Authority [EMEA EVHUMAN NLP, RO-NMA-2021-SPCOV11448] concerned a 71 year old female of an unspecified ethnic origin and race. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 21C11-03 expiry: unknown) 1 dosage forms, 1 total administered on 22-MAY-2021 for Covid-19 immunisation. No concomitant medications were reported. On 04-JUN-2021, the patient experienced anaphylaxis. The action taken with covid-19 vaccine ad26.cov2.s was not reported. The patient recovered from anaphylaxis. This report was serious (Other Medically Important Condition).; Sender''s Comments: 20210646691-COVID-19 VACCINE AD26.COV2.S-ANAPHYLAXIS. This event is labeled and is therefore considered potentially related.


VAERS ID: 1428141 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC8889 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic shock, Blood pressure measurement, Depressed level of consciousness, Hypotension, Muscle spasms, Poor peripheral circulation, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
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: Test Date: 20210604; Test Name: Blood pressure; Result Unstructured Data: Test Result:60/40 mmHg; Comments: Min:60/40 mmHg; Test Date: 20210604; Test Name: Blood pressure; Result Unstructured Data: Test Result:60/40 mmHg; Comments: Max:60/40 mmHg
CDC Split Type: DKPFIZER INC2021688073

Write-up: Anaphylactic shock; the patient began to cramp; Tachycardia; Hypotension; Decreased level of consciousness; Capillary refill time $g3 s; This is a spontaneous report from a contactable physician downloaded from the regulatory authority. A 16-years-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular on 04Jun2021 (Batch/Lot Number: FC8889) as 1st dose, single for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. On 04Jun2021, seven minutes later, the patient developed Anaphylactic shock with Depressed level of consciousness, hypotension, Poor peripheral circulation and Tachycardia and the patient developed cramps. The ADRs were by the reporter reported as life threatening and the patient was given 0.3 mg adrenaline IM which was repeated 5 minutes later as the patient consciousness level again began to be affected and the patient began to cramp. The ADR Anaphylactic shock was recovered 04Jun2021 after 5 hours. Test results 04Jun2021 included: Blood pressure: min. 60/40 mmHg, max. 60/40 mmHg. Outcome of Depressed level of consciousness, hypotension, Poor peripheral circulation, Tachycardia and cramps was recovered 04Jun2021. SKIN AND MUCOUS MEMBRANE SYMPTOMS: None; AIRWAY SYMPTOMS: None; CARDIOVASCULAR SYMPTOMS: INCLUDED: Hypotension, Tachycardia, Capillary refill time $g3 s, Decreased level of consciousness NOT INCLUDED: Reduced central pulse volume, Loss of consciousness; GASTROINTESTINAL SYMPTOMS: None; No follow-up attempts possible. No further information expected. Information about batch number has been obtained.


VAERS ID: 1434888 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Nausea, SARS-CoV-2 test, Vaccination site bruising, Vaccination site pain
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC2021709901

Write-up: Injection site bruising; Injection site pain; Nausea; This is a spontaneous report from a contactable consumer received from the Regulatory Authority; the Regulatory Authority report number is GB-MHRA-WEBCOVID-202106141814586390-HDSB4 and the Safety Report Unique Identifier is GB-MHRA-ADR 25472364. An 18-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on 04Jun2021 (batch/lot number was not reported) at 18 years old, as DOSE 1, SINGLE for COVID-19 immunization. The patient''s medical history included lactation decreased from an unknown date. The patient was not enrolled in clinical trial. Patient was not currently breastfeeding. Patient has not had symptoms associated with COVID-19. Concomitant medications were not reported. The patient experienced nausea on 04Jun2021, injection site pain on 05Jun2021, and injection site bruising on 06Jun2021. The patient recovered from the event nausea on 05Jun2021, from the event injection site pain on 08Jun2021, and from the event injection site bruising on 12Jun2021. The events were reported as medically significant. The patient has not tested positive for COVID-19 since having the vaccine; patient tested no - negative for COVID-19 virus test on an unspecified date. No follow-up attempts are possible; information about the batch/lot number cannot be obtained.


VAERS ID: 1443000 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-21
Onset:2021-06-04
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPEI202100104153

Write-up: Myokarditis; This regulatory authority case was reported by a physician and describes the occurrence of MYOCARDITIS (Myokarditis) in an 18-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3002334) for COVID-19 vaccination. No Medical History information was reported. On 21-Apr-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 01-Jun-2021, received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On 04-Jun-2021, the patient experienced MYOCARDITIS (Myokarditis) (seriousness criteria hospitalization and medically significant). At the time of the report, MYOCARDITIS (Myokarditis) had not resolved. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication were not provided by the reporter. Treatment information was not provided by the reporter. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Action taken with mRNA-1273 to the events was not applicable; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1443758 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC8889 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure measurement, Depressed level of consciousness, Feeling hot, Hypotension, Nausea, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210604; Test Name: Blood pressure; Result Unstructured Data: Test Result:95/60 mmHg; Comments: Min:95/60 mmHg; Test Date: 20210604; Test Name: Blood pressure; Result Unstructured Data: Test Result:120/80 mmHg; Comments: Max:120/80 mmHg
CDC Split Type: DKPFIZER INC2021688085

Write-up: Anaphylaxis; Started with blurred vision; Started with feeling of warmth; Nausea; Hypotension, continuingly decreasing blood pressure after treatment with alnok, tavegyl and solumedrol.; Decreased level of consciousness; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority (RA), regulatory authority number DK-DKMA-WBS-0070474. A 17-years-old female patient received bnt162b2 (COMIRNATY, formulation: Solution for injection, Batch/Lot Number: FC8889) intramuscular on 04Jun2021 (at the age of 17-years-old) as dose 1, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. On 04Jun2021, 10 minutes after the vaccination, the patient experienced anaphylaxis (lasted for 4 hours), blurred vision, feeling of warmth, nausea, hypotension and depressed level of consciousness. The adverse drug reactions were by the reporter reported as resulting in hospitalisation on 04Jun2021. The patient was treated with Alnok (CETIRIZINE) as oral treatment and with Solu-medrol (Methylprednisolone Sodium Succinate) and Tavegyl (Clemastine) as intramuscular injections. The patient underwent lab tests and procedures which included Blood pressure, minimum 95/60 mmHg and maximum 120/80 mmHg on 04Jun2021. Brighton scale criteria was time onset first reaction 10 min. acute reaction was yes, rapid progression was yes, duration of reaction 4hr. No skin and mucous membrane symptoms. No airway symptoms. Cardiovascular symptoms included hypotension, decreased level of consciousness, not included tachycardia, capillary refill time greater than 3 s (second), reduced central pulse volume, loss of consciousness. Gastrointestinal symptoms included nausea and not included vomiting, diarrhoea, abdominal pain blood pressure was minimun 95/60 and maximum 120/80 S-tryptase, acute as no value. S-tryptase, base as no value. The patient was hospitalised in response to all events and all events were considered as medically significant. Temperature maximum no value. Outcome of all events was recovered on 04Jun2021. No follow-up attempts possible. No further information expected.


VAERS ID: 1452103 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC6997 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Headache, Loss of consciousness, Muscle spasms, Presyncope, Syncope, Vertigo
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC2021752182

Write-up: loss of consciousness of very short duration; Syncope vasovagal; spasmophilia attack; headaches; vertigo; vasovagal reaction; This is a spontaneous report from a contactable physician downloaded from the WEB FR-AFSSAPS-2021074840. A 18-year-old male patient received bnt162b2 (COMIRNATY), intramuscular, administered in Deltoid Left on 04Jun2021 (Batch/Lot Number: FC6997) as DOSE 1, SINGLE at the age of 18 years old for COVID-19 immunisation. Medical history was reported as none. The patient''s concomitant medications were not reported. On 04Jun2021, 5 minutes after the vaccination, the patient had spasmophilia attack with clones/violent vagal discomfort, loss of consciousness of very short duration. Again the symptoms recurred with headaches and vertigo leading to prompting hospitalisation for monitoring. Summary of ongoing medical care: Hospitalisation in surveillance for 3 hours then discharge from hospital. Conclusion : Post-vaccination vasovagal reaction. The outcome of the events was recovered on unspecified date. No follow-up attempts possible. No further information expected.


VAERS ID: 1468026 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   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 FA8016 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Culture throat, Investigation, Maternal exposure during pregnancy, SARS-CoV-2 test, Threatened labour, Ultrasound scan, Urine analysis, Vaccination site pain
SMQs:, Guillain-Barre syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIMOFEROL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy; Rhinitis allergic; Surgery (adenoid surgery)
Allergies:
Diagnostic Lab Data: Test Date: 20210605; Test Name: throat swab; Test Result: Negative ; Test Date: 20210605; Test Name: infective workup with pyretism; Test Result: Negative ; Comments: Negative infective workup with pyretism; Test Date: 20210605; Test Name: vaginal swab; Test Result: Negative ; Comments: negative vaginal swab; Test Date: 20210605; Test Name: SARS-CoV-2 test; Test Result: Negative ; Test Date: 20210605; Test Name: ultrasound of the cervix; Result Unstructured Data: Test Result:cervix at 26 mm; Comments: cervix at 26 mm with minimal image of the water pocket, The uterus is contractile with painful contractions.; Test Date: 20210608; Test Name: Ultrasound of the exit cervix; Result Unstructured Data: Test Result:cervix at 29-30 mm.; Comments: Ultrasound of the exit cervix: cervix at 29-30 mm.; Test Date: 20210605; Test Name: cytobacteriological examination of urine; Result Unstructured Data: Test Result:sterile; Comments: sterile cytobacteriological examination of urine
CDC Split Type: FRPFIZER INC2021796162

Write-up: Threatened premature labor; Maternal exposure during pregnancy; Asthenia; Vaccination site pain; This is a spontaneous report from a contactable consumer from the WEB, regulatory authority number FR-AFSSAPS-2021072533. A 32-years-old pregnant female patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in the left arm on 04Jun2021 (Batch/Lot Number: FA8016) as dose 1, single (at the age of 32 years-old) for COVID-19 immunisation. Medical history included allergic rhinitis, adenoids surgery, unexplored penicillin hypersensitivity. The patient had no previous obstetric history. Concomitant medications included ascorbic acid, ferrous sulfate (TIMOFEROL) from an unknown date for an unspecified indication. On 04Jun2021 the patient experienced threatened premature labor, asthenia, and vaccination site pain. The mother was 29 Weeks + 6 days pregnant at the onset of the event (04Jun2021). No data if spontaneous pregnancy, G1P0. Date of LMP was 08Nov2020, either estimate DDR 08Nov2020 or early pregnancy 21Nov2020. The mother was due to deliver on 15Aug2021. The patient was hospitalized from 05Jun2021 to 08Jun2021 for threat of premature delivery. Clinical course is as follows: on 04Jun2021, 5 hours after vaccination onset of pain at the injection site, onset also on the same day of asthenia, 15 hours after vaccination onset of contraction episodes (at night) leading to an emergency room visit. On 05Jun2021 the patient underwent lab tests and procedures which included: an ultrasound of the cervix was performed with results: cervix at 26 mm with minimal image of the water pocket. The uterus was contractile with painful contractions. Negative infective workup with pyretism, sterile cytobacteriological examination of urine, negative vaginal swab, negative throat swab and negative COVID PCR. On 08Jun2021 Relay by SPASFON, Ultrasound of the exit cervix: cervix at 29-30 mm. The patient no longer presented with painful uterine contractions. Monitoring was reassuring. The differential diagnosis was provided as: infectious causes: negative assessment, afebrile; maternal causes: G1P0, age less than 35 years, minimal water bag rate but no data on socio-economic level, tobacco / toxic, NF (anemia?), type of work, trauma, T2 / T3 metrorrhagia, long daily trips; Obstetric history: 0; ovular causes: not mentioned but a priori no hydramnios or placenta preavia. The patient was healing and discharge from the hospital on 08Jun2021 with prescription for AT from 05Jun2021 to 11Jun2021, SPASFON 80mg 2-2-2 PARACETAMOL 1g 1-1-1, with recommendations of Midwife follow-up at home twice a week until childbirth and for patient to change position every 2 hours, avoid long journeys by car, avoid intense physical activity, and keep walking at a moderate pace. Therapeutic measures were taken as a result of threatened premature labor and included establishment of an ADALATE LP 20mg protocol for 48h and the patient also benefited from corticosteroid therapy with CELESTENE in IM 2 times at 24 hour intervals for fetal lung maturation. The clinical outcome of the event threatened premature labor was recovered on 08Jun2021, asthenia recovered on an unknown date and vaccination site pain recovered on 05Jun2021. No follow-up attempts possible. No further information expected.


VAERS ID: 1478706 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-12
Onset:2021-06-04
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW6126 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Abortion spontaneous, Karyotype analysis
SMQs:, Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: VITAMINE D; ASAFLOW; FOLIUMZUUR
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Analyzes of the karyotype of the fetus; Result Unstructured Data: Test Result:in progress
CDC Split Type: BEPFIZER INC2021824245

Write-up: Miscarriage at 10 weeks pregnant. Cardiac activity stopped observed on 04Jul2021. Curettage.; This is a spontaneous report from a contactable consumer or other non hcp downloaded from the WEB, regulatory authority number BE-FAMHP-DHH-N2021-97258. A 34-year-old female patient received the first dose of BNT162B2 (COMIRNATY; solution for injection; Lot #: EW6126) via an unspecified route of administration on 12May2021 (at the age of 34-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. Concomitant medications included colecalciferol (VITAMINE D), acetylsalicylic acid (ASAFLOW) and folic acid (FOLIUMZUUR), all taken for unspecified indications on unspecified dates. On 04Jun2021, the patient experienced miscarriage at 10 weeks pregnant. Cardiac activity stopped observed on 04Jul2021. The event was serious for hospitalization. The action taken in response to the event for concomitant medications colecalciferol, acetylsalicylic acid and folic acid was reported as unknown. The clinical outcome of the event was recovered/resolved with sequel on 04Jun2021. No follow-up attempts possible. No further information expected.; Reporter''s Comments: Treatment - Yes Evolution of the ADR - Healing with sequelae Examinations - Analyzes of the karyotype of the fetus are in progress. ADR description - Miscarriage at 10 weeks pregnant. Cardiac activity stopped observed on 06/04.


VAERS ID: 1370992 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: -Multivitamin pill -Iron supplements -Biotin gummies -Allegra
Current Illness:
Preexisting Conditions: Asthma,
Allergies: -Shellfish -Peanuts -Tree nuts -Apples
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting every 20 minutes for a period of 3 times.


VAERS ID: 1371088 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Arthralgia, Impaired work ability, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No medications
Current Illness: fibromyalgia
Preexisting Conditions: None
Allergies: Sulfa and morphine
Diagnostic Lab Data: Staff memeber will be going to urgent care when it opens today @ 10:00. She was sent home at this time.
CDC Split Type:

Write-up: Staff member received vaccination @ 10:35 on 6/2/2021 @ Health Care Center from nurse . She awakened this morning with swelling and pain noted to the right index and middle finger on the right hand. She received her injection on the right arm. Staff member complains of all over joint pain. She does have a history of fibromyalgia. She has not other symptoms at this time.


VAERS ID: 1371112 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Computerised tomogram, Laboratory test, Magnetic resonance imaging, Parotid gland enlargement
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Sudden onset Parotid Gland swelling, Initial selling on 2/6/21 mostly resolved then a prolonged period of swelling lasting 3 weeks starting on 4/2/21


VAERS ID: 1371171 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0190 / 2 LA / IM

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

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

Write-up: Patient with history of vasovagal syncope. Patient took the vaccine at 0817 and felt light headed. Patient did not lose consciousness, however felt light headed and leaned toward her mom. Patient was laid down, given ice, juice/water and snacks. Patient was observed for a little while until she felt better, then went home.


VAERS ID: 1371193 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochorothiazide 12.5 MG - only prescription medicine Vitamins & supplements: Calcium/Magnesium/Zinc, Vitamn E, Super B-Complex, Fish Oil
Current Illness: none
Preexisting Conditions: none
Allergies: maybe penecillin
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: I got up in the middle of the night to go to the bathroom as usual, and after washing my hands, apparently passed out. My husband heard and attended to me ( I have a large bump on the back of my head, and a cut on my forehead). This morning, I''m okay except for a slight blurriness when reading. My physician recommended going to urgent care, which I am doing. I cannot remmber ever having fainted in my entire life.


VAERS ID: 1371206 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling of body temperature change, 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:
Other Medications: Effexor, Prazosin
Current Illness:
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient experienced mild nausea and lightheadedness about 10 minutes after her shot. Some alternating warmth and cold feelings. No chills. No symptoms to suggest allergic reaction. No near syncope or syncope. Symptoms were self limiting and resolved on their own. VSS throughout her stay. no orthostasis.


VAERS ID: 1371207 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose normal, Electrocardiogram, Fall, Presyncope, Sinus rhythm
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: EKG: SINUS RHYTHM BG: 101
CDC Split Type:

Write-up: 9:50- Patient was sitting in chair talking to girlfriend. Per girlfriend patient''s head started to tilt back, and then he fell on his right side. Patient had a vasovagal response X 10 seconds. EMT and NP rushed to patient, immediately assessing patient, hooked him up to EKG, took vitals and blood sugar. When patient woke up he was A&OX3, patient stated he did not eat anything for the day. Vitals: 140/88, pulse 67, 100% O2, BG 101. 1000: 12 LEAD EKG was performed, patient is in SINUS RHYTHM. Another set of vitals were taken. 115/70, 91 pulse, 100% O2. Patient was given cereal bar and orange juice. 1010: Third set of vitals 123/71, pulse 74, 100% O2 1030: Patient stated he was well. Patient was able to walk to car with girlfriend. Did not request any further medical intervention.


VAERS ID: 1371215 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Patient passed out immediately after receiving vaccination


VAERS ID: 1371225 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling hot, Nausea, Presyncope
SMQs:, Acute pancreatitis (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: BCP, Buspar, Prozac
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient developed warmth, clamminess, nausea and lightheadedness shortly after her shot. She admitted to near syncope, but there was no LOC. No tunnel vision. Symptoms resolved on their own. VVS throughout. No orthostasis.


VAERS ID: 1371238 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Altered state of consciousness, Dizziness, Fall, Immediate post-injection reaction
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), 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: No other medications.
Current Illness: No other illnesses.
Preexisting Conditions: No chronic health conditions.
Allergies: No known allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 1 minute after administering vaccine, patient asked for water with complaints of lightheadedness. As he walked up to pharmacy door for water, he collapsed to the ground. He went in and out of consciousness while laying on the ground for about ten minutes. He had no other complaints other than lightheadedness. He did not eat any food today. He said in the past he had fainted after getting a numbing injection for a dental procedure and believes it may be a similar reaction. The paramedics were called and evaluated him. His blood pressure and HR were within normal limits. He refused to be taken to the hospital for further evaluation.


VAERS ID: 1371246 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-27
Onset:2021-06-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site rash, Injection site swelling, Injection site warmth, Lymph node pain, Lymphadenopathy, Musculoskeletal stiffness, Paraesthesia, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (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: Pain and swelling in lymph nodes in injected arm underarm, feeling of pins and needles, stiffness in whole arm (like the feeling you get when you need to stretch, but no relief after stretching), hot red itchy rash and swelling around injection site that started 1 week after injection.


VAERS ID: 1371248 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 477C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: trazodone, atorvastatin, breo ellipta, tizanidine, duloxetine, gabapentin, meloxicam, wellbutrin, furosemide, finasteride, potassium chloride, folic acid, vitamin d2, norco, ca-d3-mag#11-zinc-cupr-man, proventil hfa
Current Illness: none
Preexisting Conditions: hypertension hyperlipidemia RA
Allergies: PCN, lexapro
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: The patient has not experienced an adverse event. This report is being submitted because the patient was given Moderna vaccine for his 2nd dose, but was supposed to receive the Pfizer vaccine.


VAERS ID: 1371253 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cough, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Thyroid
Preexisting Conditions: Hypothyroid
Allergies: Sulfa Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pains Runny nose Cough Fever


VAERS ID: 1371278 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Mobility decreased, Nervousness, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second Moderna vaccine. Was nervous, started shaking shortly after, than reported her arm started getting numb, and was having trouble lifting her arm. Her heart rate and BP was fine, no dizziness, SOB either. Told patient to go to walk in clinic/ urgent care for review


VAERS ID: 1371293 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

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

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

Write-up: Patient received J&J vaccine and walked to sit down for her post injection wait time. Patient had previously fainted after a vaccine so she was suppose to sit for 30 minutes anyway. Patient immediately after sitting down got extremely light headed, pale, and dizzy. We immediately moved her to the floor and put her feet up. After approximately 3 minutes, patient regained color and was feeling a lot better. EMS was called but father who was with her called to cancel and refuse after patient felt better so quickly. Patient had history of anxiety with shots and it seemed to be truly an anxiety issue.


VAERS ID: 1371327 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

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

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

Write-up: Patient was given second dose post 9 days after the first dose.


VAERS ID: 1371332 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / IM

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

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

Write-up: 67 y/o female with past medical history of Migraines and Hypertension who presents with dizziness post vaccination. Patient states that this is her second dose in the two-dose series. Patient states that she received her vaccination to the right arm. Patient states that with the first vaccination she did experience dizziness, nausea and migraines. Patient denies headache, vision changes, sore throat, difficulty swallowing, difficulty breathing or chest pain. Patient denies feeling nervous or anxious with vaccinations. Patient initial vitals with Hypertension noted, 197/112 BP, 78 HR, 98 % RA, 12 Resp. Patient instructed to lay on cot and water bottle provided. Patient vitals continuously monitored with persistent hypertension present (186/103, 223/118 BP) at this time the NP requested the Paramedics to obtain the BP manually. Patient BP manually taken every 5 minutes x2 with readings as follows, 150/96 and 138/80. Patient states that she is feeling better and dizziness has resolved. Patient placed in sitting position for 5 mins and then instructed to stand for 5 mins. Patient stable on her feet with no dizziness reported. Patient discharged in stable condition and ambulated without difficulty. Patient has a follow up appointment immediately with HCP post vaccination, today.


VAERS ID: 1371344 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-04-22
Onset:2021-06-03
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypotension, Mobility decreased, Nausea, Paraesthesia
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lunesta, Seroquel, Trazodone, Levothyroxine, Prazosin, Stool Softener
Current Illness: Small reaction to first Pfizer COVID-19 vaccination
Preexisting Conditions: Iron Deficiency Anemia, Leukopenia, Lymphopenia, Stage 3A Kidney Disease, Hypothyroidism, Mood Disorder, Insomnia
Allergies: Cucumber, Pickles, Relish
Diagnostic Lab Data: Given an anti nausea medication and Benadryl.
CDC Split Type:

Write-up: Drop in blood pressure (92/58), nausea, dizziness, tingling in hands and feet, trouble breathing through a mask, lightheaded, unable to sit up. Symptoms were similar to how an adverse reaction to my food allergy starts.


VAERS ID: 1371361 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Breath sounds abnormal, Dizziness, Hyperhidrosis, Musculoskeletal stiffness, Pallor, Seizure like phenomena, Tremor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: XANEX 0.25 ATORVASTATIN 20MG IBUPROFEN 600MG LEVOCETRIZINE 5MG LEVOTHYROXINE 25MCG LEXAPRO 5MG
Current Illness: NONE
Preexisting Conditions: HYPOTHYRIODISM HYPERLIPIDIMA DEPRESSION AND ANXIETY
Allergies: EPINEPHRINE HYDROMORPHONE
Diagnostic Lab Data: BP 1.ST-145/90, 2ND - 138/86
CDC Split Type:

Write-up: PT STARTED TO FEEL DIZZY, WHEN LAID BACK SHE STARTED TO HAVE SEIZURE LIKE ACTIVITY. LEGS AND ARMS SCHAKING, VERY STIFF, GARGLING NOISE FROM MOUTH, SWEATY, PALE, AND WASNT RESPONSIVE. 911 WAS CALLED AND DR. CAME IN ROOM TO ASSIST UNTIL EMS ARRIVED. SEIZURE LIKE ACTIVITY LASTED AROUND A MINUTE AND A HALF. ONCE PT CAME TO SHE WAS STILL UNABLE TO RESPOND TO ME FOR ANOTHER MINUTE AND THEN WHEN SHE COULD RESPOND SHE DIDNT HAVE ANY RECOLECTION OF WHAT HAD HAPPENED. PTS VITALS WERE MONITORED AND GLUCOSE WAS ALSO CHECKED, ALL WERE NORMAL. EMS ARRIVED AND TRANSPORTED PT TO NEAREST ER.


VAERS ID: 1371405 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Incorrect dose administered, Presyncope
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Patient was given the wrong dosage. She was given a double dose of vaccine. Patient was instantly light-headed. She has diabetes and had not eaten. Provider feels it was a vagal response instead of the vaccine reaction. Patient was monitored for 1 hour until symptoms resolved. Patient was contacted this afternoon, she is feeling much better.


VAERS ID: 1371408 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirizine 10 Mg Cap 1 daily, Imitrex 100mg tablet prn migraine
Current Illness: Back Pain
Preexisting Conditions: Seasonal Allergic Rhinitis due to pollen Morbid Obesity Intractable periodic headache syndrome
Allergies: Cephalexin - Hives Latex-Hives
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pfizer/BioNTech vaccine incorrectly diluted. It was only diluted with 0.8mL of Sodium Chloride instead of 1.8mL Sodium Chloride. Pt given dose of the incorrectly diluted vaccine. After waiting her 15 mins post vaccine she did not have any adverse reaction.


VAERS ID: 1371435 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra 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 accidently given a double dose of vaccine. No adverse symptom as of yet.


VAERS ID: 1371445 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

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

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

Write-up: Felt lightheaded and dizzy after vaccination. Did not eat prior to vaccine. Drank juice and felt better. VSS. BP: 112/66, HR 56, O2 95% ORA


VAERS ID: 1371465 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cardiac Med (Unknown by patient)
Current Illness: Cardiac
Preexisting Conditions: Cardiac
Allergies: NKA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: This is for documentation only. Patient stated she received her 1st dose of Pfizer on May 13th, 2021. Confirmed by her daughter. However, the state reporting system says she got Johnson and Johnson. Patient received dose of Pfizer today. No apparent adverse reaction at this time. Patient was held for 30 minutes. No problems. Patient did not bring her vaccination card to appointment


VAERS ID: 1371468 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

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

Write-up: immunization given past 12 hour time once drawn from vial


VAERS ID: 1371469 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLUOXETINE 20 MG DAILY
Current Illness: NONE
Preexisting Conditions: ANXIETY, DEPRESSION, HYPERLIPEDEMIA
Allergies: SULFA ANTIBIOTICS
Diagnostic Lab Data: None completed at this time
CDC Split Type:

Write-up: Patient was administered an expired dose of PFIZER BIONTECH COVID 19 vaccination on 6/3/2021 at 0838. Vaccination was outside of the recommended time allowed following first vial puncture. Syringe containing Pfizer vaccination was approximately 12-16 hours out of the recommended 6 hour allotted time frame for administering. Writer contacted manufacturer, Pfizer regarding above error. Please use reference if further information is needed regarding call. No recommendation was given by manufacturer as this particular situation has not been studied in clinical studies to da,Client from Pfizer medical information notes they are unable to provide medical guidance regarding patients, it is up to the discretion of primary care provider to determine when patient can safely another COVID 19 vaccination. Patient was notified of error and is not currently experiencing any adverse side effects. Patient will contact clinic with any further concerns or development of symptoms listed in the Pfizer-Biotech Covid 19 emergency use authorization literature.


VAERS ID: 1371474 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: Pt felt fine after vaccination and proceeded to waiting area and sat down to wait 15 minutes. A few minutes after she sat down she felt faint and fell out of her chair and bumped her forehead. We helped her back into the chair and held on to her. With her permission we had her sniff an ammonia inhalant and she said she felt a little better. She did not want us to call 911 or anybody at home. A pharmacy technician sat with her for about a half hour and a store manager filled out a report and said we will follow up with her later. She said she felt better and was able to leave on her own.


VAERS ID: 1371485 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Tenderness
SMQs:

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

Write-up: Armpit has become really sore and tender.


VAERS ID: 1371503 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: BP 109/70; HR 73 and 98% O2 on room air.
CDC Split Type:

Write-up: After receiving 2nd dose of Moderna, she felt dizzy and was diaphoretic. On site EMS responded. Vitals listed below. She was given water and cookies and was monitored. She felt better and was released to home.


VAERS ID: 1371505 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM

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

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

Write-up: VS 121/64, HR 73, OxSat 98%. Vaccine received and pt. States he blacked out. No loss of consciousness, but foggy. Alert x 3. VS obtained when pt. Placed on cot and monitored by Fire fighter.


VAERS ID: 1371515 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-13
Onset:2021-06-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

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

Write-up: A 10YO PT WAS VACCINATED WHEN HE DID NOT MEET THE AGE REQUIREMENTS. PER PT''S MOTHER, PT DID NOT REPORT ANY ADVERSE REACTIONS OR SYMPTOMS.


VAERS ID: 1371519 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature decreased, Dizziness, Hyperhidrosis, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: The patient complained about feeling lightheaded, sweaty, and blurred vision. Spo2 99 HR 96, BP 124/98 T 95.1 The patient?s mother stated that he always gets that way when he receives a vaccine or donates blood. The clinical staff attended to him. He stated that he felt fine after about 5 minutes.


VAERS ID: 1371529 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, Migraine, Neck pain, Pain in extremity, Peripheral swelling, Vaccination error, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt went to clinic to get her 2nd dose of the Pfizer vaccine and was given Moderna instead. Pt was told to call us to report the vaccination error. Pt says her left arm is very painful and she is vomiting, has a migraine along with neck pain.


VAERS ID: 1371538 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Musculoskeletal discomfort, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reported taking 2 Benadryl''s by mouth prior to vaccine.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported within minutes of having generalized, constant itching, mild erythema noted to patient''s upper back, where she scratched repeatedly, no rash or respiratory distress noted


VAERS ID: 1371539 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness: 0
Preexisting Conditions: 0
Allergies: 0
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache Pain Nausea


VAERS ID: 1371550 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: none stated
Diagnostic Lab Data:
CDC Split Type:

Write-up: fainted and looked pale


VAERS ID: 1371559 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Muscle spasms, Muscle twitching, Seizure like phenomena, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Tums, gabapentin, pravastatin, corianor, Vit D3, Dialyvite, Sacubitril/Valsartan, Coreg, Lantus, Phoslo, Trulicity
Current Illness: none
Preexisting Conditions: ESRD on dialysis
Allergies: Iodine, Morphine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt received Moderna Covid-19 vaccine (second in series) at 1011, BP before vaccination 109/58, P/77. BP 20 minutes after vaccine was 93/57, P/60. At the end of pt''s tx, 1035, pt stated she was cramping and then became unresponsive with some seizure like activity, upper body twitching. O2 applied, NS given, pt became responsive, then had another seizure like episode, then again became responsive. BP 115/80, P/88 at this time. NP was on site. Due to the fact that the pt had the Covid vaccine and did not have a seizure history, NP ordered for EMS to be called (1038). Upon their arrival (1042) pt was A&O X 4, BP 150/88, P/65, T/ 97.0. Report given, care was transferred to EMS, belongings sent with pt. Pt requested to be taken to hospital.


VAERS ID: 1371571 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Extreme constant headache that is not going away


VAERS ID: 1371573 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fainted frequently happens after getting vaccinations according to the patients mother.
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient fainted after receiving shot. He came too after 1 to 2 minutes. He was pale in the face but was back to normal after waiting for 30 minutes after the episode.


VAERS ID: 1371580 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Irregular menstruation - menstruation began on June 3rd even though patient''s cycle had ended two days prior to receiving the vaccine.


VAERS ID: 1371589 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Vaccine was diluted with smaller amount of diluent resulting in a higher concentrated dose.


VAERS ID: 1371593 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, Immediate post-injection reaction, Paraesthesia, Tinnitus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE REPORTED
Current Illness: NONE REPORTED
Preexisting Conditions: NONE REPORTED
Allergies: PENICILLIN
Diagnostic Lab Data: On day of event (6/3/2021), patient blood pressure, pulse oximetry, heart rate, and respirations monitored by pharmacy staff until EMS arrived. Patient was hypotensive, oxygen saturation of $g95% on room air, Patient was provided water and evaluated by EMS. EMS confirmed no life-threatening event associated with vaccination. Patient was encouraged to follow-up with medical provider as soon as leaving the facility by both EMS and pharmacy staff.
CDC Split Type:

Write-up: Immediately following administration of the vaccine, the patient reported lightheadedness, tinnitus, and paresthesia of extremities. Patient experienced these symptoms within 15 seconds of vaccine administration. Symptoms persisted for approximately 15 minutes.


VAERS ID: 1371597 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Vaccine administered was diluted w amount of diluent smaller than recommended resulting in a higher concentration of vaccine administered.


VAERS ID: 1371601 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 18993 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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: Ventolin Tessalon Perles Lexapro Advil Silvadene cream Tretinoin cream
Current Illness: none
Preexisting Conditions: Anxiety OCD
Allergies: Ceclor Pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: left arm pain/ afebrile/ dizzy/ weak


VAERS ID: 1371605 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 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: 1371610 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: Error: Diluent Administered Instead of Vaccine


VAERS ID: 1371611 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Vaccine was diluted w smaller than recommended volume of diluent resulting in a more concentrated dose administered.


VAERS ID: 1371612 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product temperature excursion issue
SMQs:, Medication errors (broad)

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

Write-up: Dose temperature excursion


VAERS ID: 1371615 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-01
Onset:2021-06-03
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lactation disorder
SMQs:, Functional lactation disorders (narrow)

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

Write-up: One month after 2nd dose my breast milk tanked, barely producing milk after not changing anything in baby or mom diets. Baby is 6 months.


VAERS ID: 1371624 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / IM

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

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

Write-up: Patient was 17 at the time of administration.


VAERS ID: 1371632 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C91A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

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

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

Write-up: Patient received 2nd dose too early. First dose was administered 5/14/2021 and second dose was administered 6/3/2021 when it was due to be given 6/11/2021.


VAERS ID: 1371634 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Site: Bruising at Injection Site-Mild, Additional Details: Sufficient bruising 3-4 inches from injection site, 4-5 inches in diameter


VAERS ID: 1371651 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2055A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Condition aggravated, Electrocardiogram normal, 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, patient reported fainting during childhood vaccine
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No Known Allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient had two syncope events after vaccine administration lasting approximately 5-10 seconds. He was monitored continuously. EMS were called and checked blood pressure, blood glucose, and did an EKG -all values were normal. Additionally, patient remained being monitored for 30 minutes until picked up by family member. Patient recovered from adverse events.


VAERS ID: 1371662 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-03-16
Onset:2021-06-03
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

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

Write-up: more than 6 weeks between doses in series.


VAERS ID: 1371666 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Oxygen saturation decreased, Retching, Throat tightness, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 1st pfizer dose similar reaction but did not need Epi
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: about 10 minutes after injection patient experienced throat tightening and gagging with slight decrease in O2 (95%), given epi 0.3mg IM and 50mg benadryl IM with improvement ~1min after, improved O2 to 97%, transported via 911 to ED for further management


VAERS ID: 1371675 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NONE
CDC Split Type:

Write-up: INADVERTENT PFIZER SECOND SHOT INSTEAD OF MODERNA


VAERS ID: 1371677 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Hot flush, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: Nausea, hot flashes, and chest pain with racing heart about a half hour after being given the Covid vaccine. Pepcid and Zyrtec given.


VAERS ID: 1371680 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Feeling like having heart "palpitations." @13:46 B.P.192/131 100% Puls: 86 @13:51 B.P.200/109 100% Pulse: 80 @13:58 B.P. 178/97 100% Pulse: 85 Stated takes blood pressure medications " going home to take medication now."


VAERS ID: 1371690 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 3 RA / IM

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

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

Write-up: Patient was administered third dose of vaccine by health department staff. contacted health department to administer vaccines to new patients or those who only received one dose. When health department staff returned to agency to enter vaccines administered in Impact, it was noted that patient already received two doses administered on 1/14/21 and 2/12/21.


VAERS ID: 1371695 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Big red rash on arm about 4 to 5 inches across like a band


VAERS ID: 1371696 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Hyperventilation, Hypotension, Malaise, Paraesthesia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Pt reported near syncope and severe anxiety with all injectable medicines/vaccines
Other Medications: None Known
Current Illness: None known
Preexisting Conditions: None known
Allergies: None reported by patient
Diagnostic Lab Data: Blood pressure 63/45 prior to EMS transport.
CDC Split Type:

Write-up: Pt reported severe anxiety and syncope when receiving injectable medication and blood draws. Pt was agreeable to receive vaccine and a plan was made ahead of time to administer to her in her vehicle with the seat laid flat. Upon receiving the vaccine, the pt immediately stated, " I don''t feel good" and began to hyperventilate and complaint of tingling in all extremities. Pt then vomited and an EMS crew on standby was notified to evaluate the patient. The patient was eventually transported to the ER due to near syncope and hypotension.


VAERS ID: 1371712 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

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

Write-up: Pt accompanied with mother to receive first dose. Pt tolerated well at the time of vaccination. Pt had dizziness and ''feeling hot'' while at the observation area. Pt brought back to an exam room to be examined by Dr Dr. and MOP confirmed that this issue was because pt didn''t eat anything today. Vitals taken at 1255 are B/P: 91/56, P: 92, SPO2: 100%. Pt states pain is localized to the site of injection and was minimal. Dr. required vitals every 15 minutes for the next hour. Vitals at 1310: B/P: 110/73, P: 77, SPO2: 99%, pt reported no dizziness at this time. Vitals at 1325: B/P: 117/72, P: 79, SPO2: 100%. Vitals at 1340: B/P: 108/73, P: 85, SPO2: 98%. Vitals at 1355: B/P: 111/75, P: 86, SPO2: 98%, pt denies dizziness, pain or nausea. Dr. reviewed vitals taken and assessed pt prior to discharge.


VAERS ID: 1371718 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: Patient received a dose of the Jassen covid vaccine and was sitting in the waiting room for his 15 minutes of observation. After about 10 minutes he passed out and fell out of his chair bumping his head on the way down.


VAERS ID: 1371725 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hypertension, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: IBUPROFEN/PINEAPPLE
Diagnostic Lab Data: BP 124/79 HR 67
CDC Split Type:

Write-up: AFTER RECEIVING THE VACCINE SHE COMPLAINED OF THE LEFT SIDE OF HER FACE BEING NUMB. ON STIE EMS RESPONDED. VITALS LISTED BELOW. SHE FELT BETTER ONCE IT HAD BEEN 30 MINUTES AFTR THE VACCINE AND WAS RELEASED HOME.


VAERS ID: 1371733 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 fainted during observation period after pfizer covid vaccine. The patient was laid flat on her back with feet elevated and the pharmacy called EMS. The pt left with EMS


VAERS ID: 1371735 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Rash
SMQs:, Anaphylactic reaction (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden rash and increased anxiety. Liquid benadryl given. 1037 fine rash noted. Itching abated. 1047 rash abated.


VAERS ID: 1371746 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Sensory disturbance
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (narrow), 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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient was fine at time of injection. Patient stated he started feeling the vaccine throughout his body and that he was going to pass out. Patient passed out and came back to quickly; patient drank a bottle of water once he came to. I had the patient wait for 30 minutes in the pharmacy; he was fine at the time he left. Called back at 3:11pm; he states he is doing fine. He passed out with the first vaccination as well.


VAERS ID: 1371753 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 2nd covid shot was administered 64 days after the 1st shot.


VAERS ID: 1371754 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-03
Onset:2021-06-03
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dyspnoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient arrived on 03JUN2021 to receive 2nd dose of Pfizer. Patient reported that following 1st dose of Pfizer and completing standard observation period of 15min, he developed onset of Hives and SOB 1 hour (10am) following administration of the Pfizer vaccine at 0900. Patient reports that he did not seek medical attention and chose to wait out the symptoms. Patient reported that his SOB resolved 30min following onset without medical intervention. Patient reported that his Hives resolved 2hours following onset without medical intervention. Patient 2nd dose of Pfizer was not given due to potential adverse reaction to 1st dose.


VAERS ID: 1371765 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ear discomfort
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: Amlodopine, Diovan, Latanaprost, Cosopt take daily
Current Illness: High blood pressure,
Preexisting Conditions: Lupus, High blood pressure,Glaucoma
Allergies: IVP dye,Iodine, nitroglycerin, aspirin/NSAIDS, Prolensa, Sulfa drugs, penicillin, Shellfish, Cats, Dogs, Horses, Pollen, Dust, Mites
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Adverse event: ears "clogged up" i.e. filled with fluid. A common allergic reaction with me. Lasted several hours. Going away after a few hours.


VAERS ID: 1371766 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

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

Write-up: Pt stated feeling nausea, mother stated pt passed out for 15 seconds then gained consciousness. P:80 BP: 126/79 O2: 99% T: 77.5 F RR:14


VAERS ID: 1371780 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Craniocerebral injury, Electrocardiogram normal, Skin laceration, Syncope, Tension
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: While in observation after vaccine was given, 18 y/o male had a tension of body and fainted out of chair from sitting position. Head did hit the concreate floor. Male immediately jumped up once he hit the floor. Syncopal event occurred. HE was brought back into treatment area and placed on EKG along with vitals. Normal sinus rhythm, BP and HR stable. Small laceration to right side of temporal lobe about 1cm long, minimal depth, no stiches required, bleeding stopped immediately and ice pack placed. Neurological intact, pupils equal and reacted to light. AAOX4, No nausea, vomiting or dizziness. Male is stable condition with brother. Advised to seek further eval with x-ray of skull for precaution. He was in agreement and understood.


VAERS ID: 1371782 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Fatigue, Hyperhidrosis, Joint hyperextension, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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 family stated that he has a history of passing out after vaccine administration. This was not told to the clinical staff
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 28 year old male presented for initial dose of Phizer-BioNtech at 1100 AM on 6/3/21. Pre-assessment form was filled out and reviewed with nursing student administering the vaccine. The client stated no known allergies to medications, food, venom, or environmental elements. He also stated no allergic reactions to previous vaccines. The client also stated that he had no known health issues. After administration the patient stated he was dizzy and then immediately became unresponsive, diaphoretic, eyes rolled back, and head hyperextended. Family was present and we asked if he had any seizure history and his family declined. At this time the patient and family informed us that after vaccines in the past he does faint but didn''t inform staff before this vaccine was administered. The patient remained unresponsive for 45 seconds. Then his feet were elevated and he asked to lay down. At 11:11 AM his HR was 60 and O2 was 97% on pulse oximetry. He felt hot and was still diaphoretic and felt very fatigued. Once he started feeling better we sat him back up and his HR was 89 and O2 was 99%. We gave him 2 bottles of water and crackers. He remained in our care for 45 minutes. He then waited an additional 30 minutes in the post vaccine area. His family stated they were going to drive him home and get some food. The patient is expected to return June 24, 2021 for his second dose of the Phizer vaccine. We provided additional discharge instructions


VAERS ID: 1371788 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

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

Write-up: Pt stated feeling nausea, mother stated pt passed out for 15 seconds then gained consciousness. Pt left at 2:25 feeling better P:80 BP: 126/79 O2: 99% T: 77.5 F RR: 14


VAERS ID: 1371792 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Device connection issue
SMQs:, Medication errors (broad)

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

Write-up: While administering the shot, the syringe separated from the needle, preventing proper administration


VAERS ID: 1371797 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram normal, Hyperhidrosis, Panic attack, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 21 y/o male here with brother whom he witnessed having an adverse reaction. Male moved into treatment area with brother and started to have a panic attack/vasovagal response. Became lightheaded, dizzy and diaphoretic. Placed on EKG per EMS, stable normal sinus rhythm, heart rate 71, BP 120/73. Placed in supine position, AAOx4 neurologically intact. Waited about 30 minutes, stable. No complaints or any other issues at this time. Able to walk out with brother.


VAERS ID: 1371822 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Gaze palsy, Hyperhidrosis, Loss of consciousness, Nausea, Pallor, Refusal of treatment by patient
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), Vestibular disorders (broad), Ocular motility disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Peanuts, Shellfish
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Approximately 5 minutes after receiving the vaccine, the patient passed out and his eyes rolled back (possible seizure activity). This activity lasted for approximately 1 minute. Patient also felt dizzy, sweaty, nauseous, and became pale. Patient was given a cold ice pack to lower his body temperature. Patient was also given crackers for nausea, and a bag just incase he had to vomit. Patient''s mother was also here to tend to the patient. The mother also gave him clear fluids (sprite) to help with the nausea. After approximately 10 minutes, the patient was able to stand without feeling dizzy. He left the store with his mother to be watched closely (His mother is a nurse.) They also refused emergency medical services.


VAERS ID: 1371825 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: The patient recieved the janssen covid vaccine at about 2:35pm. Patient passed out by his chair. It was about a few minutes after getting the janssen covid vaccine. We called 911. I went to assist him and was alert. He sat on the floor and I checked his pulse. He was pale. I offered him water which he drank after about 5 minutes. The EMT''s arrived after a few minutes and checked him out. Took his vitals and looked him over. The patient left after 20 minutes.


VAERS ID: 1371826 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Immediate post-injection reaction, Loss of consciousness, Memory impairment, Muscle spasms, Muscle twitching, Nausea, Photophobia, Posture abnormal
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), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: atient was in for 2nd covid-19 (Pfizer lot was EW0167, exp 8/31/2021): It was her and her brother receiving the vaccine. Brother went first and was fine. She was second. After receiving the vaccine (~30-60sec) she appeared to lose conciseness (not sure if complete or partial) she said she didn''t remember all of it, but it was more like a dream. During that she had some twitches/spams (involving circular motions with her arms and leg, leg extended and then retracted, but her head rolled back). Upon coming out/waking she appeared sensitive to light and was nauseous. Left her in the room with her mom to get an ice pack, water, paper towel. Total episode lasted less than a minute, but took about 10-15 minutes (estimate, unsure of full time spent) before she felt good enough to use a wheelchair and get in her mom''s car to drive home.


VAERS ID: 1371829 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: Persistent tinnitus in left ear that started a couple hours after getting 2nd dose of Moderna covid-19 vaccine.


VAERS ID: 1371832 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Vaccination site bruising, Vaccination site pain, Vaccination site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: My arm around the vaccination site is very red and swollen and sore. And where I got my shot it is badly bruised.


VAERS ID: 1371835 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Dysuria, Fatigue, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Triamcinolone prn, famotidine 20mg BID, Flonase, Aripiprazole, Strattera, Depo-Provera, Atorvastatin, Loratadine, Flovent 110 BID
Current Illness: None
Preexisting Conditions: Obesity, GERD, ADHD, Sleep apnea, Asthma, Dyslipidemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever up to 101.9F, fatigue, myalgia, abdominal pain, dysuria, headache. Pt declined treatment, opted to go to ER for evaluation


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