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

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



Case Details (Reverse Sorted by Onset Date)

This is page 246 out of 8,010

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VAERS ID: 1679334 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-01-01
Onset:2021-09-07
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Laboratory test, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Plavix, aspirin, Lipiton, Metformin, spironolactone, apixaban
Current Illness:
Preexisting Conditions: CAD, DM, CHF, HTN
Allergies: None
Diagnostic Lab Data: chest Xray, labs
CDC Split Type:

Write-up: Respiratory failure


VAERS ID: 1679337 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None Known
Current Illness:
Preexisting Conditions:
Allergies: Contrast Dye
Diagnostic Lab Data: 1:26pm Pulse Ox- 97 BP- 118/79 Pulse 79 1:41pm Pulse ox 96 BP 130/81 Pulse 81 Patient left on her own accord
CDC Split Type:

Write-up: Patient was without symptoms at 16 min mark- Patient left- Came back about 10 minutes later with symptoms of "arm tingling". She described a headache at VAS score of 4-5 on left sinus area. No tongue swelling but after 40 minutes, she described slight tingling on one side of tongue. We recommended them to stay longer but they insisted on leaving at approximately 40 minutes. She described a history of anxiety related to injections Benadryl 50 mg was given to her and counseling of worsening symptoms to seek emergency care.


VAERS ID: 1679339 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, General physical condition abnormal, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the Pfizer Covid Vaccine today. As patient was returning to her chair from getting the immunization, patient began to turn white and feel faint. She alerted me to the situation as she was coming into the pharmacy after administering the vaccine to the patient. The patient told her dad she thought she was about to pass out. As I was approaching the scene, the patient''s body went limp and color drained from her skin. The dad had his daughter and together we gently laid her on the floor. The patient was still breathing. The dad and I both starting trying to get the patient''s attention. She started blinking her eyes. All the while, I monitored her breathing (watching her chest rise and fall, as well as listening for breaths, and feeling for her pulse). I applied cold compresses to patient head and neck. As she was coming to, I found out she had not eaten anything today. We got the patient a water and a small bag of popcorn from the pharmacy. After sitting up on the floor for a moment, patient wanted to get in the chair. Dad and I moved patient to the chair. Patient was coherent and answering appropriate questions, and stated she wanted to try a soda and something to eat. He got the patient a Sprite and a protein bar. Patient sipped on the Sprite and took two bites of protein bar. Then patient started turning pale and going limp. Dad and I moved patient back to lying down, and this time I had him bring the CPR air mattress out for patient to somewhat lay on. I continued to monitor breathing, and although breathing was shallow, patient never stopped breathing, blinking her eyes, or answering questions...as this was the only way we told patient we would not call 911. Patient''s blood pressure remained steady at 86/57 with a pulse of 72. I continued to monitor patient for another 10-15 minutes before trying to sit patient up again. Once patient was upright, she sipped the sprite some more and kept ice packs. After another 10 minutes, patient said she felt ok and wanted to go home. Dad and I told her she would have to continue to talk with her dad all the way home to be sure she was staying coherent. He retrieved a wheelchair from the front of the club and the patient''s brother pushed her to the front of the store with dad. As a side note, dad did tell me that patient has had these fainting spells previously and been to the ER for them. They had told him as long she was breathing and talking with eyes open, no need to come to ER.


VAERS ID: 1679341 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Syringe issue, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Leak from luerlock and unable to estimate if more than half a dose given; full dose immediately administered after in opposite arm


VAERS ID: 1679343 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 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: vaccine was given at 21 days instead of 28 days


VAERS ID: 1679352 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3684 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: did not say
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: none listed
Diagnostic Lab Data: pt got taken to hospital
CDC Split Type:

Write-up: patient received 1st dose of pfizer COVID 19 vaccine and while waiting her 15 minutes she passed out


VAERS ID: 1679357 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO183-H / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Eye swelling, Pruritus, Rash, Rash erythematous, Rash papular, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Denies other illnesses
Preexisting Conditions: Denies chronic conditions
Allergies: Anaphylactic RXNs to sulfa, cats, milk. Uticaria reaction to sunlight
Diagnostic Lab Data: None
CDC Split Type:

Write-up: PT received 1st dose Pfizer at 1100 and c/o ?itching? to arms at 1118, presenting with raised red uticaria BL to arms. PT denies any other symptoms beyond her usual baseline. HX anaphylaxis; allergies are sulfa, cats, milk and sunlight. PT denies exposure to other allergens, says this reaction does not feel like her previous anaphylactic reactions. PT reported that itchiness was worsening, spreading to back and face. PT noted to have raised red rashes to these areas as well. VS at 1128 were: SPO2 99% RA, HR 83, BP 100/64 (retaken 3 minutes later at 108/72, denies dizziness/lightheadedness, s/s hypotension). PT appeared to have no respiratory distress, reporting ?I feel good.? When asked to rate itchiness sensation, PT reported 8/10, 10 being the worst. 25 mg liquid benaryl provided PO at 1127, no facial swelling noted at this time. VS at 1138: SPO2 99% RA, HR 75. Uticaria were visibly reducing to arms, abdomen, though a slight redness was noted across cheekbones and slight swelling to eyes noted. PT continued to deny distress, symptoms except for rash. PT advised that standing orders allowed for additional doses of Benadryl, PT declined at this time, saying ?I?m fine.? PT reported itching improved to 5/10 at 1138, but levels did not improve from there. PT accepted juice and water. At 1152, PT report that itchiness was ?the same?. VS at 1155: BP 110/70, HR 64, SPO2 99% RA, RR 18. PT continued with swelling to cheeks and eyes. Education on s/s anaphylaxis/when to seek medical care was provided, PT verbalized understanding. PT was also advised to report reaction to her PCP before getting 2nd dose. At 1205, PT accepted an additional 25 mg of Benadryl PO. Uticaria to arms were resolved, improvement seen in rash to face, swelling to eyes. VS at 1215: 110/74 BP, BP 75, SPO2 98% RA. PT?s mother was on site and educated on anaphylaxis, when to seek medical care, to report events to PCP. Mother verbalized understanding. PT reported feeling well and that itchiness had improved, uticaria were resolved. PT exited facility at 1219 with mother, PT reported that she will be with family at home.


VAERS ID: 1679359 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (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: Armour thyroid
Current Illness: none
Preexisting Conditions: hypothroidism
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported numbness throughout her body shortly after receiving vaccine. No treatment was given. Patient refused further medical care.


VAERS ID: 1679360 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / IM

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

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

Write-up: Pt was given a second dose of Covid 19 from a syringel that expired on Friday 9/3/2021, the staff member thought because it was in the fridge it was ok to give, pt has not had any reaction at this point. We will disgard any vaccine that is left at the end of the day even if if expires in the evening as we close at 5 to assure there are no syringes in the fridge that expire the next day.


VAERS ID: 1679361 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: No illness at the time of vaccination.
Preexisting Conditions: Unknown
Allergies: No known allergies
Diagnostic Lab Data: No medical test conducted
CDC Split Type:

Write-up: Moderna Vaccine expired on 9/4/2021 and was administered to individual on 9/7/2021. During fifteen therapeutic observation patient did not report any adverse signs and/or symptoms after administration of vaccine.


VAERS ID: 1679374 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

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

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

Write-up: Patient received Covid vaccine dose #2 prior to required 3 week interval between doses. Patient was observed after incident for any effects, none was noted.


VAERS ID: 1679378 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 5mg Tablet Rosuvastatin Calcium 5mg Tablet Vascepa 1gm Capsule Eliquis 5mg Tablet
Current Illness: No illness at the time of vaccination
Preexisting Conditions: Hypertension Elevated cholesterol Hx of Deep Vein Thrombosis (DVT) Unspecified fracture of shaft of right tibia and fibula subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delaying healing Elevated hemoglobin A1C Mixed hyperlipidemia
Allergies: Dilantin Ibuprofen Penicillin G Potassium Banana
Diagnostic Lab Data: No medical test conducted
CDC Split Type:

Write-up: Moderna vaccine expired on 9/04/2021 and was administered to individual on 9/07/2021. During fifteen therapeutic observation period patient did not report any adverse signs and/or symptoms after administration of vaccine.


VAERS ID: 1679379 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 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: vaccine given 21 days instead of 28 days


VAERS ID: 1679382 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 2 RA / IM

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

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

Write-up: Patient was given expired vaccine. No events reported to the pharmacy at this time.


VAERS ID: 1679392 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

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

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

Write-up: Patient received the vaccine around 8am without incident. The patient returned to the pharmacy at around 3pm later that day. She reported that a few hours after her vaccine she broke out into hives. At the pharmacy she had small red hives visible behind both arms and redness across her chest. The patient denied difficulty breathing and reported that she was breathing just fine. The patient was counseled to take otc antihistamines and to seek medical attention if it worsens.


VAERS ID: 1679396 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Muscle spasms, Tremor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (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: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At approximately 1318, security guard alerted facility staff that medical personnel are needed outside. At approximately 1318, 2 nurses responded to security and ran patient to outside. RN saw patient sitting inside vehicle in driver''s seat. Patient''s eyes were closed. Patient was unresponsive to verbal and physical stimuli. At approximately 1318, RN notified Lead RN. At 1319, RN activated EMS. Lead RN arrived on scene and assessed patient. Patient was responsive to verbal and physical stimuli. Patient was oriented to person, place, and situation. Patient denied itchiness, rashes, and difficulty swallowing. Patient''s husband reported patient was driving out of parking space and patient asked "do your muscles hurt". Patient then parked car. Patient''s left and right hands started "cramping" and "shaking". Patient then closed eyes and became unresponsive to verbal stimuli. Patient''s husband alerted security guard and said he "needs to see a nurse". RN educated patient''s husband on signs/symptoms of when to seek care, to follow up with primary care provider, and to sign up on v-safe. At approximately 1322 patient vomited on asphalt. At approximately 1325, paramedics arrived on scene and assumed care. At approximately 1345, patient transported to hospital for further care. At approximately 1345, patient left facility via ambulance.


VAERS ID: 1679397 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Cold sweat, Dizziness, Hypertension, Immediate post-injection reaction, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (narrow), 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: pt states on 8/27 car accident Left arm sprain. reports she choose the side affected to be injected
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT c/o vertigo and lightheadedness immediately after post vaccination at 11:02 am. Pt transferred to post observation cot via w/c. VS at 11:10 am with PT supine were HR 95 BP 144/88 O2 sat 100. PT c/o nausea,? clammy?. PT states that she feels better laying supine with cold pack and knees bent. PT sat up and reports a decrease in nausea, requesting H20 and tolerated drinking without emesis. Continued to monitor; PT anxious, but without agitation and was affable. PT presented with HTN (does not believe she has a hx of HTN, except for preeclampsia with my twins), though PTs BP did drop once when attempting to sit. (See below for progression of vital signs) PT recovered BP quickly and reported feeling better at 1147, denies dizziness/nausea and shakiness?. PTs VS improved after bathroom visit, PT was able to stand without VS change at 1208, verbalized that she was feeling better. PTs appearance had returned to baseline. At 1219, after further monitoring, PT exited facility accompanied by daughter, reports she will be at home with family today. 1110 BP 144/88 HR 95 O2sat 100 supine 1114 am HR 108 BP 160/100 O2 sat 100% 1119 BP 146/96 HR 94 O2sat 99% sitting did not tolerate well resumed supine position 1122 BP 142/88 HR 87 O2 sat 100% 1126 BP 150/88 HR 94 O2sat 100% sitting 1137 BP 104/70 HR 105 O2sat 100% sitting and immediately reverted to supine position 11:38 BP 132/80 HR96 O2sat100% Pt states feels much better 1150 BP 168/96 HR 103 O2sat% 100. sitting 1201BP 130/84 HR 71 O2sat 100% post bathroom break 1205 BP 144/98 HR81 O2sat 100% 1208 BP 136/8 HR 89 O2sat 100% standing


VAERS ID: 1679401 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood pressure 110/80; HR = 70.
CDC Split Type:

Write-up: Approximately 10 minutes after administration, patient fainted. He woke up within 30 seconds, blood pressure 110/80; HR = 70.


VAERS ID: 1679403 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None per PT report
Current Illness: None per PT report
Preexisting Conditions: None per PT report
Allergies: NKA per PT report
Diagnostic Lab Data: 15:09 BS 119
CDC Split Type:

Write-up: 2:58 pm PT c/o dizziness, staff helped him down on his back, legs elevated, SpO2-98%, HR-40, AOx4 2:59 pm EMS arrived, SpO2-98%, HR-40, AOx4, 3:04pm PT repositioned upright, drinking Gatorade, he c/o nausea, diaphoretic 3:07 pm staff helped PT on his back , BP 88/42 mmHg, PT diaphoretic, c/o nausea 3:09pm PT sitting, c/o nausea, drinking Gatorade, diaphoretic, BS 119mg/dl, T-96.6 15:10 911 called, AOx4, EMS doing EKG, 15:13 HR-59, SpO2 98%, 15:15 PT c/o nausea 2/10, not diaphoretic, skin warm to touch, AOx4, 15:18pm EKG NSR per EMS,HR-66, SpO2 -97% 15:22 PT standing BP 131/77, HR 50, SPO2 98%, PT reported feelong "OK" 15:25 PT sitting AOX4, BP 107/70, PT reports "feeling good" also is eating food.


VAERS ID: 1679408 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

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

Write-up: Patient feels dizzy and light headed. She was given water and laid down for 15 minutes. Patient felt immediate relief. She said she has a history of feeling light headed when receiving vaccines.


VAERS ID: 1679513 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

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

Write-up: Treatment: Observation LN responded immediately, PT transferred to cot, walking without difficulty. PT was affable, responding appropriately to questions. PT reported itching to face, right and left arm, and lower back. No evidence of hives, swelling of face/tongue noted. No respiratory distress noted. VS at 900 were BP 124/82, HR 82, RR 18, SPO2 96% RA. EpiPens were made ready, but PT declined EPI treatment or calling 911. PT accepted 50mg Benadryl PO at 0901. PT reported that treatment was effective in reducing itchiness, especially to left arm, 15 minutes after Benadryl administration. VS at 0910: BP 136/80, HR 83, RR 18, SPO2 98% RA. 0920 VS: 134/78, HR 74, SPO2 98% RA. VS at 0930: BP 124/82, HR 76, SPO2 97% RA. PT self-administered 10mg Zyrtec at 0922 from his personal supply. PT remained stable throughout episode of care, with no changes to mentation, vital signs, breathing. PT educated on s/s anaphylaxis, when to seek medical help. PT verbalized understanding of education, reports he plans to take a repeat dose of 50mg Benadryl in 4-6 hours, if needed. PT reports that he is a firefighter and that he would not be home alone. Outcome: PT reported that he felt safe and ready to return home. PT returned to post-observation area to wait through partner?s observation period, will exit with partner. Witnesses: RN, RN, ARNP, RN.


VAERS ID: 1679527 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-04
Onset:2021-09-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Lymphadenopathy
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: .100 Levothyroxine for Hypothyroidism
Current Illness: N/A
Preexisting Conditions: Hupothyroidism
Allergies: N/A
Diagnostic Lab Data: NA rash is still on my shoulder, lymoh gland in neck swells and goes down and sells again.
CDC Split Type:

Write-up: My first Phizer In my left arm lot FA7484 3 days after I was at my desk and got dizzy like i stepped off a carnival ride, a couple different times for about 40 seconds each time, the lymph gland in my right side neck swelled big and soft between my collar bone and neck, and I got a fingertip size rash on my right shoulder, that Is over three weeks trying to heal it to go away. , this second dose Lot FC3184 Left arm, so far I was at my desk today 3rd day since the vaccine, and got a worse dizzy feeling like I stepped off a carnival ride for about a minute, i thought i was going to pass out or faint.


VAERS ID: 1679529 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE 3592 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fatigue, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: She is only allergic to dust and dogs/cats/horses
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: High fever of 102 all day since 9:00 am. Fatigue. Shortness of breath. Dizziness..


VAERS ID: 1679538 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-08-27
Onset:2021-09-07
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F1A / 1 LA / IM

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

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

Write-up: 2 itchy raised welts around the injection site. Patient applied coillodal silver, coconut oil, and CBD oil and they welts have improved within a few hours


VAERS ID: 1679540 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 LA / IM

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

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

Write-up: Pt has received the first dose of Pfizer and was here for the second and the MA administered Moderna.


VAERS ID: 1679542 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: No other illnesses documented at this time
Preexisting Conditions: No known chronic or long-standing health conditions.
Allergies: No known drug & food allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 2nd dose of Pfizer vaccine at 2:00PM and called back to the pharmacy around 4:00PM with complaints of a rash. Patient did not complain of any other symptoms besides the rash and informed us that the rash/hives appeared only on her arms. The pharmacy advised the patient to take benadryl and continue to monitor her symptoms and to seek medical attention if symptoms worsen or do not improve.


VAERS ID: 1679549 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dry throat
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient received first dose Pfizer on 08/16/2021. Patient reported she felt woozy one hour after her vaccination. Patient report
Other Medications: Oral iron
Current Illness: None reported
Preexisting Conditions: Anemia
Allergies: None reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At 1536, patient reported she felt "woozy" and had a "dry throat". RN assessed patient. Patient denied itchiness, rashes, difficulty swallowing, and difficulty breathing. Patient offered water and gatorade. Patient able to drink water and gatorade. Patient reported feeling "woozy" one hour after her first dose (VAERS: 637639). Patient reported she took Tylenol and symptom went away. Patient reported history of anemia, no current medications, and denied history of severe allergic reactions. At 1541, RN assessed patient vital signs: blood pressure 156/100 mmHg, pulse 92 beats/minute and SpO2 98%. At 1550, RN reassessed patient: blood pressure 150/98 mmHg, pulse 93 beats/minute, and SpO2 99%. Patient reported feeling "woozy" and feeling symptom "not as much". At 1601, RN reassessed patient vitals signs: blood pressure 136/100 mmHg, pulse 72 beats/minute, and SpO2 99%. Patient reported she felt "woozy" a "tiny bit but nothing terrible". Patient advised to wait for further observation. Patient denied advise and reported she was "okay" to drive. RN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider and to sign up on v-safe. At 1607, patient left facility with unlabored respirations and steady gait.


VAERS ID: 1679551 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Mouth swelling, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: During post vaccine observation time, patient complained of feeling of swelling in mouth and neck. Provider of the day was immediately called to assess patient and 911 was called. Medics arrived approximately 10-15 minutes after call. Medics took over assessment and noted clear lungs, no signs of distress, only noted elevated BP, recommended patient to be evaluated at ER. Patient declined ambulance, signed AMA for medics stating will go to hospital.


VAERS ID: 1679553 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

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

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

Write-up: over 42 days. 1st dose 03/9/2021, 2nd dose 09/7/2021


VAERS ID: 1679556 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ranexa, aldactone, buspar,effient, norvasc, cozaar, lipitor, gabapentine
Current Illness: CAD, severe obesity, cardiomyopathy, osa
Preexisting Conditions: see above
Allergies: NKDA
Diagnostic Lab Data: positive covid pcr
CDC Split Type:

Write-up: hosp w/ covid


VAERS ID: 1679558 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Client reported feeling itchiness on the back of the head and both arms as well as aching in bones to, RN at 11:22 after receiving the 2nd dose COVID vaccine (Pfizer, Lot #FD0809) in the L arm on 09/07/2021. RN took client vitals, transferred client to zero gravity chair, and provided client a water bottle. Client vitals at 11:23 were BP 130/80 in the R arm sitting upright, HR 70, and RR 15. Lead RN assessed client who presented A&O x4 and denied SOB, chest pain, tingling, numbness, dizziness, and trouble swallowing. No redness or swelling observed. Client stated she did not have an adverse reaction to the 1st dose COVID vaccine and has NKDA. At 11:26 client reported itchiness was was now located at her legs, arms, and back of head. RN offered client IM Benadryl to relieve itchiness and client provided verbal consent. RN drew up 50mg IM Benadryl and RN administered 50mg IM Benadryl in the R arm at 11:26am. Client reported she is not currently taking medication and has no chronic conditions or significant health history. Client took sips of water. At 11:31 RN took client vitals with BP of 135/90 in the R arm sitting upright, HR 135/90, HR 74, and RR 16. At 11:32 client stated the itching was decreasing on her legs and arms but continued on the back of head. Client denied numbness, tingling, swelling, SOB, and trouble swallowing. Client reported body aches were improving but still present in lower legs. Vitals were taken by RN at 11:38 with BP 112/80, HR 72, and RR 16. At 11:40 client reported feeling mild dizziness. Lead RN provided client with juice box, nutrigrain bar, and water bottle. Client took sips of juice and water, and ate the nutrigrain bar. RN educated on side effects of Benadryl, advised client to remain in observation for another 30 minutes, and advised client to call a friend or family member to pick her up from the vaccine site. RN took vitals at 11:43 with BP 128/82, HR 64, and RR 16. Client reported that itchiness and aching was gone in her arms and legs but was still experiencing mild itchiness on the back of her head and neck. At 11:48 client vitals taken by RN were 130/80, HR 68, and RR 14. At 11:55 client denied dizziness while sitting down. Lead advised client to stand up with assistance to assess for dizziness. At 11:58 client stood up and reported mild dizziness. RN advised client to remain in zero gravity chair and provided juice box and chips. Client finished both juice and chips. At 12:08 RN took orthostatic BP: 124/82 sitting down and 130/80 standing up. At 12:11 client reported her itching and dizziness had completely subsided. Client reported she had only had coffee in the morning before receiving the vaccine and stated the "juice and snacks helped a lot". At 12:20 client reported she was unable to find someone to drive her home. Lead RN advised client to contact ride share or taxi services but client declined. At 12:25 client presented A&O x4 and denied dizziness, changes in vision, tingling, numbness, trouble breathing, and chest pain. At 12:28 RN assisted patient with standing up and assessed for dizziness, client denied dizziness when standing, no imbalance or distress while standing was observed. RN observed client walking around the room with a steady, balanced, and symmetrical gait. Client denied dizziness when walking. Lead RN reviewed ER precautions, when to f/u with PCP, and health authority information. At 12:35 client left the vaccine site.


VAERS ID: 1679559 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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
Diagnostic Lab Data: Uknown
CDC Split Type:

Write-up: Patient was given expired vaccine. No symptoms reported.


VAERS ID: 1679720 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Syringe issue, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient received the 1st dose COVID vaccine (Moderna, Lot#014F21A, Exp 09/31/2021) on 09/07/2021 at 4:10pm from RN. RN reported to Lead RN that some of the vaccine leaked from the needle and was wasted during administration. RN assessed amount of vaccine wasted and approximated about 0.2mL of the Moderna COVID vaccine was wasted on the clients are and chair. Lead RN reported information to RN supervisor who advised that re-vaccination is not indicated if less than half the amount of the full dose was wasted. Lead RN approximated client received 0.3mL of the Moderna Vaccine and therefore educated client that he did not need to receive another vaccination. Lead RN provided education and demonstration to RN on tightening needles to syringe before vaccination to reduce errors. RN verbalized and demonstrated understanding.


VAERS ID: 1679721 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-30
Onset:2021-09-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Post-traumatic neck syndrome, Tenderness
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Previous neck injury due to severe whiplash, occured 5 years ago.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states his neck feels like his whiplash is back after 5 years. States neck feels tender to touch.


VAERS ID: 1679726 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache
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: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: PT received 2nd dose Pfizer at 1617, c/o gradual onset headache7/10 and dizziness at 1635. PT was transferred to WC, then to cot. Reported feeling better lying down. No LOC noted. VS at 1637: BP 102/70 laying, HR 76, SPO2 99% on RA. No s/s respiratory distress. 1640: 120/54 BP laying, HR 72, SPo2 99% RA. PT was provided cold compress at 1644, accepted and drank juice. PT denies nausea and reports she ate lunch and had fluids last at 1300. VS at 1643: BP 108/62, HR 74, SPO2 99% RA. 1647: BP sitting is 124/78, HR 83, SPO2 99% RA, RR 18. Reports HA is 5/10 at 1649. PT reports she had no problems, SE after first dose. At 1651, PT stood without difficulty, verbalized that he head felt ''good'' and pain was 2/10. Denies dizziness, reports that she feels ''back to normal. VS at 1651: BP 164/84 standing, HR 92, SPO2 99% RA. 1655: BP 140/86 sitting, HR 72, SPO2 99%. Standing BP at 1655 is 128/64. PT reports that she is back to baseline, denies further headache, dizziness, walks a short distance at 1700 with no difficulty. PT educated on vasovagal reaction, verbalized understanding. Exited facility with mother at 1702.


VAERS ID: 1679733 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), 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: no
Preexisting Conditions: no
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient passed out but was able to recover upon getting her on the ground and lifting her feet.


VAERS ID: 1679737 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, 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), 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: pt stated similar previous reaction after receiving HPV vaccine
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt bobbed her head while seated, appearing to briefly pass out during the 15 minute monitoring period after receiving a dose of moderna covid-19 vaccine. Pt remained upright sitting in chair and did not fall. Pt was given juice and water, and offered to call 911 several times; pt refused each time. Pt was told to remain under observation for 30 minutes instead of 15. After 30 minutes pt stated she felt better, still did not want us to call an ambulance and left the store. Although on the VAR form pt indicated that she has never had a reaction after receiving a vaccination, the pt later told technician that she had a similar reaction after getting a HPV vaccine. today''s event has been reported through the VAERS system. I called pt an hour and a half after, pt states she was doing okay, I encouraged pt to contact her primary care physician with any further questions or concerns. I also contacted pt''s primary care provider listed on VAR sheet, the prescriber''s MA said she would reach out to the pt tonight or tomorrow to follow up with the pt.


VAERS ID: 1679743 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

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

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

Write-up: Approximately 10 minutes after I gave the patient her Moderna vaccine, she got my attention and said her cheeks felt flushed. I went out to her and 1 cheek was definitely red and the other slightly pink. She took a couple of drinks of water that she had and said she felt ok, just flushed. She said her tongue and lips did not feel funny, but she had her dentures in and said it was hard to "sense" anything. I asked her to stay in the store longer than the 15 minutes just to make sure everything was ok. The patient stayed for around 40 minutes and her cheeks returned to normal while she was here. She said she felt fine. I asked the patient to call me after she got home and let me know how she was feeling. She called me at 8:05pm and said she was feeling fine.


VAERS ID: 1679746 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM

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

Write-up: Pt and her mother came to pharmacy 09/4/21 and asked for vaccine covid-19. Pharmacist gave her Pfizer for her age. 09/07/2021 when reporting her vaccine into immunization registry, Pharmacist found that pt. already completed her series of 2 and second dose was 06/22/21. Pharmacist contacted the pt''s. family and her sister, she stated that she already knew that pt. got the 3rd dose of Pfizer. Sister stated that her pt. and mother needed to go for COVID testing but ending up got vaccinated; this was due to the miscommunication between pharmacy and pt. Pharmacist failed to check the immunization registry prior to giving vaccine as well as the in completed questionnaire sheet According to sister, pt. is Ok at this time, no adverse reaction experienced. Pharmacist will further follow up Pharmacist contacted pt. primary care doctor and was advised that her doctor will discuss with family about the extra dose she received in the next visit.


VAERS ID: 1679750 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:1954-02-05
Onset:2021-09-07
   Days after vaccination:24686
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Fluoxetine Trazadone Hydroxyzine
Current Illness: Polysubstance Abuse
Preexisting Conditions: Drug abuse Alcohol abuse
Allergies: NKA
Diagnostic Lab Data: 911 called patient is sent to emergency rooms in stable condition be a 911 ambulance
CDC Split Type:

Write-up: Patient returned to vaccine clinic at 11 AM and reported that he was dizzy with associated chest pain and shortness of breath.


VAERS ID: 1679752 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Write-up: Patient was accidently given Pfizer for second COVID dose instead of Moderna. He did not have any apparent adverse events.


VAERS ID: 1679755 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Unknown  
Location: Oregon  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / 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: Unk
Preexisting Conditions: Unk
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt gave birthdate a year later than birthdate given in the medical record. Possibility exists pt was 11 instead of 12 years when given first dose of Pfizer.


VAERS ID: 1679949 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Diarrhoea, Injection site pain, Migraine, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aimovig Prozac Multivitamin
Current Illness: N/A
Preexisting Conditions: Migraines Major depressive disorder
Allergies: Hydrocodone Pollen- tree, grass, weed Pineapples Bananas Latex
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Migraine Injection site pain Pain in legs, so bad I can barely walk Nausea Diarrhea


VAERS ID: 1679972 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Posture abnormal, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: uknown
Allergies: Tylenol causes itchy throat but she doesn''t carry epi-pen ok to take IBUprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was waiting after receiving shot, loss consciousness and head tipped back, off duty paramedic who was in waiting room jumped to assist and put her head strait and she regained consciousness . we called 911, pt started to look better then she vomited and stated she felt better. fire department came and checked her out. She refused to go to hospital and was able to walk out.


VAERS ID: 1679973 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-30
Onset:2021-09-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / SYR

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

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

Write-up: 1 week after injection, my left arm now has a rash, some swelling, a lump, warm to the touch and itchiness at the injection site.


VAERS ID: 1680145 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dyspnoea, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Patient complained of dizziness, nausea, headaches (similar to the 1st dose) starting this morning (around 24 hours after receiving the shot). However, there''s chest pain & shortness of breath this time. Pt said she could not breath without opening her mouth. She tried Tylenol 500mg & Ibuprofen 800mg today, but the symptoms could not resolved or better. I told patient to see urgent care tonight and let us know later.


VAERS ID: 1680274 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hyperventilation, Hypoaesthesia, Paraesthesia, Tremor
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient experienced shaking of hands, sweating, and lightheadedness approximately 3 to 5 minutes after administration. Patient started to feel "pins and needles" feeling in hands and fingers 1 minute after. No swelling of the throat or mouth or blockage of airway was observed. 911 was dialed after symptoms of numbness and tingling of hands and fingers, sweating and heavy breathing were persisting after 2 minutes. Stayed with patient until emergency services arrived. While waiting, patient''s symptoms of heavy breathing begin to subside


VAERS ID: 1680281 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hyperhidrosis, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: patient experience syncope ( feeling faint, dizzy, nauseated, sweating) and had a headache


VAERS ID: 1680284 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Eye movement disorder, Fall, Hyperhidrosis, Pallor, Tremor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PATIENT LISTED NO MEDS AND HAD NO PCP
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: WITHIN MINUTES PATIENT WAS PALE, SWEATY AND UNRESPONSIVE, FELL TO HIS SIDE ON THE BENCH, EYES ROLLED BACK AND SHAKING /JERKING WERE WITNESSED. AMBULANCE WAS CALLED AND PATIENT WAS TRANSPORTED TO HOSPITAL. WITHIN A FEW MINUTES, WITH ASSISTANCE AND USE OF ICE PACKS ON HEAD, NECK AND PALMS , PT SLOWLY RETURNED TO NORMAL BEFORE AMBULANCE ARRIVED


VAERS ID: 1680288 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient became dizzy, clammy and was having trouble walking. Had patient lie on the floor for about 5 minutes and was feeling better. He then sat in a chair for about 15 minutes and felt fine to leave.


VAERS ID: 1680300 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Nausea, Pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to a specific psych medication
Diagnostic Lab Data: No test, given Zofran at urgent care at 8:42 on 9/7/21
CDC Split Type:

Write-up: Throwing up, body aches, nauseous, weakness and trouble breathing. It started about 1.5 hours after injection


VAERS ID: 1682076 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / 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: 1682077 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Fatigue, Flushing, Hyperhidrosis, Immediate post-injection reaction, Lethargy, Nausea, Pain, Tinnitus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Body Aches Generalized-Mild, Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Mild, Systemic: Tinnitus-Mild, Systemic: Weakness-Mild, Additional Details: Patient received vaccine and immediately after complained of dizziness, weakness, feeling nauseated and sweatiness. Pharmacist on duty gave patient water and some candy and some sugar, in case of low blood sugar. Patient diabetic. Patient waited 15-20 minutes; stated he felt better and went home. We asked that he call the pharmacy later this evening if he had any other issues regarding the vaccination today.


VAERS ID: 1682079 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Error: Booster Given Too Early-


VAERS ID: 1682173 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Hyperventilation, Respiration abnormal, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Flushed / Sweating-Severe, Systemic: Hyperventilation-Severe, Additional Details: Immediately before, during, or after vaccine administration, the patient started breathing very fast & loudly nasally while starring wide eyed straight ahead of himself & would not respond to his environment or commands. This lasted anywhere from 10-20 seconds. Once patient regained consciousness, he calmned down & began sweatting profusely. Paramedics were called & cleared him on the condition he call if he experienced signs & symptoms again & to follow up with his PCP.


VAERS ID: 1682185 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1682196 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium


VAERS ID: 1682197 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Hypertension-Medium, Additional Details: Patient reported waves of feeling like her heart was racing shortly after receiving covid vaccine. BP 143/96, HR 72. Patient refused to lay down. Patient then said history of tachycardia, possibly occuring because dinner time and hungry. I gave her a chocolate chip granola bar and water. About 30 minutes post vaccination, patient reported chest pain. I then called 911 and EMS came to assess her. She opted not to be transported and went home. She will f/u with her cardiologist.


VAERS ID: 1682198 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Injection site erythema, Injection site pain, Injection site pruritus, Injection site reaction, Injection site swelling, Lymphadenopathy, Muscle tightness, Myalgia, Paraesthesia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (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: 1st dose of Moderna vaccine: Sore arm; felt as thought I worked out very, very hard the previous night. Age: 22. Date recieved:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm. Originally felt a tingle down my arm only minutes after receiving the vaccine. Now, the area around injection site is red in color, swollen/welted/raised, itchy, and sore as of two days after the second dose. Reaction site is approximately 2x3 inches around injection. Armpit is swollen and achey, possibly due to lymph nodes swelling. Shoulder/neck muscles are sore and tense. Whole arm is tingly occasionally. Joint pain, especially in the hand. Seems to be getting worse over time. Tried massaging the area, and it becomes more itchy.


VAERS ID: 1682203 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, Malaise, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Hypotension-Severe, Additional Details: After about 5 minutes after getting the vaccine (@around 7:20pm), pt said she did not feel well and needed some water. Pt looked very pale. I gave her water and measure her temperature @7:20pm 94.4F, @7:25pm 94.7F, @7:30pm 95.4F, @7:45pm 96.7F. Blood pressure: @7:27pm 98/62/55, @ 7:35pm 84/61/low, and @7:42pm 114/72/66. At around 7:45pm, pt said she felt fine and was ok to leave,


VAERS ID: 1682400 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Systemic: Vomiting-Mild, Additional Details: PATIENT COMPLAINED THAT SHE IS ABOUT TO FAINT AND THEN SHE HAD VOMITING. SHE STARTS TO FEEL BETTER AFTER VOMITING.


VAERS ID: 1682402 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-18
Onset:2021-09-07
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Fatigue, Productive cough, SARS-CoV-2 test positive, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Elevated troponin - 442.0 pg/mL - on 9/7/21 Positive COVID-19 PCR test on 9/7/21
CDC Split Type:

Write-up: Patient was hospitalized due to shortness of breath, productive cough, and fatigue in addition to an elevated troponin result. He was coincidentally tested for COVID-19 which was positive.


VAERS ID: 1682411 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-30
Onset:2021-09-07
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Transfusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: I haven?t had a period in almost two years since I?ve been pregnant and breastfeeding and am now having the heaviest period I?ve ever had and saturating through my tampons past my undergarments. My SIL was hospitalized for the same reason and received two transfusions.


VAERS ID: 1682415 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 - / IM

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

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

Write-up: Patient was given a syringe of pfizer on 9/7. Vaccine had been drawn into syringe on 9/3 and was in the fridge until time of administration. Stability once drawn up is 6 hours.


VAERS ID: 1682433 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ADEN_4_7: ADENOVIRUS TYPES 4 & 7, LIVE, ORAL (NO BRAND NAME) / TEVA PHARMACEUTICALS 34600561 / UNK MO / PO
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS P49X7 / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U7190AA / UNK - / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 575HC / UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. U007475 / UNK - / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 15 minutes following immunizations patient experienced hives


VAERS ID: 1682439 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-03
Onset:2021-09-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (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: Emergency room physician saw patient on 09/07/21, approximately 4 days after 2nd dose of Pfizer Covid vaccine. MD reports patient appears to have shingles on nose, lower lip, and left cheek.


VAERS ID: 1682459 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

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

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

Write-up: Employee calling to report a reaction after receiving a COVID-19 vaccine. Vaccine Name - Pfizer Vaccine Date - ? 09/07/2021 Is this your first or second dose- 2nd Date of symptom onset - ? 09/07/2021 Symptoms - ? stated he had fever of 101, Headache, Body aches, and uncontrollable shivering that lasted 5 minutes Last day of work and shift - ? 09/07/2021 Home remedies- stated he took Advil at 8pm on 9/7/2021 and Tylenol at 3am on 9/8/2021 Any improvement- stated the Tyelonol helped with the HA, body aches, and fever Recommendation- Advised to continue taking Advil and Tylenol per package instructions for pain and fever. Advised if symptoms persist, worsen or ones develop to follow up with PCP. Employee voiced understanding Employee of information ? Yes Employee voiced any concerns ? No Employee''s questions answered to employee?s satisfaction -Yes


VAERS ID: 1682484 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-04-28
Onset:2021-09-07
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 002B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: KETOTIFEN DROP, ACETAMINOPHEN, FLONASE, CETIRIZINE, PREDNISONE, AZITHROMYCIN, BENZONATATE
Current Illness: CLOSED FRACTURE OF METACARPAL, LOWER RESPIRATORY TRACT INFECTION
Preexisting Conditions: HTN, IRON DEFICIENCY, OSTEOARTHRITIS, CHRONIC LOW BACK PAIN, HYPOTHYROIDISM, ALCOHOL ABUSE, MIXED HYPERLIPIDEMIA
Allergies: NKA
Diagnostic Lab Data: 09/07/21: POSITIVE POC SARS COVID RAPID ANTIGEN (QUICKVUE)
CDC Split Type:

Write-up: UNKNOWN AT THIS TIME


VAERS ID: 1682492 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / IM

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

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

Write-up: Administered Moderna Covid Vaccine to 15 year old patient, instead of Pfizer Covid Vaccine.


VAERS ID: 1682501 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: denies per consent
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: pt had fist dose here on 08/17/2021 for second dose Pfizer, however when we went to document it in system we found he had received 2 doses of Pfizer at vaccine site . Pt has had a total of 4 doses all Pfizer


VAERS ID: 1682507 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-28
Onset:2021-09-07
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 - / -

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

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

Write-up: hospitalized on 9/7/21, SARS-CoV-2 positive


VAERS ID: 1682518 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / IM

Administered by: Work       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: None known
Current Illness: None known
Preexisting Conditions: 5/23/2018 Childhood Obesity. BMI on 7/27/2018 is 39.7.
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient arrived at clinic for 2nd Moderna Covid19 vaccine. The nurse took a syringe from the Pfizer container that was sitting on the desk and administered Pfizer vaccine. The patient was observed for 25 minutes after the injection and had no adverse reaction. The patient was educated on signs and symptoms of severe allergic reactions to the vaccine.


VAERS ID: 1682543 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2021-09-07
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Fatigue, Malaise, Pain, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient is a 74-year-old female with past medical history of essential hypertension, obesity, chronic kidney disease and diabetes mellitus .
Allergies:
Diagnostic Lab Data: COVID positive by PCR on 9/7/2021
CDC Split Type:

Write-up: Patient has been feeling shortness of breath with a productive cough, fatigue, malaise, and generalized body aches for about 3 weeks (beginning mid August?). She presented to the hospital on 9/7/21 and tested positive for COVID.


VAERS ID: 1682544 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-19
Onset:2021-09-07
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1682549 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-10
Onset:2021-09-07
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / IM

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

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

Write-up: patient tested positive 9/7


VAERS ID: 1682563 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-19
Onset:2021-09-07
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram abnormal, COVID-19, Decreased appetite, Dizziness, Dyspnoea, Electrocardiogram ST-T segment abnormal, Intensive care, Pulmonary embolism, SARS-CoV-2 test positive, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No significant PMHx
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/7/21: Patient arrived at the ER due to sinus congestion, shortness of breath, decreased appetite and one episode of dizziness. Patient tested positive for COVID on 9/7. Patient was brought to the ICU on 4L NC satting at 100%, CTA chest showed bilateral large volume PEs with RV strain.


VAERS ID: 1682568 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-12
Onset:2021-09-07
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was fully vaccinated for COVID but was hospitalized for COVID symptoms on 9/7/2021 at Hospital


VAERS ID: 1682576 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-29
Onset:2021-09-07
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6206 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated for COVID on 3/8/21 and 3/29/21, but hospitalized with COVID symptoms on 9/7/21


VAERS ID: 1682594 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immunisation, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received dose #2 of Pfizer vaccine on 6/10/2021 and was notified by email that vial was left in freezer past recommended time frame. Medication expired beyond its freezer allowable date. Email recommended patient get re-vaccinated with dose again. Physicians re-administered dose on 9/7/2021 as recommended. No adverse reactions identified on site.


VAERS ID: 1682596 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-09-07
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Fall, Femur fracture, Lung opacity, Pulmonary vascular disorder, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Interstitial lung disease (narrow), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amiodarone, apixaban, ASA, furosemide, u-500 insulin, keppra, metoprolol, rosuvastatin
Current Illness: no
Preexisting Conditions: Obesity, Asthma, CVA, Paroxysmal atrial fibrillation, CAD, Chronic systolic heart failure, Hypertension, Diabetes type 2, Hyperlipidemia, CKD stage IV, Anemia, Hodgkin''s lymphoma, Seizure disorder
Allergies: percocet
Diagnostic Lab Data: Covid + PCR 9.7.2021. CXR: reveals prominence of pulmonary vasculature with airspace opacities most notably left lung
CDC Split Type:

Write-up: Breakthrough case. Posible CAP on CXR. Other admission reason L femur fx secondary to fall


VAERS ID: 1682597 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-13
Onset:2021-09-07
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

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

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

Write-up: Breakthrough case. Covid positive on 9/7/2021 by PCR test


VAERS ID: 1682607 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-09-07
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed COVID-19 requiring hospitalization post-vaccine.


VAERS ID: 1682611 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-09-07
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: DM 2, breast Ca, asthma
Allergies: Sulfa drugs
Diagnostic Lab Data: CVID swab-positive
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1682620 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called 9/8/21 stating that she had pain in her arm and is unable to use it. She is concerned that her vaccine was given to high and possibly in the bursa. She was contacting her primary care as well.


VAERS ID: 1682637 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-23
Onset:2021-09-07
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Malaise, Pyelonephritis acute, SARS-CoV-2 test positive, Sepsis, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, ASA, biotin, vitamin D, estradiol, fluoxetine, meclizine, rosuvastatin, spironolactone, tolterodine, trazodone
Current Illness: no
Preexisting Conditions: TIA, CAD, hyperlipidemia, GERD, Nephrolithiasis, Arthritis, Anxiety
Allergies: iodine, bee sting, sufa, polyester, diatrizoate, percocet
Diagnostic Lab Data: covid + 9/7/2021, symptom onset 8/31/2021, CXR clear
CDC Split Type:

Write-up: breakthrough case, mild symptoms, admission for acute pyelonephritis w/ sepsis


VAERS ID: 1682654 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor, Singulair, Claritin, Dupixent, birth control
Current Illness:
Preexisting Conditions: Asthma, Atopic Dermatitis
Allergies: Shellfish, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Face and arms became red and blotchy. Chest became red. Neck felt heavy


VAERS ID: 1682660 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 RA / IM

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

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

Write-up: Vaccine administration error, unauthorized age group


VAERS ID: 1682680 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Concerta 36mg once daily
Current Illness: Pregnancy-induced hypertension
Preexisting Conditions: Asthma
Allergies: Anaphalactic reaction to Benadryl
Diagnostic Lab Data:
CDC Split Type:

Write-up: At approximately 15:20, client received 1st COVID vaccine (Janssen, lot #206A21A exp 09/21) at approximately 15:20. Client received vaccine in a zero gravity chair due to reports of history of dizziness during vaccines. Client remained in zero gravity chair for a 30 minute observation. At 15:35, client reported feeling lightheaded and experiencing left arm pain at injection site. Nurse responded. Client denies SOB, swelling of mouth, tongue, throat; denies itching; client does c/o headache to which she commented "probably because of my anxiety". Client commented "I think I''m feeling lightheaded"; We reclined patient in chair, offered juice and granola bar (client accepted juice, declined granola bar). Client commented "I''m having pain where I was vaccinated". Client is 6 months pregnant, reports a history of asthma and pregnancy-induced hypertension. Client takes Concerta 36mg once daily. Client has severe allergic reaction (anaphylaxis) to Benadryl. Vital assigns were measured: 15:38 - Blood Pressure 148/90; Pulse 70; Respiratory Rate 12 15:55 - Blood Pressure 138/90; Pulse 66, Repiratory Rate 10 Client Alert/Oriented to person, place, time, situation. Client reports feeling anxious about getting the vaccine, commenting "my family is anti-vaccine but I had to come get the vaccine so I could keep working at my job or I''ll be out of compliance" and "I think I''m feeling lightheaded because of my anxiety about it". Nurse observed client appearing tearful 3-4 times throughout observation period. At 15:55, client reports lightheadedness resolved, continues to deny shortness of breath, swelling or itching; reports headache resolved. Client reported feeling able to stand and walk. Nurse assisted client to standing position and observed client walking. Client reported she felt ready to leave and safe to drive. Nurse observed client with steady gate out of the vaccine area and down the lobby corridor. Lead nurse provided education to client on when to seek care.


VAERS ID: 1682690 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-09
Onset:2021-09-07
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR test positive on 09/07/2021. Hospitalized on 09/07/2021
CDC Split Type:

Write-up: Developed Covid-19 after complete vaccination


VAERS ID: 1682697 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-29
Onset:2021-09-07
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Hip fracture, Infection, SARS-CoV-2 test positive
SMQs:, Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, atorvastatin, budesonide/formoterol, metformin, MVI, senna, trazodone
Current Illness: no
Preexisting Conditions: COPD, CAD, HTN, hypothyroid, stroke, ETOH abuse, DM
Allergies: nkda
Diagnostic Lab Data: PCR + 9/7/2021 when planning dc to SNF following hospitalization for hip fx
CDC Split Type:

Write-up: breakthrough + but asymptomatic


VAERS ID: 1682710 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Speech disorder, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: Swollen tongue, unclear speech


VAERS ID: 1682728 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-01
Onset:2021-09-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A211A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Activated partial thromboplastin time, Burning sensation, Chest X-ray, Differential white blood cell count, Dry mouth, Electrocardiogram, Facial paralysis, Full blood count, Head discomfort, Headache, Lipase, Magnetic resonance imaging head, Metabolic function test, Muscular weakness, Nasopharyngitis, Neck pain, Paraesthesia, Prothrombin time, SARS-CoV-2 test, Tremor, Troponin, Urine analysis, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (broad), Arthritis (broad), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Raynauds
Preexisting Conditions: Chronic migraine
Allergies: Shellfish, verapamil, topomax (critical); Antibiotics (mild)
Diagnostic Lab Data: Head MRI, EKG, chest x ray, APTT, COVID-19 PCR, complete blood count with automated differnrential, comprehensive metabolic panel, lipase, prothrombin time, sars cov-2 PCR, toponin, UA
CDC Split Type:

Write-up: Intense stomach pains 3 days after shot, 6 days after shot, stomach pains, blurry vision, almost like the beginning of a migraine, cold, headache, droopy left face, shaking, weak left arm and leg, front head in a vice, back of head tingling with fire, cottonmouth, back left side of neck hurts too


VAERS ID: 1682729 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait inability, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (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: Venlafaxine ER, Amitriptyline - has been taking for years per husband
Current Illness: none that pt reported
Preexisting Conditions: unknown other than has been on an antidepressant for years
Allergies: none known by the pharmacy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient''s husband reported that her arm pain started shortly after injection. It got worse and spread to her right arm and foot. The pain was so intense by 8:30 pm 9/7/2021 that she couldn''t walk. She may have had a little fever at night on 9/7/2021. She did take some Ibuprofen. Husband reports that she might have been a little better this morning. He came to the pharmacy around 11 am on 9/8/2021 wanting us to contact her PCP for pain medication. He refused to take her to the ER because of the wait times. He also refused to contact the dr''s office himself. I contacted the doctor, who the patient''s husband reported as her PCP. The physician''s office said that they could not find her as an established patient but they would be happy to talk to the patient if they called. I relayed this information to the patient''s husband and he was going to have her call doctor office.


VAERS ID: 1682731 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-09-07
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, COVID-19, Dizziness, Dyspnoea, Headache, Hypotension, Nausea, Palpitations, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient tested positive for Covid at Hospital on 9/07/2021. Has received Pfizer vaccine with 1st dose on 02/22/2021 and 2nd dose on 03/15/2021 per ED Note: Patient is a 76-year-old female with past medical history of benign essential hypertension, diverticulosis and dyslipidemia presenting to emergency department with chief complaint of hypotension and shortness of breath. Patient states that she tested positive for COVID-19 viral illness on Tuesday of last week. She states that since that time she has been experiencing mild shortness of breath. She also states that yesterday she had a temperature of 102 Fahrenheit and oxygen saturation of 90% on room air. This morning she states that she is feeling some dizziness in addition to her shortness of breath, headache and also states that her heart "feels like it is beating hard." She is also describing some nausea and a cough beginning yesterday which is productive of "white sputum." Patient denies vomiting, loss of taste or smell, chest pain, abdominal pain, numbness, weakness or tingling her extremities.


VAERS ID: 1682751 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A LA / IM

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

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

Write-up: Student was supposed to have her second dose of Pfizer but was given mistakenly J&J at 0.3ml dose.


VAERS ID: 1682760 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Vitreous floaters
SMQs:, Retinal 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: Vit D
Current Illness: None
Preexisting Conditions: Leukopenia
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sudden onset of eye floaters


VAERS ID: 1682776 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Abdominal pain, Chills, Fatigue, Headache, Myalgia, Pyrexia, Respiratory tract congestion
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa antibiotics
Diagnostic Lab Data: No e
CDC Split Type:

Write-up: Chills, headache, fever, fatigue, muscle aches, abdominal pain, congestion beginning 2230 on 09/07/2021.


VAERS ID: 1682782 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest pain, Chills, Fatigue, Hyperhidrosis, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever (104F), severe body aches, weakness, chest pain, fatigue, sweating, chills. These items lasted from approximately 6pm on 9/7, until 5am 9/8 and have been beginning to subside since then.


VAERS ID: 1682788 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-09-07
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamins with Minerals oral Cap Sig: Take 1 capsule by mouth Daily. citalopram (CELEXA) 20 mg oral tablet Sig: Take 20 mg by mouth once daily. hydroCHLOROthiazide (HYDRODIURIL) 25 mg oral tablet Sig: Take 25 mg by mouth once daily.
Current Illness:
Preexisting Conditions: ? COPD (chronic obstructive pulmonary disease ? Heartburn ? HTN (hypertension) ? Hypothyroid ? Renal disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID RESULT 9/7/21. KNOWN EXPOSURE ON 9/2/21 FROM FAMILY MEMBER


VAERS ID: 1682811 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-31
Onset:2021-09-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

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

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

Write-up: Patient reports itching and red rash around injection site starting 7 days post vaccination.


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