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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 26 out of 5,069

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VAERS ID: 1484471 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Cough, Pain, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: i have not gone to any facility yet
CDC Split Type:

Write-up: chills body pain loss of energy cough and congestion joints pain


VAERS ID: 1484539 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cheilitis, Fatigue, Lip swelling, Paraesthesia, Paraesthesia oral, Pharyngeal swelling, Rash macular, Stomatitis, Throat irritation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Had a routine colonoscopy exactly 2 weeks prior to vaccine. Take daily food-based women''s multivitamin, fish oil, magnesium, Vit D3 drops in morning at breakfast
Current Illness: None -- but had a routine colonoscopy exactly 2 weeks prior to vaccine
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None performed
CDC Split Type:

Write-up: Vaccine administered approximately 5 pm on 7/12/2021 in left arm. Felt left arm tingle right after injection, within 24 hours throat and epiglottis areas felt swollen and had red and white blotches/sores in throat, around uvula, tonsils and surrounding tissues in mouth. Lips a bit tingly as well. Felt very fatigued. As days passed, throat sores increased and migrated on roof of mouth and towards lip region and inside of upper lip had red sores that looked bloody and lips with some swelling and tingling. today, 7/19/21, one week after vaccine was given, throat and lips are almost back to normal, but not quite-still with some mild upper lip irritation, swelling and redness and mild throat irritation and blotches but to a much lesser degree. Did some warm water salt rinses throughout the week, rested, took Advil or tylenol. I did not go to the doctor''s office.


VAERS ID: 1484722 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Condition aggravated, Decreased appetite, Dehydration, Dizziness, Fatigue, Migraine, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Lo Loestrin Propranolol
Current Illness: none
Preexisting Conditions: Headaches/migraines
Allergies: none
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Migraine, body aches, fatigue, fever, chills, loss of appetite, lightheadedness/dizziness, nausea, dehydration


VAERS ID: 1484792 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-06
Onset:2021-07-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Erythema, Tenderness, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ESTARYLLA 0.25MG/0.35MG TABLETS
Current Illness: NONE REPORTED
Preexisting Conditions: NON REPORTED
Allergies: NONE REPORTED
Diagnostic Lab Data: PATIENT WENT TO DR ON 07/15/2021
CDC Split Type:

Write-up: PATIENT STARTED 8 DAYS AFTER THE VACCINE DEVELOPING "WHEELS" ON THE UNDER SIDE OF LEFT ARM, CHEST, RIGHT ARM AND UPPER THIGHS. SOME SPOTS STARTED AS BRUISING THAT WAS TENDER TO THE TOUCH, THEN TURNED RED


VAERS ID: 1484836 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-09
Onset:2021-07-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 - / -

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

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

Write-up: Hives.


VAERS ID: 1484873 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-29
Onset:2021-07-13
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/08/21,pfizer,Lot#EL3248 2nd dose: 01/29/21,Pfizer,Lot# EN5318 Diagnosed covid positive:07/13/21 Exposure:Community Symptoms:Asymptomatic.


VAERS ID: 1484985 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-22
Onset:2021-07-13
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Laboratory test, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT Scan and lab 7/13/2021
CDC Split Type:

Write-up: Pulmonary Embolism Blood Thinners


VAERS ID: 1484990 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Pt reports childhood allergy to PCN - response is a rash
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt arrived for vaccine. He received a vaccine that had expired 3 days prior. No adverse reactions.


VAERS ID: 1485110 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Laboratory test, Muscle spasms
SMQs:, Dystonia (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: gabapentin, ropinirole, oxycodone, ramipril, asa, omeprazole, pravastatin, escitalopram
Current Illness: n/a
Preexisting Conditions: DM2, depression, pain, gerd, RLS, hyperlipid
Allergies: iodine, fentanyl, bupropion
Diagnostic Lab Data: pending
CDC Split Type:

Write-up: unilateral Right sided muscular spasms in both upper and lower extremities; onset 1 day after injection


VAERS ID: 1485112 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-06
Onset:2021-07-13
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin, Lasix, Prozac, Synthroid, gabapentine
Current Illness: a.fib, DM2 w/ CKD 4,HTN, gout, high lipids
Preexisting Conditions: a.fib, DM2 w/ CKD 4,HTN, gout, high lipids
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: hosp for covid pneumonia 7/14-7/18


VAERS ID: 1485118 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-26
Onset:2021-07-13
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Myalgia, Nausea, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: o Test date: 7/17/2021 o Test performed: SARS CORONAVIRUS-2 RNA, V o Route: Nasopharyngeal o Result: DETECTED
CDC Split Type:

Write-up: Resides in a household with 2 positive cases, first one tested positive on 7/7/21. Sx onset 7/13/21 with sore throat, muscle aches, headache, fatigue & nausea. Tested on 7/17/21 for COVID-19 which returned as positive.


VAERS ID: 1485127 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-20
Onset:2021-07-13
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER6213 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Fatigue, Headache, Myalgia, Nausea, Oropharyngeal pain, SARS-CoV-2 RNA increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: o Test date: 7/17/2021 o Test performed: SARS CORONAVIRUS-2 RNA, V o Route: Nasopharyngeal o Result: DETECTED
CDC Split Type:

Write-up: Resides in a household with 2 positive cases, first one tested positive on 7/7/21. Sx onset 7/13/21 with sore throat, muscle aches, headache, fatigue & nausea. Tested on 7/17/21 for COVID-19 which returned as positive.


VAERS ID: 1485163 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Gastrooesophageal reflux disease, Headache, Hypoaesthesia, Immediate post-injection reaction, Muscle spasms, Myalgia, Nausea, Productive cough, Pyrexia, Respiratory tract irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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: gabapentin, glucosamine, MSM, Vit-D3, antihistamines
Current Illness: N/A
Preexisting Conditions: Arthritis
Allergies: nicotine, most foaming agents
Diagnostic Lab Data: None pursued
CDC Split Type:

Write-up: Immediate numbness L-arm/shoulder blade, lungs felt "hot" on inhalation (for 5 days), progressed to mildly productive cough (5 days), nausea & GERD (6 days), headache (7 days so far), intermittent fever (7 days so far), moderate to severe muscle aches mostly upper body, increased nighttime leg cramps, exhaustion (lasted 7 days)


VAERS ID: 1485399 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-11
Onset:2021-07-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shots
Other Medications: Estradiol, progesterone, omeprazole, Strattera
Current Illness: Acid reflux, ADHD
Preexisting Conditions: Acid reflux, ADHD
Allergies: Penicillin, all cillin drugs, all sulpha drugs.
Diagnostic Lab Data: Called doctors office.
CDC Split Type:

Write-up: Rash on back that itches. Hands are still Swollen from 1st shot.


VAERS ID: 1486792 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

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

Write-up: Minor itch on skin surface all over body


VAERS ID: 1486794 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-01
Onset:2021-07-13
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: SYMPTOMATIC COVID19 POSITIVE DIAGNOSED 7/15/21


VAERS ID: 1486892 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaesthesia oral, Chest discomfort, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: calcium + vitamin D, Duloxetine, Gabapentin, Levothyroxine, Tylenol, Vitamin B complex
Current Illness: N/A
Preexisting Conditions: Fibromyalgia, hypothyroidism
Allergies: Aspirin, Ibuprofen, Hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: tongue change sensation, persistent nausea and heavy chest


VAERS ID: 1486907 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / IM

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

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

Write-up: after administration of vaccine, up and about to another chair, next to his friend, to help interpret medical questions. he fainted while sitting on a chair, his friend helped him go down to the next empty chair. pass out about 1 minute, elevated his feet with other chair and applied cool compress on his forehead. awake and alert, gave some water and juice. up and sitting on a chair in the waiting room, friends bought his lunch and was eating. no vomiting and alert and talking.


VAERS ID: 1486958 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-26
Onset:2021-07-13
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

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

Write-up: Shingles outbreak. Prescribed Valtrex.


VAERS ID: 1486972 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

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

Write-up: The technician was under the impression that you added 1.8 ml of diluent (NaCl 0.9%) to the vial prior to drawing up each 0.3 ml Pfizer dose. She added 1.8 ml of diluent to the non-punctured vial and drew up the first dose correctly. She then proceeded to add another 1.8 ml to the same vial and drew up dose #2, which was administered to a different patient. She then added another 1.8 ml to the same vial and drew up dose #3, which this patient ended up receiving. The patient received a dose that had been over diluted with NaCl (a total of 5.4 ml of diluent had been added to this vial prior to drawing up that 3rd dose). We contacted Pfizer to seek guidance on an administration error and to clarify if another dose was to be given. The representative informed us that Pfizer did not have any specific guidance other than the recommendations outlined by Agency for administration errors, which outlined that doses administered with diluent volume greater than 1.8 ml do not require the dose to be repeated. This was the patients first dose, so the patient will receive their second dose at the recommended interval of 21 days as outlined in Agency recommendations.


VAERS ID: 1487023 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-03
Onset:2021-07-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Chest pain, Chills, Cough, Electrocardiogram ST segment elevation, Electrocardiogram normal, Hydrogen breath test normal, Laboratory test normal, Pleurisy, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Generic for Flonase Claritin Allergy medication
Current Illness: Only seasonal allergies
Preexisting Conditions: He occasionally gets migraines/abdominal migraines. This is primarily controlled with diet.
Allergies: Neomyasin clindamycin
Diagnostic Lab Data: 7/13/21-Emergency Room. Chest X-ray-normal; EKG showed slight elevation of S-T lines. Due to recent vaccine, lab work was completed. He had normal labs, no triponen found in his blood. Ruled out immediate concerns with heart. 7/15/21- Allergy and Ashtma. Depending on outcome, another EKG at a later date may be requested. 7/16/21- Allergy and Asthma, Dr. Ruled out asthma, breathing test was normal. He believes Patient has seasonal allergies that need better maintained (cough due to post-nasal drip). Prescribed additional nose spray and switching back to Zyrtec. He also believes patient may have Plueritis due to vaccine side effect. If this is correct, he believes the chest pain will resolve itself eventually and as long as additional symptoms do not appear, this is not a serious condition. Next appointment is 8/13/21.
CDC Split Type:

Write-up: We had a preventative EKG completed on 6/26/21 for a baseline before the vaccine as a precaution and I am happy to make these available to you. Vaccine was 7/3/21. Patient started having body chills within 24-48 hours after the shot. He still has daily chills as of 7/20/21. Starting 7/13/21 Patient complained of chest tightness and "pain", localized around the center of his chest and a little below. He has seasonal allergies, including a cough that started acting up 7/11/21. The location of pain and description is significantly different than his normal allergy symptoms. Pain and tightness occurred with stationary activities and would come/go, regardless of whether he just coughed. He still has chest pain and occasional tightness as of 7/20/21. No breathing issues, fever, or other symptoms.


VAERS ID: 1487034 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product administration error, Product preparation issue
SMQs:, Medication errors (narrow)

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

Write-up: Technician was under the impression that you add 1.8 ml of diluent (NaCl 0.9%) to the vial prior to withdrawing each vaccine dose. She added 1.8 ml of diluent to the non-punctured vial and withdrew a 0.3 ml dose, which was correct and given to a patient. She then proceeded to add another 1.8ml of diluent to the same vial and then withdrew dose #2. This patient received dose #2, which contained twice the normal amount of diluent. Another 1.8 ml was added to this same vial and a 3rd dose was withdrawn and given to a different patient. The error was realized when she attempted to add another 1.8 ml to the vial to draw up dose #4 and could not physically add any more diluent into the vial. We contacted Pfizer to seek further guidance on the administration error and whether another dose was required to be given. The representative informed us that Pfizer did not have any specific recommendations themselves regarding the administration error, but stated that we should follow the current recommendations outlined by the Committee. They emailed us the Committee recommendations outlined in Appendix A, which indicate that for doses administered with diluent volume greater than 1.8 ml, do not repeat dose.* (Note: dilution with a volume up to 4.0 ml [which exceeds vial capacity] results in more-than-half of the authorized dose administered). The dose given in error was the first dose and the second dose will be administered to the patient at the recommended interval of 21 days, as specified in Appendix A. No adverse reactions have been reported by the patient as of 7/20/21.


VAERS ID: 1487140 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-07-13
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Influenza like illness, 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: Benlysta, prednisone, lisinopril, gabapentin, sertraline, topiramate, trazodone, albuterol, cetirizine
Current Illness:
Preexisting Conditions: SLE Migraines Hypertension Depression
Allergies:
Diagnostic Lab Data: COVID Positive 7/16
CDC Split Type:

Write-up: No ADR to the vaccine, but patient tested positive for COVID greater than 2 weeks since her previous injection. She started having flu-like symptoms on 7/13. She tested positive on 7/16. She was exposed to her new 8 month old foster baby who tested positive for COVID. She has a history of lupus and takes immunosuppressants. We scheduled her to receive the monoclonal antibody.


VAERS ID: 1487328 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-17
Onset:2021-07-13
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 - / -

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

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

Write-up: Patient hospitalized after testing positive for COVID-19. Patient is fully vaccinated.


VAERS ID: 1487420 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-08
Onset:2021-07-13
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Headache, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Unkown
Allergies: Unknown
Diagnostic Lab Data: SARS CORONAVIRUS-2 RNA, V; Detected
CDC Split Type:

Write-up: Symptomatic, started on 7/13 with fever, fatigue, cough, headache, & muscle aches.


VAERS ID: 1487425 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-08
Onset:2021-07-13
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Headache, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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 RNA, V; Detected
CDC Split Type:

Write-up: Symptomatic, started on 7/13 with fever, fatigue, cough , headache, & muscle aches.


VAERS ID: 1487483 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Breast enlargement, Breast pain, Diarrhoea, Dysmenorrhoea, Headache, Intermenstrual bleeding, Menstrual disorder, Nausea
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Lipodystrophy (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baclofen As Needed 800 mg ibuprofen as needed Citirizine as needed
Current Illness: None
Preexisting Conditions:
Allergies: Environment Allergies, Seasonal Allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, Diarrhea and Headache developed within 4 hours of getting shot. Menstrual spotting, and cramping, started less than 24 hours after getting shot. Enlarged and painful breasts started with in 48 hours of shot. Spotting and cramping lasted 4 days from onset. Breast symptoms lasted 5 days from onset. Still experiencing lingering headaches and nausea a week later. I have not menstruated in almost ten years. Had a D&C, Hysteroscopy and Uterine Ablation to end my heave periods.


VAERS ID: 1487484 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cyproheptadine 4mg
Current Illness: none
Preexisting Conditions: n/a
Allergies: nka
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient was ending her menstrual cycle on the day of her 2nd Moderna vaccine. She then started to bleed heavy again and has been bleeding now for almost 2 weeks. Her menstrual cycles are always regular and last no more than 4-5 days.


VAERS ID: 1487511 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen armpit after receiving second dose of Pfizer vaccine. Still have lump and no improvement.


VAERS ID: 1488510 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-22
Onset:2021-07-13
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Dizziness, Hyperhidrosis, Hypersomnia, Impaired work ability, Pain, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone taken 2 days after first Pfizer vaccination due to burning itching rash on palms of hands and bottom of feet; also asymmetrical rash on lower arms, sides of torso, top of hands and top of toes; inflammation of fingers causing my
Current Illness: Overnight of second Pfizer vaccination woke up with chills, 102.2 fever, alternatively sweating and shivering; aches and joint pain, dizziness. Had to take the day off sick from work. Slept the entire day without eating or drinking until 7:00 pm at which time I felt a bit better. By 11:00 pm I felt feverish again and checked my temperature which was back up to 102 again. Woke up the next morning with absolutely no symptoms.
Preexisting Conditions: None.
Allergies: Pennicillins
Diagnostic Lab Data: I went the next day and was seen by a doctor there who prescribed Prednisone 20 mg tablets. The rash was going a day later and never returned.
CDC Split Type:

Write-up: On day 2 after first vaccine in the middle of the night I developed a burning itching rash on the bottom of my feet and the palms of my hands that got me up out of bed to apply cold water and as that didn''t help, I tried witch hazel which helped enough that I was able to get back to sleep. The next day I had a rash on both sides of my torso, on the backs of my hands and at the base of the upper side of my toes. Also from my armpits on both arms past my elbows.


VAERS ID: 1489774 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01C21A / 2 LA / IM

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

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

Write-up: Patient received their first dose on 24June 2021. Patient then came in and received their second dose on 13July2021, on day 19. Patient has had no adverse reactions. Patient has been notified of their early dosing.


VAERS ID: 1490089 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 UN / IM

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

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

Write-up: Error: Patient too young for vaccine administered.


VAERS ID: 1490258 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 UN / IM

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

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

Write-up: Error: Patient Too Young for Vaccine Administered-


VAERS ID: 1490282 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-10
Onset:2021-07-13
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / -

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

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

Write-up: Patient hospitalized due to COVID-19. Patient is fully vaccinated.


VAERS ID: 1490461 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-25
Onset:2021-07-13
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: CHF, CAD, hypertension, hyperlipemia, pacemaker, sleep apnea, rheumatoid arthritis, a fib
Allergies: Beta Blocker- Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19 positive, COVID pneumonia and admission to inpatient hospital


VAERS ID: 1490519 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Mild tinnitus that began the day following vaccination. I have never previously experienced ringing of the ears nor any other sort of ear injury or hearing issues. It has remained relatively constant since the onset.


VAERS ID: 1490596 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 8889 / 7+ LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 8889 / 7+ LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest discomfort, Electrocardiogram
SMQs:, Anaphylactic reaction (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: Shrimp
Diagnostic Lab Data: EKG 7/21/21 Blood work 7/21/21 Chest X-ray 7/21/21
CDC Split Type:

Write-up: First day after the second vaccine I experienced chest tightness. I am still feeling this 10 days later.


VAERS ID: 1490606 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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

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

Write-up: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490649 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-29
Onset:2021-07-13
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase increased, Chest discomfort, Chest pain, Dyspnoea, Echocardiogram normal, Ejection fraction normal, Electrocardiogram ST segment elevation, Haemodynamic test normal, Pain, Pericarditis, Troponin I, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: baclofen 10mg bid carbamazepine 200mg TID citalopram 40mg daily fluticasone nasal spray bid PRN Allergy eye drops, PRN daily
Current Illness:
Preexisting Conditions: Epilepsy
Allergies: aspirin
Diagnostic Lab Data: 7/18: CK total 281, troponin I high sens <3, WBC 6.4, Afebrile, stable vitals with HR 70s-80s, RR 35-18, BP 121/58 ECG diffuse ST elevation and P wave depression
CDC Split Type:

Write-up: Diagnosed with pericarditis Presented to the emergency department on 7/18/2021 with chest pain (substernal) and does not radiate, but reports heaviness and pressure. The pain was severe at onset. This is exacerbated by exercise but are relieved by nitroglycerine and fentanyl. Family history of CAD. Also reports shortness of breath. Pain onset was abrupt while riding his bicycle. ECG shows diffuse ST selevation in multiple coronary distributions with P depression. Bedside ECHO showed normal heart. EF was ~60%. Hemodynamically stable. Given one dose of Toradol., SL nitro 0.4mg Admitted to the hospital Started on colchicine 0.6mg bid and ibuprofen 600mg tid with plan of 10 days of treatment.


VAERS ID: 1490654 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490656 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blister, Condition aggravated, Pain, Pain in extremity, Purpura, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estazolam 2 MG Tab TAKE 1 2 (ONE HALF) TABLET BY MOUTH AT BEDTIME AS NEEDED cyanocobalamin (VITAMIN B-12) 500 MCG Tab Take 500 mcg by mouth every day. vitamin D (CHOLECALCIFEROL) 1000 UNIT Tab Take 1,000 Units by mouth 2 Times a Day.
Current Illness: None
Preexisting Conditions: Chronic low back pain ? Fatigue ? Chronic pain of left knee ? Primary osteoarthritis of left knee ? Barrett''s esophagus ? Primary osteoarthritis of both hands ? Gastroesophageal reflux disease with esophagitis ? Insomnia ? History of colon cance ? BPH (benign prostatic hyperplasia)
Allergies: None at the time of vaccine.
Diagnostic Lab Data: Multiple tests pending 7/21/2021 to evaluate purpura.
CDC Split Type:

Write-up: 2nd moderna vaccine given 7/12, that night developed some mild low back pain. The next morning the pain was more severe and associated with left leg pain (throbbing). He developed a rash as well (purpura with some bulla) on the buttocks which then traveled down his leg and into the left foot (not painful/pruritic). No fever, chills or other adverse SE.


VAERS ID: 1490679 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490715 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490918 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 25 mg
Current Illness: none
Preexisting Conditions: hypoglycemia
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT WAS GIVEN THE COVID VACCINE AND DIDN''T WAIT THE FULL 15 MINUTES. WHEN THE PATIENT WENT TO LEAVE SHE PASSED OUT AND LANNDED FACE FIRST ON THE FLOOR.


VAERS ID: 1490995 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: pt received dose not stored according to manufacturer


VAERS ID: 1491461 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-21
Onset:2021-07-13
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster, Incomplete course of vaccination
SMQs:, Medication errors (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Progesterone 200 mg q hs Estradiol gel 0.06/100g - 2 pumps q hs Ambien 0.5 mg q hs
Current Illness:
Preexisting Conditions: Chronic Insomnia
Allergies: Sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: shingles on D 22 post vaccine. Confirmed diagnosis of shingles on D 23 post vaccine. Second dose of vaccine postponed pending recovery from shingles


VAERS ID: 1491656 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphonia, Feeling abnormal, Hypertension, Intensive care, Lip swelling, Swelling, Wheezing, White blood cell count normal
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol inhaler, Amlodipine 5mg QDay, Cholecalciferol 25mcg BID, Diclofenac gel PRN, Glipizide 5mg BIS, Meclizine 12.5mg PRN, Metformin 1000mg BID, Pravastatin 40mg QDay
Current Illness: n/a
Preexisting Conditions: DM HTN HLD Breast cancer in situ Shingles in V1 distribution with anterior scleritis (May 2021, resolved)
Allergies: Lisinopril - cough Atorvastatin - cough Valsartan - throat swelling Mag Ox tablets - throat swelling
Diagnostic Lab Data: 7/13/21 WBC 6.0
CDC Split Type:

Write-up: Pt reports that she had a globus sensation and some shortness of breath PRIOR to receiving the vaccine. She was monitored 15 minutes post-injection without incident. When she walked out to the hallway to go home she reported that she felt like she was going into anaphylaxis and a Rapid Response was called overhead. She was complaining of feeling like her hands and feet were swelling and that he voice was hoarse. Her lips were noted to be large and her husband confirmed that they looked larger than normal. She was found to be hypertensive to 196/109 so analyphylactic shock was ruled out and she was not treated with an epi pen. She was transferred to the ER. Exam found scattered wheezing, mildly protuberant lower lip, no tongue swelling, no drooling. She was treated with IV solumedrol 125mg, IV benadryl, IV famotidine, and a racemic epi nebulizer. ENT came and visualized her airway via NPL and found no oropharyngeal or laryngeal edema. She was admitted to the MICU for 48-hour anaphylaxis observation and continued on steroids and anti-histamines. By the following morning she was feeling well.


VAERS ID: 1493594 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-06
Onset:2021-07-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 13975 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein normal, Chest pain, Dyspnoea, Fibrin D dimer normal, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Microgestin
Current Illness: none
Preexisting Conditions: none
Allergies: amoxicillin
Diagnostic Lab Data: D-dimer, CRP, and Sed Rate-results normal . Chest Xray ordered but not yet complete.
CDC Split Type:

Write-up: 1. Chest pains and tingling 2. Pt said she got covid vaccine J&J two weeks ago. She has chest pain. Was hiking in the mountains is back from trip and still has. Yesterday had tingling in hands and toes comes randomly either makes hands go numb or make them tingle. Some Sob when she was traveling not when hiking but when she was in bed. Chest pain last 30 min to hour comes and goes. Happends when she is laying down and when she is moving. 3. Got home three days ago. No SOB since coming home. But has chest pain every day. Has random bruise on right ankle not sure how she got not sure if it is related. Not dizzy or lightheaded


VAERS ID: 1493620 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dyspnoea, Fatigue, Headache, Injection site pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medication prescribe.
Current Illness: Before filling out this document. NO
Preexisting Conditions: No sickness
Allergies: None before the mandatory vaccine that my boss make take by the University.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms after and until now are injection site pain, tiredness, headache, shortness of breath when I move around and I have a habit of running every morning. Since the vaccine I lack of more air. I have dizziness and before I didn''t have any, also I have slight chest pains and tiredness which previously I didn''t have.


VAERS ID: 1493631 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location:   
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Impaired work ability
SMQs:

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

Write-up: Severe headache, had to take off work 2 days


VAERS ID: 1493635 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-15
Onset:2021-07-13
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 UN / SYR

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

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

Write-up: Hospitalized for COVID-19 pneumonia


VAERS ID: 1493647 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-15
Onset:2021-07-13
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Full blood count abnormal, Platelet count decreased, Platelet transfusion, Thrombocytopenia
SMQs:, Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: bupropion ER 300 mg daily vit D3 1000 units daily colace 100 mg twice daily loratidine 10 mg daily valacyclovir 1 gm daily MVI daily sertraline 150 mg daily
Current Illness:
Preexisting Conditions:
Allergies: No know allergy
Diagnostic Lab Data: Tranfusion 1 unit of PLTs on 7/21, CBC,s daily
CDC Split Type:

Write-up: Thrombocytopenia - Platelet count on 3/12/21 = 143. On 7/20/21 PLT =17, 6 and 15 on 7/21/21 and 31 on 7/22/21. Extensive bruising which was resolving on day 3 of admission.


VAERS ID: 1493648 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Erythema, Headache, Herpes zoster, Inflammation, Pain, Rash erythematous, Skin warm, Vertigo
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Vestibular disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tramadol , Losartan, Vitamin D, probiotic
Current Illness: Fibromyalgia, osteoarthritis, Hypertension
Preexisting Conditions: Fibromyalgia, osteoarthritis
Allergies: NKA
Diagnostic Lab Data: See above.
CDC Split Type:

Write-up: 1. Day after injection, I had local reaction to upper arm of redness, inflammation and warmth to skin in more than 1 spot. No treatment 2. The day after the injection, I woke up with a headache and vertigo. Took Ibuprofen for headache, no other treatment 3. 6 days later I noticed red bumps that then over the next few days turned into blisters. I was experiencing a right sided headache and sharp, shooting pains. On Saturday, 7/ 17/2021, I went and was diagnosed with shingles. I was prescribed Valacyclovir 1gm TID for 7 days. ( however, nothing was given for pain or inflammation. On Monday, 07/19/21 I went to my pcp who again confirmed Shingles, and prescribed Gabapentin 300mg BID for pain and Prednisone (tapered dose) for inflammation.


VAERS ID: 1493678 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

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

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

Write-up: ?Pt received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the pt will need to be re-vaccinated.?


VAERS ID: 1493737 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: ?Pt received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the pt will need to be re-vaccinated.?


VAERS ID: 1493744 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Pt received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the pt will need to be re-vaccinated


VAERS ID: 1493895 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling and numbness in the arms, fingers and legs


VAERS ID: 1494106 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

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

Write-up: an few hours after receiving the vaccination she developed tingling and numbness to feet and hands. The evening of the day she received the vaccine she developed difficulty swallowing. Trout symptom resolved after 2 doses of benadrly and 8 hours.


VAERS ID: 1494170 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

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

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

Write-up: ?Pt received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the pt will need to be re-vaccinated.? Pt received replacement dose on 7/21/21


VAERS ID: 1494174 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Blood calcium decreased, Blood parathyroid hormone increased, Blood test, Chills, Hypersensitivity, Hypoaesthesia, Joint contracture, Nausea, Pyrexia, Sleep disorder, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad), Tumour lysis 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B12
Current Illness: none
Preexisting Conditions: eczema
Allergies: none
Diagnostic Lab Data: blood work
CDC Split Type: vsafe

Write-up: After the 2nd dose, that evening I went to bed with a low grade fever of 99 degrees and chills. I woke up at 2am, feeling chills and nausea. After I threw up, both hands started to have uncontrollable clenchings. My legs started to feel a little numb but I could walk. I also had pain on my left side of my stomach. I went to the ER, one of the nurses grabbed my hands to try to straighten them out. They gave me an IV containing calcium, 2 TUMS orally, and Benadryl. I did feel so much better. I did get discharged with a diagnosed with Covid vaccine allergic reaction, low calcium levels, and allergies. I did follow up with my PCP and they wanted to check my calcium levels which showed low calcium and high PTH (parathyroid). I was prescribed 1200mg of calcium daily. I am to follow up with an endocrinologist.


VAERS ID: 1494328 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: no signs or symptoms after event.


VAERS ID: 1494363 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-20
Onset:2021-07-13
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Electrocardiogram abnormal, Myocardial infarction, Stent placement, Troponin
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Plavix 75mg ,Norvasc 2.5mg , Adderall, clonazepam , Prozac 15mg, sinaside multivitamin, red cherry extract, 1000mg green tea extract ,levothyroxine 2,5 micrograms, tumic, probotic
Current Illness:
Preexisting Conditions: Lupus, Rheynaulds,
Allergies:
Diagnostic Lab Data: bloond work Tripone was . Stint was put in . Ekg
CDC Split Type:

Write-up: Heart attack


VAERS ID: 1466650 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-05
Onset:2021-07-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Heart rate irregular
SMQs:, Cardiac arrhythmia terms, nonspecific (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: 1 tylenol
Current Illness: na
Preexisting Conditions: na
Allergies: Pollens
Diagnostic Lab Data: na
CDC Split Type:

Write-up: unnormal heart beat all AM,


VAERS ID: 1475861 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IUD
Current Illness: None
Preexisting Conditions: Catamenial seizures, Graves disease, minor asthma
Allergies: Sulfa, Fish oils, seasonal
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Injection site pain (within 1 hour and continuing 48 hours plus) High fever 101.2 (6 hours after injection lasting 24 hours) Whole body aches (lasting 48 hours plus) Chills and pain (lasting 24 hours Headache (lasting 48 hours)


VAERS ID: 1488624 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-07
Onset:2021-07-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Diabetic ketoacidosis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: Diabetic ketoacidosis; This regulatory authority case was reported by a physician and describes the occurrence of DIABETIC KETOACIDOSIS (Diabetic ketoacidosis) in an 18-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 07-Jul-2021, the patient received dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Jul-2021, the patient experienced DIABETIC KETOACIDOSIS (Diabetic ketoacidosis) (seriousness criterion medically significant). At the time of the report, DIABETIC KETOACIDOSIS (Diabetic ketoacidosis) had resolved with sequelae. For mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The concomitant medications were not reported. The treatment information was not provided. The patient was admitted in Intensive care unit with the onset of event. Also he had no known medical history of diabetes. Post vaccination patient felt unwell. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1490888 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-05
Onset:2021-07-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Dyspnoea, Electrocardiogram, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Shrimps/ibuprofen
Diagnostic Lab Data: ECG- BUT they did not performed it properly so the result are not that clear.
CDC Split Type:

Write-up: Got severe palpitations and up until now i experiencing difficulty in breathing. Knowing that i''m a healthy person before i got the vaccine. I went to clinic to have it checked. But the doctor dismissed me immediately and keep saying that this is not related to vaccine. But why i am experiencing this?


VAERS ID: 1464059 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Menstruation irregular, Mucosal discolouration, Secretion discharge
SMQs:, Fertility disorders (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: Vitamin D
Current Illness: NA
Preexisting Conditions: NA
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Skipped period 73 days after both doses. June1-got period and it was full of mucus and brown clots-lasted a little over a week. 7/26 period was normal again.


VAERS ID: 1464121 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LEXAPRO, AMLODIPINE, DEXILANT, OZEMPIC, LAMOTRIGINE, PRAMIPREXOLE
Current Illness: ADDISON''S DISEASE, MOVEMENT DISORDER, HEPATIC LIVER DISEASE
Preexisting Conditions: ADDISON''S DISEASE, MOVEMENT DISORDER, HEPATIC LIVER DISEASE
Allergies: AZITHROMYCIN, KEFLEX, AND RISPERIDONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT PASSED OUT FOR A COUPLE MINUTES AFTER GETTING THE VACCINE. Pfizer-BioNTech COVID-19 Vaccine lot EW0168. SHE REGAINED CONSCIOUSNESS AND INTERACTED WITH US AFTER A FEW MINUTES. THE FIRE DEPARTMENT CAME SHORTLY AFTER AND BROUGHT HER OUT.


VAERS ID: 1464166 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fall, Generalised tonic-clonic seizure, Mouth haemorrhage, Tooth fracture, Tooth injury
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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: after receiving injection, pt. sat in chair @ about 0918 pt. fell to ground, noted having tonic clonic seizure like activity lasting about 15 seconds, pt. .placed on his side. After about 15 seconds, pt. became arousable, awake alert and oriented, noted to have "chipped tooth" and slight bleeding in his mouth. Pt. states has hx. of syncopal episodes after receiving injections. Denies any history of seizures. Team alert was called and Pt. was taken to ED for further evaluation


VAERS ID: 1464201 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: Patient felt like passing out, got very white in the face, eyes rolled back into head. Then he was ok.


VAERS ID: 1464208 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-12
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 4 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Extra dose administered
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Medication errors (narrow)

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

Write-up: Patient unknowingly received 4 doses of covid vaccine and had a cardiac arrest on 7/12/21


VAERS ID: 1464210 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 RA / 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:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 16 year old who was inadvertently administered with first dose of Moderna on 04/10/21 at Medical Center. Regulatory authority was contacted via telephone and email, please see e-mail below. Per regulatory authority , patient can be administered with 2nd dose of Moderna. Patient''s mother agreed for patient to receive 2nd dose of Moderna and was scheduled for 07/12/21 here at facility. Patient did not have any adverse reaction for first dose per mother. Patient did not have any adverse reaction for 2nd dose while in clinic today. Patient was discharged in stable condition after office visit with provider and 2nd dose of Moderna. Greetings, Thank you for contacting the regulatory authority regarding Coronavirus Disease 2019 (COVID-19). Vaccines Type Administration error/deviation Interim recommendation All currently authorized vaccines (Pfizer-BioNTech Moderna, and Janssen COVID-19 vaccines) Site/route oIncorrect site (i.e., site other than the deltoid muscle [preferred site] or anterolateral thigh [alternate site]) oDo not repeat dose.* Inform the recipient of the potential for local and systemic adverse events. oIncorrect route (e.g., subcutaneous) oDo not repeat dose.* Inform the recipient of the potential for local and systemic adverse events. Age oUnauthorized age group oIf received dose at age less than 12 years, do not give any additional dose at this time.? oIf age 12 to 17 years and a vaccine other than Pfizer-BioNTech was inadvertently administered: ?If Moderna vaccine administered as the first dose, may administer Moderna vaccine as the second dose (as off-label use, because Moderna vaccine is not authorized in this age group). ?If Janssen vaccine administered, do not repeat dose with Pfizer-BioNTech vaccine. Interim Clinical Considerations for Use of COVID-19 Vaccines | CDC


VAERS ID: 1464250 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: Client received janssen vaccine and was dizzy after receiving the vaccine. Client was lowered to the ground with legs elevated. clients vitals observed. Clients vitals was within normal limits and client started feeling better. client position changed to upright and then on to chair. Client then complained of chest heaviness. Client was breathing and awake. EMS was called. EMS arrived at 11:30am and client left with EMS at 11:40 am along with her parents.


VAERS ID: 1464263 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoacusis, Syncope, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: About 5 minutes after receiving the vaccine the patient felt light headed and fainted into her dads arms while scheduling her second appointment. Dad sat her into a chair and by the time the pharmacist reached her she was already coming to. She did report some trouble hearing and focusing her eyes. She drank some water and sat for about 15 more minutes before she felt back to normal. She then left with her father.


VAERS ID: 1464266 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

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

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

Write-up: Patient developed syncope very soon after injection. We helped her lay flat and provided wet cloths and ice to keep her comfortable. We monitored her blood pressure and she walked out of store with help from parents about 1-1/2 hours later.


VAERS ID: 1464288 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, albuterol
Current Illness: asthma, anxiety
Preexisting Conditions: asthma
Allergies: trees, penicillin, grass, mold, dust, cats, dogs, mosquitos, roaches, dairy, almonds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy throat


VAERS ID: 1464296 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Site: Redness at Injection Site-Mild


VAERS ID: 1464310 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Shakiness-Mild, Additional Details: Within a minute of giving patient her first dose patient leaned backwards in chair seemed like she fainted for brief moment, grabbed her to make sure she didnt fall out of chair and was responsive within a few seconds. It happened a 2 more times where she leaned back again for a brief moment and doesnt rememeber. The 3rd time she leaned foward and spit up a little of the water she just had. Called 911 after the second time EMS came and checked her blood pressure and make sure she was ok.


VAERS ID: 1464327 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-09
Onset:2021-07-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

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

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

Write-up: Marble sized lump felt under skin on left size of body where neck and chest meet (lowest part of neck). Painful to touch. Ibuprofen taken - still waiting for lump to disappear.


VAERS ID: 1464331 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-12
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Work       Purchased by: ?
Symptoms: Oral mucosal blistering, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, hydroclothizide, mili tablets 28s
Current Illness: Hypertension
Preexisting Conditions: Animiea, hypertension
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Mouth soars. Blisters that are in the back of my mouth started to come up in a few hours after the shot. Large in size.


VAERS ID: 1464333 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

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

Write-up: The dose was taken out of a vial that had been removed from dry ice on 5/19/21 and stored in refrigerator. Vial should have been discarded on 6/20/21 after being stored at refrigerated temperatures for more than 30 days. Vial was mixed and dose was drawn and administered on 7/12/21.


VAERS ID: 1464349 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Hypersensitivity, Paraesthesia oral
SMQs:, Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood pressure medication
Current Illness:
Preexisting Conditions: atrial fibrillation, hypertension, current smoker
Allergies: penicillin-diarrhea, keflex-throat swelling, difficulty breathing
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose moderna vaccine on 7/12/21 at approximately 1235. Patient requested assistance due to "having an allergic reaction" at 1250. Patient reports, feeling "a little dizzy", lips tingling, and "it feels like when I go into a-fib." Initial vital signs: 140/70, 80 HR, 95% on RA, 17 RR. Patient stated during initial vital signs that her symptoms were resolving. Patient denied any shortness of breath, throat swelling or chest pain. Requested patient remain for 10-15 additional minutes of monitoring. At 1305 patient stated symptoms were resolved. Vital signs as follows: 130/72, 83 HR, 16 RR, 93% on RA.


VAERS ID: 1464350 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

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

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

Write-up: The dose was taken out of a vial that had been removed from dry ice on 5/19/21 and stored in refrigerator. Vial should have been discarded on 6/20/21 after being stored at refrigerated temperatures for more than 30 days. Vial was mixed and dose was drawn and administered on 7/12/21.


VAERS ID: 1464363 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Dyspnoea, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu vaccine
Other Medications: Flexeril
Current Illness: none
Preexisting Conditions: obesity
Allergies: flu vaccine
Diagnostic Lab Data: Patient placed in a quite calm environment and water given for thirst.
CDC Split Type:

Write-up: Patient with complaints of nausea, vomiting, light headiness, shortness of breath and elevated blood pressure


VAERS ID: 1464366 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Haloperidol decanoate, haloperidol (PO), milk of mag (PRN), Mylanta (Prn), acetaminophen (PRN), Genvoya, diphenhydramine, buspirone, nicotine patches, divalproex , Miralax, and lisinopril
Current Illness: none
Preexisting Conditions: Schizophrenia, HIV, Type II diabetes, essential hypertension
Allergies: Lurasidone (Latuda)
Diagnostic Lab Data: none needed - no ADR reported
CDC Split Type:

Write-up: At approximately 12:30pm today PT received the Janssen COVID-19 vaccine in the treatment room. He was monitored for 30 minutes; no side effects were reported. At 1:50p, I went to enter the vaccine administration information, I saw that he had completed the Moderna COVID-19 vaccine series. His second dose of Moderna was on 06/16/2021, 26 days prior to today''s administration. PT reported no previous administrations of any other COVID-19 vaccines on his consent form. As of 2:45pm still no adverse events for him have been reported


VAERS ID: 1464377 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: Patient came in for her second dose of the Covid 19 vaccine. She was given Moderna for the first dose and Pfizer for second dose.


VAERS ID: 1464382 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), 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: Gabapentin, Advair, SIngulari and Nor-EE
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient describes numbness, tingling and warm sensation down entire arm, injection site to wrist. Injection was IM and placement was correct


VAERS ID: 1464427 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Agonal respiration, Angiogram, Angiogram abnormal, Antinuclear antibody negative, Antiphospholipid antibodies negative, Apnoeic attack, Aspartate aminotransferase increased, Beta-2 glycoprotein antibody negative, Blood alkaline phosphatase normal, Blood triglycerides increased, Cardiac imaging procedure abnormal, Cardiolipin antibody, Cardioversion, Catheterisation cardiac, Chest pain, Condition aggravated, Cyanosis, Double stranded DNA antibody, Echocardiogram, Full blood count normal, Implantable defibrillator insertion, Low density lipoprotein, Magnetic resonance imaging heart, Myocarditis, Posturing, Pulmonary embolism, Pulse absent, Resuscitation, Syncope, Transaminases increased
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenoloL 100 mg tablet Take 1 tablet by mouth daily. FLUoxetine 20 mg capsule Take 3 capsules by mouth daily. metFORMIN ER 500 mg tablet,extended release 24 hr Take 3 tablets every day by oral route. minocycline 100 mg capsule Tak
Current Illness: none
Preexisting Conditions: acne; allergic rhinitis; asthma; chronic constipation; depressive disorder; idiopathic scoliosis; migraine; mixed hyperlipidemia; myocarditis; non-alcoholic fatty liver; obesity; prediabetes; pulmonary embolism; supraventricular tachycardia
Allergies: Advair Diskus; FLUTICASONE/SALMETEROL; Imitrex; SUMATRIPTAN; meperidine; naproxen
Diagnostic Lab Data: as above
CDC Split Type:

Write-up: 5/31 patient developed chest pain while at work, presented to clinic at work. Had ECG changes, and MI was suspected, received SL NTG. 35 minutes after nitro she collapsed pulseless and apneic, cyanotic with agonal breathing and posturing. CPR initiated, external defibrillator was used with CPR device- received 4 shocks which failed. Spontaneously converted to sinus rhythm with restoration of pulse, awoke intact neurologically. Transferred to Hospital, underwent emergent LHC, did not show infarction and had normal epicardial anatomy. TTE was normal. CTA confirmed LLL small Pulmonary Embolism. Was started on Xarelto. She had an NSTEMI type II subendocardial injury secondary to V. fib arrest in context of PE or arrhythmia. Lab tests done during admission significant for mild transaminitis with AST 132, ALT with 36 ALP 51, triglycerides 608 unable to calculate LDL, beta-2 glyco 1 IgG normal at less than 9, lupus anticoagulant not detected, double-stranded DNA antibody 2 which is normal, ANA not detected, cardiolipin antibody IgG less than 10 which is normal, cardiolipin antibody IgM less than 10 which is normal, complete blood count unremarkable. Cardiac MRI with scar likely secondary to myocarditis. Started by cardiology on colchicine. Unknown etiology for pulmonary embolism, perhaps result of arrest/cpr. Had ICD placed.


VAERS ID: 1464429 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-08
Onset:2021-07-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01777 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and 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? No
Previous Vaccinations:
Other Medications: Nortriptyline
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely heavy menstrual cycle with large clots.


VAERS ID: 1464447 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 3 LA / IM

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

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

Write-up: Patient was inadvertently given a Pfizer Bio-N-Tech vaccine instead of the Shingrix Shingles Vaccination. According to the patient''s husband, the patient had already previously received two pfizer doses. No immediately adverse events observed.


VAERS ID: 1464460 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

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

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

Write-up: Patient received Moderna for their first shot, received Pfizer for their second. Patient filled out form stating she needed her 2nd Pfizer shot, however, after receiving shot and checking her information, she actually received Moderna (LOT 023c21A, exp 10/21) as her 1st. Patient has had no ill effects.


VAERS ID: 1464464 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Loss of consciousness, Nausea, Pallor, Tremor
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), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Within 1 minute of receiving vaccination, patient became lightheaded and passed out. Patient regained consciousness within 1 minute of passing out. Upon regaining consciousness patient reported a headache, dizziness, shakiness, and nausea. The patient appeared pale. The patient was given water and peanut butter crackers. After 30 minutes patient returned to normal and was able to leave the pharmacy on his own.


VAERS ID: 1464466 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / N/A LA / IM

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

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

Write-up: 20 year old, male patient came in for his appointment for Janssen COVID vaccine. Patient filled out the vaccine questionnaire, and we discussed patient questions and common side effects. Patient did not state any adverse reaction to previous vaccine or fainting history on the vaccine questionnaire. Patient was given vaccine in left arm. Shortly after receiving vaccine, patient states, "uh-oh it''s happening again." I asked patient what was happening and he stated, "this happened to me when I got a blood draw. I fainted." I told patient to take some deep breaths, patient started to stare off to the ceiling and his pupils were dilated and his head fell back in the chair towards the ceiling. His legs body became stiff and he lost consciousness in the chair. I called for help and she came to assist me in the immunization room. I ran to get him a water while the pharmacy called for 911. He regained consciousness quickly, within a minute. Emergency response came quickly and attended to him and took his blood pressure and vitals. He was able to drink water and respond to all questions. He refused to be taken to the hospital and did not think he needed any additional medical attention. He was advised to follow up with his primary care physician. He was advised to sit and stay and get a ride home, which he did. An incident report and VAERS report will be reported today.


VAERS ID: 1464481 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / IM

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

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

Write-up: The employee health nurse called to inform the pharmacy that the patient passed out at work and was coming to the ER.


VAERS ID: 1464487 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LAMICTAL
Current Illness: EPILEPSY (CONTROLLED ON LAMICTAL)
Preexisting Conditions: EPILEPSY
Allergies: NSAIDS CARBAPLATIN IMITREX
Diagnostic Lab Data: NONE REPORTED TO US
CDC Split Type:

Write-up: PATIENT REPORTED FEELING A TINGLING SENSATION ON SKIN WITHIN 1 HOUR OF RECEIVING SHOT -- SENSATION MAY HAVE DEVELOPED TOWARD END OF ONSITE OBSERVATION PERIOD BUT PATIENT BELIEVED IT WAS GOOSEBUMPS FROM A/C. PATIENT REPORTED THAT OVER THE NEXT HOUR (BY APPROXIMATELY 12:30PM) SHE HAD FULL-BODY ITCHING INCLUDING TONGUE AND IMMEDIATELY WENT TO URGENT CARE. SHE WAS GIVEN A STEROID INJECTION AND SUPPLIED WITH DIPHENHYDRAMINE WHICH CONTROLLED HER REACTION. SHE HAS BEEN ADVISED THAT SHE NEEDS TO KEEP LIQUID DIPHENHYDRAMINE ON HAND AND WATCH FOR ANY RETURN OF SYMPTOMS OVER THE NEXT SEVERAL DAYS, AND IF SYMPTOMS RETURN TAKE BENADRYL IMMEDIATELY AND SEEK IMMEDIATE EMERGENT CARE.


VAERS ID: 1464501 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-07
Onset:2021-07-12
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Chest pain, Computerised tomogram thorax abnormal, Echocardiogram normal, Ejection fraction abnormal, Embolism arterial, Pleuritic pain, Pulmonary embolism, Ultrasound Doppler normal
SMQs:, Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), 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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Esomeprazole, Lisinopril, simvastatin, Topamax, ambien
Current Illness: none
Preexisting Conditions: gerd, htn, hyperlipidemia, migraines, hx cerebral aneurysms, past hx lung cancer- in remission 8 years s/p R sided lobectomy
Allergies: blue food coloring
Diagnostic Lab Data: CT Chest:Single small nonobstructing peripheral pulmonary embolus in the left descending pulmonary artery. No central pulmonary emboli. No other abnl seen. echocardiogram- normal EF, no wall motion abnl, no thrombus, no right heart strain
CDC Split Type:

Write-up: Pt was admitted to the hospital on 7/9/21 c/o pleuritic chest pain and was diagnosed with a Left sided pulmonary emboli. Because of her history of cerebral aneurysms she was treated cautiously with lovenox/Coumadin bridging at the direction of neurology. She was discharged home on 7/12/21 to follow up with her primary care with close blood work monitoring. Her venous dopplers were negative for deep vein thrombosis. She has no prior history of blood clots, does not take birth control, no family hx of blood clots, does not smoke, has had no recent/prolonged immobility or travel and no recurrence of cancer that has been in remission for 8 years, no obesity.


VAERS ID: 1464559 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Public       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: Gave second dose too early, day 14


VAERS ID: 1464568 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became extremely dizzy after receiving the vaccine. He passed out and hit the floor. Patient was going to go to the hospital.


VAERS ID: 1464570 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: came in as a walk in for Janssen COVID-19 vaccination stating that he has never received any COVID-19 vaccination prior. After administering the vaccination, I noticed in the immunization record that the patient received a COVID-19 Vaccination of Moderna on February 11,2021 and March 9,2021. Upon reviewing the vaccination injection note, patient did receive a Moderna COVID-19 vaccination on both February 11, 2021 and March 9, 2021 that was historically entered on July 8, 2021. Reported to charge nurse. Patient was monitored and had no adverse effects. Pharmacist notified and stated to report to VAERS. Reported to VAERS. Patient denies having received any prior COVID-19 vaccination.


VAERS ID: 1464585 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-11
Onset:2021-07-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Electrocardiogram QRS complex prolonged, Electrocardiogram abnormal, Left atrial enlargement, Sinus arrhythmia, Sinus bradycardia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Conduction defects (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: JULY 12, 2021 @ 8:00 AM - FAINTED TESTS AT HOSPITAL - JULY 12, 2021 @ 8:30 AM EKG results: Sinus bradycardia with sinus arrhythmia left atrial enlargement right ventricular conduction delay
CDC Split Type:

Write-up: fainting - 8:00 am after injection the day prior at 12:00 pm. EKG results: Sinus bradycardia with sinus arrhythmia left atrial enlargement right ventricular conduction delay


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