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

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



Case Details (Reverse Sorted by Onset Date)

This is page 254 out of 5,069

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VAERS ID: 1371056 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Fatigue, Flushing, Headache, Hyperhidrosis, Lethargy, Pallor, Tinnitus, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Headache-Medium, Systemic: Shakiness-Mild, Systemic: Tinnitus-Mild, Systemic: Weakness-Mild, Additional Details: few minutes after given the covid pfizer vaccine, patient felt like he was going to black out and had ringing in his ears. He was having chills and sweats. his face was becoming more pale than normal. Pt was given orange juice and a protein bar. After 911 was called, his face seemed to have gotten its color back and he did state that he did felt better than before. EMT took him away to the hospital. the patient came back few hours later, and he stated that he felt better and is doing okay now.


VAERS ID: 1371063 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A1A / 1 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1371065 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 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: 1371068 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 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: 1371069 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

Administered by: Other       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: KNA
Diagnostic Lab Data: Medically monitored overnight.
CDC Split Type:

Write-up: Youth received 2nd dose 5 days after 1st dose inadvertently.


VAERS ID: 1371071 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

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

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

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


VAERS ID: 1371078 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: Gave Benadryl 25mg. BP 110/66, O2 SAT: 98. Patient was monitored for 30 minutes - had no further reaction.


VAERS ID: 1371080 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not aware of any medications.
Current Illness: None stated at this time.
Preexisting Conditions: None stated at the time of vaccine.
Allergies: Not aware of any allergies.
Diagnostic Lab Data: None stated.
CDC Split Type:

Write-up: Patient received his first dose of Moderna vaccine at pharmacy, noted in vaccine system. Pharmacy refused to give his second dose to complete the COVID -19 vaccine series. Mom contacted the Department of Health to complete his COVID-19 vaccine series. On 6-2-21 mom and patient came in to receive his second Moderna vaccine. Patient stated his only symptom with his first Moderna vaccine was fatigue. Patient was administered his second Moderna vaccine without any adverse events.


VAERS ID: 1371081 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: Patient had previously experienced dizziness after 1st dose of Moderna. Was given benadryl 25mg 30 minutes prior to vaccine, but patient still experienced mild dizziness. Patient was monitored for 30 minutes with no further reaction.


VAERS ID: 1371085 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Hypotension, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Hypotension-Medium, Additional Details: Patient fainted after dose and was slow to respond to questions. BP: 70/40, 65/40. Patient states he did not eat very much during day prior to vaccine. Patient was kept for observation for 45 minutes until recovered, still shaky/dizzy afterward.


VAERS ID: 1371095 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Pain in extremity, Vaccine positive rechallenge
SMQs:, Peripheral neuropathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced numbness/pain in L mid-arm and hand with 15 minutes following injection. Patient reports having same reaction after the 1st vaccine given 4/29/2021. At that time, patient followed up with PCP who prescribed Naproxen 500mg q day, Claritin, Omeprazole, and Ibuprofen prn. Patient was given 25mg Benadryl following 2nd reaction and instructed to stay in observation area an additional 15 minutes. She reported improvement in L hand numbness; no change in forearm status. Patient instructed to f/u with PCP.


VAERS ID: 1371101 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: patient reports blurred vision and light headed. Vitals stable. patient asked to lay down with legs elevated. cold water given patient became fine in 15 minutes


VAERS ID: 1371102 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Headache-Mild, Additional Details: Pt fainted about 5 minutes after injection for less than 1 min. Did not require EMS call. Pt sat for 20 minutes before leaving and drank water. Slight headache also reported. Pt states this has happened about 10 years post vaccination - most likely panic attack, not a fan of needles.


VAERS ID: 1371103 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-03
Onset:2021-06-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Lagophthalmos, Magnetic resonance imaging normal, Muscle contractions involuntary
SMQs:, Dementia (broad), Dystonia (broad), Noninfectious encephalopathy/delirium (broad), Periorbital and eyelid disorders (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: MRI with contrast was done. It was normal.
CDC Split Type:

Write-up: I had a left side face contraction and my left eye was only half way opened for one minute. after my first dose I had an episode of memory loss that last 5 seconds but it was a total "blank"


VAERS ID: 1371104 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 RA / IM

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

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

Write-up: Systemic: Seizure-Severe


VAERS ID: 1371106 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: Patient was sitting in the waiting area and started to feel faint, started sweating and saying he was going to pass out. He sat down on the floor and the pharmacist attending him became very worried about the diaphoresis and we called 911. Patient was given water and an ice pack, by the time EMS arrived he was sitting upright again and felt fine, denied care from EMS.


VAERS ID: 1371107 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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-Medium


VAERS ID: 1371110 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Increased temperature to 101.8F.


VAERS ID: 1371126 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Nausea, Product preparation issue
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Nausea-Mild, Error: Incorrect Reconstitution


VAERS ID: 1371130 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Incorrect Reconstitution


VAERS ID: 1371131 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

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

Write-up: Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Tingling of center part of tongue. No swelling.


VAERS ID: 1371140 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 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-Mild, Additional Details: Patient fainted while walking down aisle with dad. She immediately regained consciousness. Although she was conscious, EMTs were called to assess vitals. She was cleared by the EMTs to go home. No injuries were sustained.


VAERS ID: 1371143 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

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

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

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1371157 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Chills, low grade fever, headache, fatigue


VAERS ID: 1371164 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Deafness neurosensory, Deafness unilateral
SMQs:, Hearing impairment (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: Animal dander mite extract
Diagnostic Lab Data: Patient will be receiving MRI in next few days to rule out other causes
CDC Split Type:

Write-up: Patient had severe unilateral sudden sensorineural hearing loss upon waking morning after vaccination. Seen here at ENT and is being treated with oral high dose steroids as well as intratympanic steroid injections


VAERS ID: 1371166 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LOT #EW0191 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: type 2 diabetic ...medication Metformin
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I''ve been experiencing itching through the night and slight headaches


VAERS ID: 1371167 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Chills and shivering, fever, head ache and nausea started about 12 hours after injection. Shivering went away after I put on more layers and warmed up, fever head ache and nausea lasted for about 12 hours. Symptoms were gone approximately 36 hours after injection


VAERS ID: 1371175 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Cyanosis, Dizziness, Nausea, Tinnitus, Visual impairment
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Reports ate a few peanut butter pretzels today. Reported lightheadedness that resolved within about 1 minute, followed by seeing spots for about 2 minutes resolved, momentary tightness on inspiration that resolved, and ringing in ears for about 3 minutes resolved. Later reported nausea on ambulation post vaccination to seat in observation area that resolved upon sitting down. Also, reported has history of similar s/sx with flu vaccination. Denies chest pain and other s/sx. Nurses responded with emergency cart. 01:47pm LUE 96/70 pulse regular R20, lungs clear, lips noted to be dusky/purplish. Benadryl 50mg PO x1 administered. Lips color reassessed and after few minutes returned to usual pink color. Reports nausea, lightheadedness, visual spots, and ringing in ears resolved, all s/sx resolved, stated "I feel normal". Counseled follow up with pediatrician, urgent care or emergency department for any return s/sx, Mom verbalized understanding. Observed for 30 minutes. Ambulated with steady gait off floor with his parent and sibling.


VAERS ID: 1371180 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 RA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mass, Pain in extremity, Peripheral swelling, Pruritus, Rash, Skin warm, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: coq10, prenatals, dexillant, albuterol
Current Illness: Severe asthma, Prior cold
Preexisting Conditions: Asthma
Allergies: erythromycin, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Painful arm, Itching, swollen , Warm to touch rash, Large rash/lump/urticaria


VAERS ID: 1371184 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

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

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

Write-up: Coronavirus 04/30/2021 1 of 2 COVID-19, mRNA,LNP-S,PF, 100 mcg/0.5mL [Moderna COVID-19 Vaccine ?] 06/02/2021 2 of 2 COVID-19, mRNA,LNP-S,PF, 30 mcg/0.3mL [Pfizer COVID-19 Vaccine ?] Client presented card and vaccinator didn''t noticed that the first dose was a moderna and client was given pfizer for 2nd dose. Vaccinator educated to ensure that correct vaccine is given and that patient could have been rescheduled to received the correct vaccine. Vaccinator verbalized understanding. Client informed of error.


VAERS ID: 1371194 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-19
Onset:2021-06-02
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Pain, 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: SARS COV2 PCR positive 6/2/21
CDC Split Type:

Write-up: Tested on 6/2 due to upcoming travel. Bodyaches and low grade also reported on 6/2.


VAERS ID: 1371216 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Flushing, Salivary hypersecretion, Skin oedema, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: VIIS ID: 41412; Pfizer COVID-19 Vaccine Vaccine Lot Number: Ew0178 2nd dose; vagal faint after vaccine#2 pfizer, hx of anxiety and vagal reaction, + 10-15 secs LOC no fall, no trauma, no neck pain/stiffness. increase oral hydration. Apprehension, flushing and/or skin edema, moderate ETOH night before. faints with vaccinations and tattoos. 540pm 140/88, P-70, R-20 POX 99%; 5:50 147/80, p-66, r-20, Pox-99%. Pt d/c home-friend driving him home.


VAERS ID: 1371217 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Diarrhoea, Head discomfort, Lethargy, Malaise, Pain in extremity, Sleep disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament 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: Shingles vaccine with swelling and red, warm area. She went to her PCP and they said that they were going to report it. There
Other Medications: Metformin, Omega 3, Lisinopril, Atenolol, Amlodipine, Simvastatin.
Current Illness: None.
Preexisting Conditions: Diabetes, high blood pressure, high cholesterol.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine at 4:00, felt fine, no problems. Then about 1-2:00 AM on 6/2/21 all of a sudden she had diarrhea and was up all night with that. She did throw up once. The next day she had chills and her head had pressure in it, just did not feel well, lethargic, did not want to go anything or do anything. Her arm was painful, but nothing that she could not tolerate. No swelling to the arm. Today, 6/3/21 she woke up and she is fine. She drank a lot of water and ate a light meal and is feeling back to her normal self today.


VAERS ID: 1371218 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: XARELTO 20mg a day. 1 BLACKSEED CHEWABLE. 2 TYLENOLS. A couple of cannabis joints Saturday
Current Illness: Pulmonary Embolism and dvt
Preexisting Conditions: 10 years
Allergies: Aleve, strawberries,
Diagnostic Lab Data:
CDC Split Type:

Write-up: servere pain in left arm pit with swelling


VAERS ID: 1371221 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received 2nd dose of Pfizer. Afterwards she felt nauseated and vomited x1. Vital signs were taken by paramedic at 11:40: BP 104/68, P74, resp 18, O2 saturation 98%. states she felt better after few sips of water. She was able to walk to observation area from vaccination area with supervision. She was given soda which helped with her nausea. Her VS was taken at 1200: BP 94/64, P69, Resp 18, O2 Sat 100%. All symptom subsided at this time. Patient left with her mother at 12:10pm.


VAERS ID: 1371226 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, 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: Cymbalta, lisinipril
Current Illness:
Preexisting Conditions:
Allergies: Penicillin doxycycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, body aches, tiredness, chills


VAERS ID: 1371228 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: School       Purchased by: ?
Symptoms: Headache, Lymph node pain, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Minor - headache, whole body muscular pain Acute - swollen lymph node, left armpit, big (~4") and very painful


VAERS ID: 1371236 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009CZ1A / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Dizziness, Gaze palsy, Hyperhidrosis, Increased bronchial secretion, Loss of consciousness, Nausea, Seizure like phenomena, Unresponsive to stimuli
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), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (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: I was dizzy, weak and nauseous. It felt as if I was going to vomit and then I went unconscious. My husband saw that I had collapsed back into the bed I was leaning against, with my eyes rolled back and I was making a gurgling sound. He attempted to get my attention several ways by loud yelling of my name and lightly hitting my cheek. I was unconscious for a few minutes and when I regained consciousness I had had broken into a heavy, soaking sweat. He described it as looking as if i had a seizure. I have no history of seizures and have never had one prior to this event and vaccine.


VAERS ID: 1371247 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Lip swelling
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: TYLENOL,
Current Illness: SEASONAL ALLERGIES 3 WEEKS PRIOR
Preexisting Conditions: NONE
Allergies: SULFA DRUGS
Diagnostic Lab Data: NONE AT THIS TIME. CALLED MD DOES NOT KNOW IF SHE WILL BE REQUIRED TO GO IN FOR VISIT.
CDC Split Type:

Write-up: PATIENT SAYS GOT SOME SWELLING OF EYES AND LIPS OF LEFT SIDE. DID NOT TAKE ANY MEDS. WILL TAKE SOME LATER ON TODAY. CALLED PCP FOR ADVICE / FOLLOW UP.


VAERS ID: 1371258 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Vital signs obtained during event 06/02/21
CDC Split Type:

Write-up: Pt with vasovagal response after vaccination. Started feeling ?hot? and like was going to pass out. Pt was seated and became extremely diaphoretic and had brief (<3 seconds) episode of syncope. Applied ice pack to neck and coached Pt on slow breathing. Vital signs remained stable throughout. Extended observation time from 15 to 30 mins and Pt was responding appropriately and ambulated to vehicle unassisted but accompanied by two colleagues.


VAERS ID: 1371261 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood urea normal, Carbon dioxide normal, Glomerular filtration rate increased, Haematocrit normal, Haemoglobin normal, Headache, Hypoaesthesia oral, Interchange of vaccine products, International normalised ratio normal, Magnetic resonance imaging head, Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume increased, Muscle twitching, Platelet count decreased, Red blood cell count decreased, Red cell distribution width increased, Tremor, White blood cell count normal
SMQs:, Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Medication errors (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? Yes
Hospitalized? No
Previous Vaccinations: per patient
Other Medications: naproxen 250 mg oral tablet, 250 mg= 1 tab, Oral, BID, PRN Pepcid 20 mg oral tablet, 20 mg= 1 tab, Oral, BID predniSONE 50 mg oral tablet, 50 mg= 1 tab, Oral, Daily predniSONE 50 mg oral tablet, 50 mg= 1 tab, Oral, Daily ZyrTEC 10 mg oral t
Current Illness: none known
Preexisting Conditions: none
Allergies: ibuprofen, Moderna COVID-19, tamiflu
Diagnostic Lab Data: There is no evidence of intracranial hemorrhage, mass, hydrocephalus, or cerebral infarction on MRI. WBC 5.1 RBC 4.18 Hgb 13.3 HCT 41.0 MCV 98.1 MCH 31.8 MCHC 32.4 RDW, blood 13 Platelets 268 Sodium 140 Potassium 4.0 Chloride 106 CO2 24 Creatinine 0.69 GFR 118 Glucose 96 BUN 11 INR 1.0 APTT 28
CDC Split Type:

Write-up: This is a 28 Years old Female presenting sent from urgent care to rule out stroke presenting with headache, twitching and tremors of the right upper and lower extremities, and tongue numbness. The patient mentions that yesterday they received the first dose of the Johnson & Johnson vaccine. She received the first dose of the modern vaccine in April but had an allergic reaction to it (hives, wheezing, cough, chest pain) so she did not receive the second dose. She received the first dose of the Johnson & Johnson vaccine at 3:15 PM yesterday and her symptoms began at 5 PM yesterday. Since their onset the symptoms have remained the same. Patient has not had similar symptoms in the past. She has not been diagnosed with COVID-19 infection as of yet.


VAERS ID: 1371265 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash
SMQs:, 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
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash around vaccination site. Doubled in size in 24 hrs


VAERS ID: 1371272 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Axillary pain
SMQs:

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

Write-up: Awful pain in armpit of the arm the shot was administered


VAERS ID: 1371285 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: naturelo bone calcium Vitamin D3 CVS Multi vitamin 50 plus for women
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA fatigue, arm pain patient took tylenol


VAERS ID: 1371289 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

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

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

Write-up: The patient, who is a family member of one of our staff, is only 16 years old. He was given 0.5mL dose of Moderna Vaccine. The patient was monitored for 30 minutes post administration with no visible reactions noted. The patient also denied any symptoms or reactions prior to leaving the facility.


VAERS ID: 1371298 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: This young lady was at the school to receive her second dose of the Pfizer vaccine, she answered all the questions with a No answer, she stated she was feeling well and had minimal reaction to first vaccine. She appeared to be nervous as reported by the nurse. after recieving her second shot, as the nurse was finishing up paperwork and filling out card, the student felt like passing out, one of the other nurses that were at her side, caught her as she fainted out of chair, she was placed on the ground and EMS was called at 10:10 and Nursing Supervisor was notified at 10:15. EMS determined she had a Vasovagal Syncope. EMS attended to patient and it was unknown if she was released after observation or taken to ED for further evaluation. a field emergency record was recorded and return to the nursing supervisor at the health department.


VAERS ID: 1371302 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 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: unknown
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted about 5 minutes after vaccination. Did not hit head. Regained consciousness in about 30 seconds. He reported fainting with prior injections. Patient refused emergency care when they arrived due to cost.


VAERS ID: 1371321 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-04-09
Onset:2021-06-02
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
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: received notification that patient was hospitalized 06/02/2021 at Medical Center with COVID-19 infection and CVA


VAERS ID: 1371331 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Inappropriate schedule of product administration, Injection site pain, Lethargy, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No prescriptions; two ibuprofen were taken the morning of June 1 for a backache.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: The first Moderna shot was received on 05/01/2021. The only symptom after the first shot was soreness at the injection site for a few days. The second shot was received on 06/01/2021. The symptom of soreness at the injection site started later that same night. The next morning a feeling of tiredness increased throughout the day with teeth-chattering chills starting in the early afternoon and a fever that spiked up to 103 degrees at one point. Nausea, loss of appetite, low-grade fever, and extreme lethargy continued. Tylenol, water, crackers, and Jell-O helped provide relief. Today (06/03/2021) there is no more fever. I still feel tired but I no longer feel extremely lethargic.


VAERS ID: 1371333 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       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: Injection was given with Consent forms signed by the long-term care facility where patient resides. Upon reporting vaccination it was discovered that the patient had previously received the Johnson Covid vaccine on March 24, 2021. No adverse reactions have occurred.


VAERS ID: 1371343 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: nausea for through the night and fatigue


VAERS ID: 1371347 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Hyperhidrosis, Lethargy, Migraine, Nausea, Pain, Pollakiuria, Pyrexia, Vomiting, Weight decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Warfarin Spirinolactone Metoprolol Lasix Levothyroxine Bupropion
Current Illness: None
Preexisting Conditions: Asthma Mechanical mitral valve
Allergies: Latex Sulfa Cefepime
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever Body aches Difficulty breathing Excessive sweating and urination Migraine Lethargic Nausea/vomiting Weight loss


VAERS ID: 1371382 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-27
Onset:2021-06-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: FIBORMYALGIA
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was experiencing mild headache after the shot on 05/27/21. As of 06/02, her headache has increased and she had a couple of dizzy spells. Advised patient to call PCP immediately.


VAERS ID: 1371385 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site rash, Injection site reaction, Injection site warmth, Rash erythematous, Rash macular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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: Zyrtec
Current Illness: N/a
Preexisting Conditions: High blood pressure
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Red splotches around injection site tender and hot to the touch. One big one right around injection and smaller ones around


VAERS ID: 1371392 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Myalgia, Pharyngeal swelling, Pyrexia, Throat tightness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sulfasalazine, metoprolol, edarbi, gemfibrozil, areds, crestor
Current Illness: None
Preexisting Conditions: Ankylosis spondylitis
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, fever, muscle aches, sweating, headache, tiredness, tightening or swelling in throat


VAERS ID: 1371400 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-13
Onset:2021-06-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head normal, Dizziness, Electrocardiogram normal, Feeling drunk, Haemoglobin decreased, Hyperhidrosis, Neutrophil percentage increased, Platelet count decreased, Thrombocytopenia, Urine analysis normal, White blood cell count decreased
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Melatonin, Vitamin D3, Zinc, Metoprolol Tart, Ferrous Sulfate, Lexapro, Eliquis, Lasix
Current Illness: No illness at time of vaccine, uncertain to up to one month prior
Preexisting Conditions: Hx. A-fib, HTN, COPD
Allergies: NKA
Diagnostic Lab Data: Neuro exams while in ED for 3 hours where neg. CT scan of head was neg.; EKG negative for A. Fib, No evidence of bleeding noted - refer to lab listed. UA - neg. WBC = 4.3, Hbg - 11.3, Plt. Count - 75, Neutrophils % - 76.9
CDC Split Type:

Write-up: Pt. presents to ED on 06/02/2021 at 0900 with c/o dizziness and sweaty while she was doing dishes. Pt. reported "feeling like she was drunk". Pt. denied any pain or SOB. Pt. does have hx. of A-fib. Pt. also admitted to not eating any breakfast. Pt. was discharged to home with diagnosis of thrombocytopenia, instructed to hold her Eliquis and to contact her PCP in the next few days. EKG did not show A. Fib so PA-C felt okay to hold Eliquis.


VAERS ID: 1371406 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Fatigue, Headache, Muscle twitching, Pain, Pain in extremity
SMQs:, Dyskinesia (broad), Dystonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 50
Other Medications: Glatiramir Acetate (Mylan) , combipatch, symbicort , albuterol, montelukast, modafinil, womens vitamin, vitamin b complex, biotin, D3, calcium, C
Current Illness: menopause ensued
Preexisting Conditions: Multiple Sclerosis and asthma
Allergies: sulfa, doxycycline, compazine, covid antibody infusion bamlanivimab
Diagnostic Lab Data: none
CDC Split Type:

Write-up: HEADACHE, sore arm, right bicep twitching, body aches, very tired.


VAERS ID: 1371410 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2032A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (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:
Current Illness:
Preexisting Conditions: Emphysema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen Covid-19 vaccine EUA. Approximately 10 hours after the dose I started developing severe chills and sweating. I checked my Temperature and it was 99.7 Degrees F. this has continued all last night and through today up to the time of submission of this report.


VAERS ID: 1371413 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-20
Onset:2021-06-02
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citracal, Biotin
Current Illness: ~1 week prior to vaccination, experienced 36 hour "stomach bug" symptoms of mild diarrhea, headache, fever of 100 degrees. Tested for Covid on 2nd day of symptoms with negative result.
Preexisting Conditions: None
Allergies: Sulfa, aspirin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Circular area ~3 inches diameter, light pink with darker pink edge, slightly swollen & painful


VAERS ID: 1371415 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pfizer COVID-19 Vaccine Vaccine Lot Number: Ew0178 2nd dose; vagal faint. Pt got dizzy after immunization, assisted to ground. Ambulating from vaccine site to chairs, slow faint to ground no LOC no sz no DOE VSS. glucose 93; weakness taken to ground, observation in EMS tent, home with parent. 5pm-94/60 p-93, r-20; 5:10 104/60 p-79, r-20, pox 99%


VAERS ID: 1371416 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-25
Onset:2021-06-02
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER 8727 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Fatigue, Headache, Rhinorrhoea, 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: smoker, history of pneumonia
Allergies:
Diagnostic Lab Data: SARS-CoV-2 RdRp Resp Ql NAA+probe- positivde
CDC Split Type:

Write-up: Client is fully vaccinated using Pfizer vaccine. Last dose on 3/25/2021. Tested positive for COVID -19 on 6/2/2021. Symptoms included: cough, shortness of breath, fatigue, headache, and runny nose. Vaccine given at hospital


VAERS ID: 1371432 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bone pain, Cough, Fatigue, Laryngitis, Oropharyngeal pain, Productive cough, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Osteonecrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: D, B, K, Zinc, Allegra, DHEA, Estrogen, Testosterone
Current Illness: None
Preexisting Conditions: Inflammation on knees (Arthritis)
Allergies: Red & Yellow Dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe fatigue, bone pain, fever, cough, sore throat., larangytis, phlem.


VAERS ID: 1371443 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Dizziness, Exposure during pregnancy, Headache, Nausea, Pyrexia, Syncope, Vomiting
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), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Levothyroxine Fluoxetine CoQ10 Vitamin D Mega Red
Current Illness: Pregnant 31 weeks
Preexisting Conditions: Hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Currently 31 weeks pregnant, estimated delivery Aug 5 Chills, fever, vomiting, joint pain, nausea, headache, dizziness, syncope Resolved at 12:30 on 6/3


VAERS ID: 1371444 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 701-351 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Bed rest, Chills, Headache, Injection site induration, Injection site rash, Injection site swelling, Loss of personal independence in daily activities, Mobility decreased, Pain, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid arm rash/57yrs/5/3/2021/Moderna
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None Tylenol every 4 hours
CDC Split Type:

Write-up: ?Moderna COVID-19 Vaccine EUA Woke at 4:00 am with the chills and a fever. My entire body was weak and ached. Had a severe headache. My arm at the site of the injection was swollen and hard. I took Tylenol every 4 hours and iced my arm. I was unable to do anything. I stayed in bed all day. With shot one after ten days I developed covid arm (a rash around the injection site).


VAERS ID: 1371448 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-26
Onset:2021-06-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation delayed
SMQs:, Fertility disorders (broad)

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

Write-up: Delayed period. Arrived over 10 days late


VAERS ID: 1371449 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0481321A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Discomfort, Fatigue, Injection site pain, Nausea, Neck pain, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None, only birth control and vitamin D at 7:30pm the night prior.
Current Illness: No
Preexisting Conditions: Chronic nausea, bulging disc lumbar spine L4-L5, arthritis lumbar spine L4-L5, digestive issues,
Allergies: Macrolids.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Slow onset of fatigue starting around 7pm. Appetite fine, but heavy body feeling, body aches, feverish feeling (fever unknown). Took 800mg Ibuprofen around 8:30pm with excellent results and relief from body and severe pain at injection site. Nausea and queasiness slow onset around 11:30pm. Took Mirtazapine and went to bed around 12:30am. Woke up at 9am and have general pain at injection, body aches, particularly in the forearms, biceps, and lower back. Feverish feeling (fever unknown), fatigue, chills, neck soreness (more on the left).


VAERS ID: 1371464 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pfizer for the patient''s 2nd dose instead of Moderna. There were no other signs and symptoms noted.


VAERS ID: 1371473 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeling hot, Hypersensitivity, Swelling, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pollen
Diagnostic Lab Data: 06/03/2021 Discharged from hospital at 0500 with the diagnosis: Allergic reaction, initial encounter.
CDC Split Type:

Write-up: Allergic Reaction (Hives, Body internally warm, vomiting, swelling)


VAERS ID: 1371477 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 RA / IM

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

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

Write-up: Pt is having no adverse effects, but received vaccine at age 14.


VAERS ID: 1371484 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, nausea, vomiting, body aches


VAERS ID: 1371501 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Patient received the 2nd COVID vaccine (Pfizer, Lot #: EW0187 and expiration date: 08/31/2021) around 1439 on the left arm. Patient walked up to the observation desk around 1449, during her 30 minute observation period, with complaints of "dizziness, rapid heart rate, and feeling hot." Patient was conscious, alert, and oriented x4 and claimed symptoms began 2 minutes status post vaccine administration. Patient denied any reaction after receiving the 1st dose of Pfizer vaccine and denied experiencing any chest pain, headache, nausea, vomiting, or diarrhea. EMTs had patient sit in the anti- gravity chair for further evaluation. Nurse responded to EMTs with patient. At 1455, EMT obtained baseline vital signs, while patient was sitting: blood pressure: 124/70, heart rate: 72, respiratory rate: 15. Pupils were equal, accommodating, and reactive to light. Skins were warm, dry, and normal. Chief complaint of "dizziness, rapid heart rate, and feeling hot" was reassessed and patient stated that symptoms had subsided. Patient explained that the symptoms had a sudden onset, but lasted less than 1 minute. Patient has a history of migraines and an allergy to Penicillin. Patient stated that she had a similar reaction after receiving a dose of Benadryl, earlier this year. Patient told EMTs that she had eaten toast, tofu, and salad about an hour and a half prior to coming to the vaccination site, with limited fluid intake. EMTs gave the patient a water bottle to sip on. At 1502 a second set of vital signs were obtained by EMT, while the patient was sitting: blood pressure: 116/68, heart rate: 74, respiratory rate: 15. Pupils were equal, accommodating, and reactive to light. Patient was advised to stay an additional 30 minutes in observation for continued evaluation. Patient stated she "felt better" and all symptoms had improved. Final set of vital signs were taken at 1514 by EMT, while patient was standing: blood pressure: 114/64, heart rate: 72, respiratory rate: 12. Pupils were equal, accommodating, and reactive to light. Skins were warm, dry, and normal. Patient was negative for orthostatic pressures. At 1540, patient stated she "felt normal and that all symptoms were gone." Patient had finished the water bottle provided. Patient was then educated on expected/ adverse reactions, when to follow up with her primary care provider, and the use of V- Safe. Patient ambulated with a steady gait on her own accord out of the facility.


VAERS ID: 1371507 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Anxiety, Electrocardiogram, Hypoaesthesia, Palpitations, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (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: levothyroxine 100 mcg (0.1 mg) oral tablet: 1 tab(s), PO, Daily
Current Illness: None Known
Preexisting Conditions: GERD (gastroesophageal reflux disease) Hypothyroidism Kidney calculus Perimenopausal symptoms Scoliosis Spider varicose vein Thyroid disorder Urinary calculus
Allergies: Cipro
Diagnostic Lab Data: EKG - No abnormalities
CDC Split Type:

Write-up: Acute anxiety; Adverse effect of COVID-19 vaccine; Heart palpitations; Numbness and tingling of right arm and leg


VAERS ID: 1371510 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Electrocardiogram normal, Hypoaesthesia, Palpitations, Paraesthesia, Vaccination complication
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine 100 mcg (0.1 mg) oral tablet: 1 tab(s), PO, Daily
Current Illness: None Known
Preexisting Conditions: GERD (gastroesophageal reflux disease) Hypothyroidism Kidney calculus Perimenopausal symptoms Scoliosis Spider varicose vein Thyroid disorder Urinary calculus
Allergies: Cipro
Diagnostic Lab Data: EKG - No abnormalities
CDC Split Type:

Write-up: Acute anxiety; Adverse effect of COVID-19 vaccine; Heart palpitations; Numbness and tingling of right arm and leg


VAERS ID: 1371528 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-03
Onset:2021-06-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right upper extremity DVT


VAERS ID: 1371553 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Lymph node pain, Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Starting about 3 am on 6/2/21 she had a severe headache that lasted about 24 hours. During the day on 6/2/21 she noticed a lump on the left side of her neck that is tender to touch. This was diagnosed as a swollen lymph node.


VAERS ID: 1371556 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

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

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

Write-up: c/o nausea shortly after taking her 2nd dose of vaccine. denies headache, SOB, dizziness and other adverse reaction symptoms. PMH includes pulmonary HTN, DM, and low saturation (hypoxia). O2 PRN at home. Allergy is shellfish and she had Epipen handy. No hhives, itching or swelling of throat noted. Pt. continuously look weak. V/S. BP 201/135, forearm 116/86. manual 146/92. BS 242mg/dl. Ambulance was called with patient permission. pt. transported to ED for futher evaluation.


VAERS ID: 1371576 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Head discomfort, Headache, Pain, Pyrexia, Tenderness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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: pt had the flu vax in 2012 and developed flu like symptoms that lasted about week.
Other Medications: Claritin
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was feeling very tired the day of getting the vax. Next day she went to work but later started feeling bad like she had the flu. She developed a severe headache, fever and body aches and pains. She went home and went to bed. She woke up next day with a headache so she contacted her PCP. She spoke with the nurse was advised to take ibuprofen. Pt is taking the ibuprofen which seems to help but she is still having head pressure and her head is very sore to touch. She is feeling extremely tired.


VAERS ID: 1371582 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Fatigue, Feeling cold, Morning sickness, Nausea, Pain in extremity, Parosmia, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast, Singulair, Topamax, Qudexy, Vitamin D 50,0000.
Current Illness: None.
Preexisting Conditions: Migraines.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, she had a sore arm, but otherwise had no reaction. The next morning at 10:00 AM she felt extremely tired as if she had not slept in days. Then she got extremely cold and had to wrap up with a blanket. She started making lunch for the children, and had made chicken nuggets for one of them, and the smell made her extremely nauseous and was throwing up 4 different times, and felt like she had morning sickness. She had to call the parents to pick up the children, and went to bed at 4:00 PM yesterday and woke up at 6:00 AM this morning. She has extremely aching of joints, low back in the waist area. She had a temp of 100.0, and when she took it this morning it was 97.9. She did not eat yesterday, and the smells again have given her dry heaves and has not eaten anything since the vaccine. She is still having the nausea and the queasy feeling, as well as back aches. She has been taking OTC Motrin for the symptoms.


VAERS ID: 1371584 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / IM

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

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

Write-up: PATIENT REQUESTED DOSE OF JANSSEN VACCINE, Pt provided Immunology report indicated on 05/11/2021 had negative covid antibody test even after 2 doses of moderna vaccinE. Per prescriber. PATIENT was recommended to get J&J vaccine. REPORTING THIS SINCE IT IS OUTSIDE OF NORMAL GUIDELINES.


VAERS ID: 1371590 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral, 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Women''s daily multivitamin, Biotin
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: Just had physical tests done like following object with eyes, checking my smile, wiggle eyebrows, etc.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Started getting a tingly/numb face and tongue at 7:10 pm on my way home from the vaccination clinic. Call PCP and was told to call 911 since the tingly feeling was mostly on the left side of face and that is a sign of a stroke. Emergency personnel did not notice any other signs of stroke but recommended visit to ER. Went to ER where the doctor on site performed some physical tests to check for stroke and other issues. Nothing else was found, I was sent home with instructions to follow up with PCP. Met with doctor from PCP office on 6/3/21. No change in face numbness since the previous day. Instructed to drink lots of water and take motrin. Still have numbness in face.


VAERS ID: 1371592 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: Patient reporting itching, hives, and rash on same arm as injection. Hives resolved with benadryl and time, however, rash is still present.


VAERS ID: 1371613 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Lethargy, Pain, Sleep disorder
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Unable to Sleep-Medium


VAERS ID: 1371623 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium


VAERS ID: 1371679 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (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: Lidocaine 5 % patch; Seroquel 25mg; Mirtazapine 15mg; Melatonin 5 mg; Xulane patches; Cetirizine 10mg; Refresh tears 0.5%; Azelastine 0.05%; Azelastine 137 mcg nasal spray; Saline nasal spray 0.65% ; Ketotifen 0.025%; Flonase 50mcg; Halobet
Current Illness:
Preexisting Conditions: PTSD; Psoriasis; Anxiety Depression
Allergies: Kiwi
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anxiety attack and hyperventilation syndrome


VAERS ID: 1371684 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Malaise, Muscle rigidity, Nervousness, Seizure, Snoring, Trismus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (narrow), Parkinson-like events (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: PATIENT WASN''T FEELING WELL AFTER VACCINE (WAS A LITTLE NERVOUS) AND ASKED FOR SOME WATER. PATIENT SAT DOWN IN WAITING AREA WHILE I WENT TO GET HIM A DRINK. WHEN I CAME BACK PATIENT WAS RIGID AND LOCK JAWED AND NOT BREATHING. WHEN WE GOT PATIENT TO FLOOR HE WAS RESPONSIVE TO A STERNUM RUB AND HAD A PULSE. AT THIS TIME HE STARTED TO PRODUCE SNORE LIKE NOISES, CONVULSED FOR LESS THAN A MINUTE THEN CAME BACK TO. EMT''S CAME AND CLEARED PATIENT. PATIENT STATED HE HAS A VASOVAGAL REFLEX HOWEVER HAS NOT HAD AN INCIDENT IN MANY YEARS. IT IS UNKNOWN IF THIS IS WHAT PATIENT EXPERIENCED OR A REACTION TO THE VACCINE.


VAERS ID: 1371699 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 25 mcg Vitamin D3(Nature''s Made Brand) 2,000 IU
Current Illness: N/A
Preexisting Conditions: Underactive thyroid Insufficient Vitamin D
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Rash developed underneath injection arm, near the armpit area. Rash developed approximately 48 hours after injection and caused a stinging sensation along with redness., Rash was about 4 inches wide. After 24 hours the rash subsided with no burning or discomfort and appeared to be clearing. No topic creams or substances used on rash nor the injection site.


VAERS ID: 1371710 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 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: adderall
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt received Moderna for 1st dose and Pfizer for 2nd dose - as of 6-2-21 8pm, pt had reported no adverse event, told pt to get in touch with us if any issues, tried to contact pt again on 6-3-21 2pm


VAERS ID: 1371721 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Mobility decreased
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: mom called and came into pharmacy on 6/3/2021 to inform us that daughter was having limited mobility in arm and was not able to raise arm unless assisted by using other arm. mom brought in article and picture of arm marking where vaccine was possibly given


VAERS ID: 1371722 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 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: Patient received 2nd Pfizer shot 2 weeks after the first shot instead of 3 weeks after (1st shot was on 5/19/21).


VAERS ID: 1371731 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: Nurse administered the 2nd dose of Pfizer vaccine to patient and within 5 minutes after administration patient slide from the chair and fell on the floor with a vaso- vagal reaction. Patient loss consciousness for a brief seconds while on the floor, one small bruising noted on R knee, no head strike. VS taken while on the floor BP 127/50, HR 100, O2sat 99% on room air. Rapid response called and patient was taken to the ED for further evaluation.


VAERS ID: 1371750 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / N/A RA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None disclosed
Current Illness: None disclosed
Preexisting Conditions: None disclosed
Allergies: None disclosed
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Medication expired 05/26/2021, no s/s or adverse reaction


VAERS ID: 1371755 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Nausea, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Xanax and Wellbutrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got the 2nd dose at 5:15pm June 1st. Woke up at 2:30am with a splitting headache and moderate nausea. Both symptoms last all day. Around 6pm, I start violently vomiting regularly (about 20-30 minutes in between) until around 11pm. Couldn?t keep anything down, including water, Tylenol, and pepto to try to ease the nausea, so there was really nothing to throw up but stomach acid. Otherwise it was dry retching for hours on end. Finally fell asleep after 11pm with mild discomfort in my stomach. Woke up the following morning (today) with just some mild stomach aches and soreness with a slight headache. I could keep down water this morning for the first time in 24 hours.


VAERS ID: 1371762 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-30
Onset:2021-06-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Angiogram normal, Blood test, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram PR segment depression, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Full blood count, Headache, Myocarditis, Pain, Pain in extremity, Pericarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not on any prescribed medications
Current Illness: No significant PMH
Preexisting Conditions: NO PMH
Allergies: NKDA / No food allergies
Diagnostic Lab Data: Patient had blood work drawn - CBC/Chemistry, troponins trended, EKG, and echo-cardiogram. On date of presentation (6/2/2021) Troponins were elevated (1.490), positive EKG changes (EKG showed ST elevations/ PR depressions inferior/ lateral leads concerning for pericarditis- date 6/2/2021), Patient had a TTE with normal LV systolic function (performed 6/3/2021).
CDC Split Type:

Write-up: 18 yo male with no significant PMH presented to the hospital on 6/2/2021 with c/o chest pain and SOB. Per patient and his mother at bedside, he received the second dose of Pfizer vaccine on Sunday. Day after had mild headache, aches, arm pain and abdominal pain. Last night woke up with chest pain and SOB. They called his pediatrician who recommended they come to the ER for evaluation. In ED was found to have elevated troponin and EKG changes. CTA negative for PE. EKG showed ST elevations/ PR depressions inferior/ lateral leads concerning for pericarditis. Patient was seen by cardiology and diagnosis of myo/pericarditis was made. Patient was prescribed Aspirin 325 mg TID and Protonix 40 mg QD for GI prophylaxis. Patient will follow up with the cardiologist 1 week after discharge for further management and medication adjustments.


VAERS ID: 1371773 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: May 11, 2021, Intramuscular, COVID19 ( Pfizer-BioNTech) Glands on left side of my face were swollen very large for about 6 hour
Other Medications: Famotidine, Aspirin, Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Shellfish, Sulfa drugs, Cipro, and Iodinated Glycerol.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At around 3:00 am on June 2, 2021, I experienced chills and an extreme headache. I took Tylenol and layed down.


VAERS ID: 1371774 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humira injections and Norgestimate and Ethinyl Estradiol tablets
Current Illness:
Preexisting Conditions: Ulcerative Colitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 24 hours after the first does, broke out in a rash along legs and arms.


VAERS ID: 1371775 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of fainting in past
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received 2nd dose Pfizer @1330 & noted to have fainting episode @1335 in observation area. Woke up with TRN support & was transferred from chair to w/c. Brought to triage area, noted w/dizziness, cool sweat & pale complexion. Pt state he has history of fainting in past. Denied CP, SOB & other abnormal sx. BP 105/57; HR 84; O2 Sat 97%) Monitored patient for 15 min & increased hydration/fluids. Pt was stable & released from vaccination site


VAERS ID: 1371778 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Electrocardiogram, Impaired driving ability, Laboratory test, Loss of consciousness, Nausea, 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), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: gastroenterologic illness (nausea and vomiting overnight) reported to us after vaccination
Preexisting Conditions: unknown
Allergies: none reported
Diagnostic Lab Data: Assessment at ED on 6/2. EKG, lab work performed, per chart notes.
CDC Split Type:

Write-up: Patient experienced brief LOC approximately 5 minutes after vaccination. Vital signs stable on waking, HR 64, SpO2 99%, BP WNL. Allowed to rest with cool packs to neck and chest, given snacks and juice/water to drink. Later, case reported feeling nauseated and vomited 2 times. Called EMS as she did not have anyone who could give her a ride and we did not feel safe allowing her to drive herself home.


VAERS ID: 1371786 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Chills, Cold sweat, Faeces soft, Headache, Hot flush, Injection site pain, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: fish oil 1,000; Zinc 100 mg, D3 2,000Ui, Vitamin C1,000. Osteo Bi-flex
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA pain in injection area at 5am (6/2/21) with severe headache, joint pain and chills (took 1,000mg of acetaminophen). Chills, hot flashes and cold sweats, body aches, fever, nauseas, soft stool (took 1,000mg acetaminophen). Went to bed around 1:30pm and slept. Felt better in the evening hours with a remaining slight headache and light body aches taking 500mg of acetaminophen at 5pm.


VAERS ID: 1371795 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site rash, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: Multivitamin, omega3, probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever to 101.9 all day on 6/2/21, red painful circular rash around injection site on 6/3/21


VAERS ID: 1371823 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-28
Onset:2021-06-02
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: SARS CORONAVIRUS 2, PCR RAPID, V : SARS COV-2 DETECTED
CDC Split Type:

Write-up: Asymptomatic, COVID-19 PCR positive beginning on 6/2/21.


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