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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 263 out of 5,069

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VAERS ID: 1364963 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Patient experienced syncope upon getting up from the chair after getting the shot


VAERS ID: 1364987 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-05-31
Onset:2021-06-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

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

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

Write-up: Patient mom says that son has tightness in chest when he breathes in and feels short of breath. Started sometime this morning.


VAERS ID: 1364990 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypertension, Palpitations, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: 37 y/o female with past medical history of Anxiety who presents with palpitations 10-15 mins post vaccination. Patient states that she received the Johnson vaccination. Patient states that the vaccination was placed to the left arm. Patient denies previous reaction to vaccinations in the past. Patient denies pregnancy. Patient denies sore throat, shortness of breath and/or difficulty breathing. Patient states that she is an anxious person. Patient initial vitals with noted Hypertension, 166/91 BP and Tachycardic 110, all other vitals within normal limits. Patient monitored for 15 mins with resolution of palpitations. Patient vitals reassessed and patient normotensive, 138/81 BP, all other vitals normal and patient discharged in stable condition.


VAERS ID: 1364999 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-22
Onset:2021-06-01
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Full blood count abnormal, Haematocrit increased, Phlebotomy, Polycythaemia vera
SMQs:, Haematopoietic leukopenia (broad), Blood premalignant disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrea 500 mg Lisinopril 30 mg Aspirin 82 mg Nattokinase 400 mg
Current Illness: N/A
Preexisting Conditions: Polycythemia Vera
Allergies: Intravenous dye
Diagnostic Lab Data: CBC Jan 22 2021 CBC Feb 19 2021 CBC and Phlebotomy April 22 2021 CBC June 1 2021 Phlebotomy tk
CDC Split Type:

Write-up: I believe this vaccine has increased my production of RED BLOOD CELLS to require, so far, two phlebotomies within a three-month timeframe. I have a chronic condition that requires me to take chemo drug orally, Hydrea, to suppress HEMATOCRIT or red blood production. I have taken this drug for approximately 10 years with no adverse reactions. In 2020, I only required one (1) phlebotomy for the entire year to keep my hematocrit below 45. I received my normal course of one phlebotomy per year (usually not more than three per year) on January 25, 2021, however, after receiving the Moderna Covid-19 vaccine Jan 22 2021, my hematocrit has been above 46, requiring phebotomies on April 22,2021, and again in June 2021. Highly irregular. Nothing in my life or disease has changed. This was caught because my doctor and nurse have been checking my numbers now every six weeks instead of every three months. I need to double my Hydrea and go back in 6 weeks.


VAERS ID: 1365026 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Client developed a reaction to 2nd dose of COVID-19 vaccine. Client described symptoms as a burning sensation on top of her left hand. At 8:32am on 6/1/21. Client refused vital signs. Ice pack was given. Client verbalized feeling better. Client exited the facility at 8:50am.


VAERS ID: 1365035 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

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

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

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


VAERS ID: 1365041 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope, Unresponsive to stimuli
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1365049 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 RA / IM

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

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

Write-up: Client verbalized feeling anxious and his heart was racing. Client was observed/evaluated by Fire Rescue. Client was observed for additional 15 mins. Client was cleared to exit the facility at 11:26am. Per Fire Rescue, client stable no further evaluation needed.


VAERS ID: 1365066 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenopia, Feeling hot
SMQs:, Corneal disorders (broad)

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

Write-up: after patient received shot she was sitting in waiting area and within 5 minutes started fanning herself. I went to check on her and she said she was hot and started to close her eyes. I helped her to lay down and had technician get her a wet rag. Once she said she was ok we moved her out of the main aisle and let her lay with cold compress until she was feeling ok and her mother came to make sure she was ok.


VAERS ID: 1365072 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Incoherent, Seizure, Staring
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient does not fill medications at this pharmacy. This pharmacy was administering Covid 19 Moderna vaccine. It is noted that patient has a history of seizures on consent form.
Current Illness: History of seizures
Preexisting Conditions: History of seizures
Allergies: none
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient has a history of seizures. Patient received 2nd dose of Moderna Covid 19 vaccination. They did ok with the first vaccine. Approximately 5 minutes after receiving the vaccine the patient had a blank stare, which the caregiver noted and informed staff that patient was having a seizure. Within 30 seconds the patient was jerking, had clenched fists, and was not coherent. The caregiver was able to keep the patient in the chair and keep her from hitting her head. After jerking motions stopped the caregiver was able to contact the person responsible for medical decisions for patient and mother decided that she need to be taken to the hospital. EMS arrived and took patient to the hospital within 15 minutes after seizure. Patient was alert and oriented when EMS arrived.


VAERS ID: 1365104 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type: 10045664352

Write-up: INMATE INSISTED HE HAD NOT HAD THE COVID-19 VACCINE PREVIOUSLY. WAS GIVEN A SECOND DOSE OF THE JANSSEN VACCINE. INCIDENT DISCOVERED 3 HOURS LATER. INMATE WAS EXAMINED AND MONITORED. TEMP 97.4, BP 130/80, PULSE 76, RR 20. INMATE DENIES HEADACHE, CHILLS, BODY ACHES, UPSET STOMACH, AND FATIGUE. INMATES STATES THAT "HE FEELS FINE." HE HAD NO REACTION TO HIS FIRST VACCINE, JENSSEN, WHICH WAS GIVEN 3/25/21. DEPUTIES ARE MONITORING HIM FOR SYMPTOMS.


VAERS ID: 1365134 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RL / SC

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Dyspnoea, Erythema, Pruritus, Skin abrasion, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: I evaluated patient, following her shot today. She had 2nd dose Moderna at about 11:40 AM. She was complaining of generalized itching, throat tightness, and shortness of breath following her shot. She has a h/o multiple drug & environmental allergies. She has used an epipen many times before, last was about a year ago for a bee sting. She had her 1st dose Moderna last month and had pruritus and throat swelling, but this feels worse. Last time she took Benadryl here, and was monitored for about 2 hours. She refused an epipen that time or to go to the ED. On exam, she is mildly anxious, constantly scratching at neck, chest, and lower back. Lungs remain clear, but somewhat diminished. Heart regular. No rash, except for redness from scratching/excoriation. Patient had her atrovent inhaler and took two doses. She had taken Benadryl & Pepcid around 9 AM this morning. By 12:20 PM the patient said she was feeling worse. She agreed to treatment with an epipen, which she self-administered. EMS was called, and arrived around 12:35 PM. She was taken quickly to the ambulance and then to ED.


VAERS ID: 1365136 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

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

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

Write-up: Patient was given the Moderna vaccine for her 2nd Covid-vaccine and was originally given the Pfizer vaccine for her first dose. At this time no adverse effects have been reported


VAERS ID: 1365146 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-30
Onset:2021-06-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Ear ache in left ear, same side vaccine was given.


VAERS ID: 1365151 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hypopnoea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

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

Write-up: Upon completion of administration, patients eye were closed and stated she felt faint. Patient became pale and breathing shallow and vomited once. Patient received an ice pack on back of neck and remained sitting with legs elevated on another chair. 911 was called and patient was taken by EMS.


VAERS ID: 1365155 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chromatopsia, Cold sweat, Dizziness, Gait disturbance, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received the 2nd COVID vaccine (Pfizer, Lot #: EW0185 and expiration date: 08/31/2021) on the left arm at 0918. Patient hailed medics attention and complained of "nausea, seeing purple, and lightheadedness" at 0921. Patient was conscious, alert, and oriented x4. Patient''s skins were normal for ethnicity, moisture and temperature. Pupils were equal, accommodating, and reactive to light. Patient appeared anxious and was coached by medic on her breathing. Signs and symptoms began about 2 minutes status post vaccine, but patient claimed no previous reaction with 1st dose. Patient denied any pertinent medical history, allergies, or medications. At 0923 patient was still conscious, alert, and oriented x4 and pupils were still equal, accommodating, and reactive to light. Patient then complained of "seeing everything in purple color," then stated she "could not see anything at all." Medic held up 5 fingers and patient advised she could not see them. Patient began to look pale and skins felt moist and warm. Patient was able to walk with assistance to anti- gravity chair. Nurse then responded to Medic with patient. Baseline vital signs were taken by Medic at 0926, while patient was sitting: blood pressure: 98/60, heart rate: 60, respiratory rate: 16. Patient stated that she runs cross country and that these vital signs were of normal range for her. Patient was given water to sip on. Color and moisture of skins were slowly pinking/drying up. Patient initially experienced nausea and lightheadedness but denied chest pain, shortness of breath, headache, dizziness, or blurry vision. Nurse informed the patient''s mother, who was waiting outside, of the situation and brought the mother inside to the patient. At 0935, patient was able to stand her own, with a steady stance. A second set of vitals were taken: blood pressure: 100/64, heart rate: 60, respiratory rate: 14. Patient was negative for orthostatic pressures. Patient stated that symptoms had resolved and that she "felt better, just tired." Patient remained in the observation area for an additional 15 minutes. Patient was conscious, alert, and oriented x4 and skins were normal for ethnicity, moisture, and temperature at 0949. Patient able to walk on her own accord with a steady gait. Mother was driving personal vehicle. Mother and patient were educated on when to contact their primary care physician with any other concerns and when to call 911 if symptoms warrant or when go to ED.


VAERS ID: 1365162 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / SYR

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

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

Write-up: Pt started having itching, no signs of hives or respiratory distress. Gave certirizine had patient wait.


VAERS ID: 1365167 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: B/P 114/72, 02 SAT 99%RA , HR 95 RR 20
CDC Split Type:

Write-up: Patient stated that she is feeling dizzy, nauseous, and shaky. patient is 3 months pregnant. Assessed done by the paramedics. patient stabilized and sent home in stable condition. No hospitalization needed.


VAERS ID: 1365186 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 10808978 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: B/P 106/65 HR 64 02 95%RA
CDC Split Type:

Write-up: PATIENT COMPLAINED OF DIZZINESS AND ALSO STATED THAT HE FEELS LIKE HE WANTS TO FAINT. ASSESSED DONE AND PATIENT SENT HOME IN STABLE CONDITION.


VAERS ID: 1365190 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received 2nd dose of vaccine after 15 days AMA after being informed of CDC recommendations.


VAERS ID: 1365191 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device connection issue, Exposure via skin contact, Immunisation, Needle issue, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Drew up dose in Safety Syringe. at administration, due to the lurer lock not being tight enough, the pressure of pushing the vaccine into the muscle caused the connection to come apart. the needle tip stayed in the patient''s arm as I held the barrel. The serum did not go into patient''s arm, instead sprayed onto the patient''s arm and shirt. I was able to remove the needle tip from her arm without incident. Administered a new dose into same deltoid muscle. Patient reports arm swelling. Advised to apply ice intermittently.


VAERS ID: 1365193 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 5 LA / IM

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

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

Write-up: SYNCOPE IS WHAT PATIENT EXPERIENCED. PATIENT LOST CONSCIOUS COUPLE MINUTES AFTER RECEIVING THE VACCINE. SHE FALL OFF THE CHAIRE SHE WAS SITTING AT , BUT WOKE UP DIRECTLY AFTER. PATIENT DID NOT HIT HER HEAD AGAINST THE FLOOR, NOR DID SHE HAVE ANY INJURY OTHER THAN A SCRATCH ON HER ARM. SHE WAS ALLERT, ORIENTED AND HAVE PROVIDED ME WITH EVERY SINGLE INFORMATION I NEEDED TO COMPLETE THIS REPORT. SHE LEFT THE PHARMACY WITH HER FATHER.


VAERS ID: 1365199 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Somnolence, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Attendee was noted to be sleeping in the observation area at 12:42 pm. Staff member went over and tapped his on the shoulder when he did not immediately rouse to her asking if he was ok. He woke up and was alert and oriented, by stated that he was lightheaded. He was escorted to the cot and place on his left side. No tachypnea or dyspnea. HR 84 BP 136/98 O2Sat 99%. Two RN''s stayed in attendance with him. At 13:24 he stated that he was feeling much better and denied any further lightheadedness. HR 86 BP 128/82 O2Sat 98%. He was assisted to a sitting position and then a standing position without any lightheadedness. At 1:30 pm he was discharge to home with his friends in attendance.


VAERS ID: 1365200 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO178 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Throat tightness, Unresponsive to stimuli, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: vicodin, atenolo, zoloft, diamox
Current Illness: fibromyalgia, becketts disease
Preexisting Conditions: asthma, fibromyalgia, becketts disease
Allergies: unk
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: Client requested to lay on stretcher for vaccine, provided. Almost immediately following vaccine, client closed eyes- briefly did not respond to name. Skin warm and dry, strong steady pulse. Responded to verbal stimuli, complained of throat tightening and wheezing. EMT called to client pod. vss. HR76, BP 109/74, sat 97 on room air. Client then closed eyes again, briefly did not respond - then opened eyes . vs''s continued stable. As per EMT positive slight wheeze. Ambulance arrived and client transported to ER.


VAERS ID: 1365205 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia oral, Pharyngeal hypoaesthesia
SMQs:, 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Diphenhydramine 50mg/mL IM
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After being vaccinated, patient began to experience numbness of the tongue that later extended to the throat.


VAERS ID: 1365215 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Posture abnormal, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: he said he had fainted before
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: paramedics came and checked his vitals which were normal, patient declined to go to hospital
CDC Split Type:

Write-up: about 5 minutes after patient received shot , he came to pharmacy counter to say he felt light headed, as I ( the pharmacist) headed out to have him sit down, dropped to a sitting position on the floor, I was able to get him up to a chair and was fanning him and we got him some water. he the passed out and his lead lobbed backwards, I got behind him so he did not hit his head and he went into a mini seizure which only lasted about 5 seconds and then he came out of, he was in sweats and we called 911. He declined to go to hospital and his mom came and picked him up


VAERS ID: 1365220 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-24
Onset:2021-06-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion, alprazolam, pantoprazole, sumatriptan, ozempic, triamterene-hctz, metformin. hydroxychloroquine
Current Illness: none per patient
Preexisting Conditions:
Allergies: flexeril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA


VAERS ID: 1365225 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: patient received vaccine and was light headed and fell twice. had patient sit and have oral glucose gel and her color came back and after 20 minutes patient seemed okay and left with mother


VAERS ID: 1365233 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-22
Onset:2021-06-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Menstrual disorder
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: My period started again after 3 days if taking my second dose. My last period prior started on 05/05/21


VAERS ID: 1365236 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Injection site haemorrhage, Injection site swelling, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: She bleed at the injection site . Held cotton ball to injection site for about 1&1/2 minutes until the bleeding stopped. There was swelling at injection site. About 2 minutes later after Band-Aid had been applied she passed out and fell to the left. Immunizer caught her just as her head hit the counter top. Held her until she came to for about one minute. Room was closed and could not call for help. Patient then put her head between her legs and started to feel better and decided to walk out of immunization room after about 5 minutes to sit in waiting room. Got her a bottle of water and patient said she wanted to lie down. Went to immunization room and patient laid down for about 15 minutes. Immunizer kept her talking and watched for any reactions. Patient then said she was okay and sat in waiting room for another 10 minutes before leaving.


VAERS ID: 1365237 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

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

Write-up: Patient received his Janssen Covid-19 immunization. The patient arrived at 11:00am on 6/1/21 and completed his pre-screening questions and temperature check. The patient then completed his "Patient Questionnaire and Consent Form." The patient was administered his Janssen Covid-19 vaccine around 11:05am. About 2 minutes after administration, the patient appeared pale and sliding out of his chair. The pharmacy technician responded and held the patient under his arms. The patient convulsed and then became unconscious. We called 911, checked the patient for breathing and responsiveness. The patient didn''t stop breathing and became conscious about 1 minute after losing consciousness. We placed the patient on the floor and placed cold compresses under his neck and on his wrists. EMTs arrived and evaluated the patient and made sure the patient was stable. EMTs offered to take the patient to the hospital but the patient declined.


VAERS ID: 1365238 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACCU-CHEK FASTCLIX LANCET DRUM Misc acetaminophen (TYLENOL) 500 MG tablet albuterol 90 mcg/actuation inhaler alcohol swabs (ALCOHOL PADS) ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG EC tablet blood sugar diagnostic (ACCU-CHEK AVIV
Current Illness:
Preexisting Conditions: Cardiovascular and Mediastinum Essential hypertension Hypertension associated with diabetes Respiratory Bronchiectasis without complication Digestive Gastroesophageal reflux disease without esophagitis Dysphagia Endocrine Multinodular goiter Hyperlipidemia associated with type 2 diabetes mellitus DM (diabetes mellitus), type 2, uncontrolled Musculoskeletal and Integument Primary osteoarthritis involving multiple joints Lumbar facet arthropathy Arthritis of carpometacarpal joint of left thumb Other Mixed hyperlipidemia History of breast cancer Obesity, morbid, BMI 40.0-49.9 Chronic bilateral low back pain without sciatica Weakness of trunk musculature History of sarcoidosis Pain of both breasts Bronchorrhea Cough Sarcoidosis
Allergies: CodeineUrticaria / Hives (ALLERGY), Shortness Of Breath (ALLERGY/intolerance) Demerol [Meperidine]Urticaria / Hives (ALLERGY), Shortness Of Breath (ALLERGY/intolerance), Nausea & Vomiting (ALLERGY/intolerance) Iv Dye [Iodinated Contrast Media]Anaphylaxis (ALLERGY), Urticaria / Hives (ALLERGY) OtherShortness Of Breath (ALLERGY/intolerance), Itching / Pruritis (ALLERGY/intolerance) TetracyclineUrticaria / Hives (ALLERGY), Shortness Of Breath (ALLERGY/intolerance), Itching / Pruritis (ALLERGY/intolerance) Venom-honey BeeAnaphylaxis (ALLERGY), Urticaria / Hives (ALLERGY), Shortness Of Breath (ALLERGY/intolerance), Itching / Pruritis (ALLERGY/intolerance) Multihance [Gadobenate Dimeglumine]Respiratory Distress (ALLERGY/intolerance) Nubain [Nalbuphine]Itching / Pruritis (ALLERGY/intolerance) TramadolItching / Pruritis (ALLERGY/intolerance), Nausea & Vomiting (ALLERGY/intolerance)
Diagnostic Lab Data: POCT Fingerstick Blood Sugar- 140
CDC Split Type:

Write-up: -nausea/vomiting, wooziness(light headedness) -was evaluated -was given Zofran for nausea


VAERS ID: 1365247 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-06-01
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lightheadedness; Heart palpitations EMS at bedside.


VAERS ID: 1365258 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle spasms
SMQs:, Dystonia (broad)

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

Write-up: Post vaccine pt started feeling crumps on the right side of the chest and in the right arm. Pt reported to feel better after moving the arm and massaging the right side of the chest. Pt reported to have had breast cancer and has experienced crumps in the same area before. Vitals obtained and monitored. Pt was released at 1515. 1507 SITTING BP 168/82 HR 76 SpO2 98%


VAERS ID: 1365270 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / UNK RA / IM

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

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

Write-up: Was called to patient observation area, pt slide out of chair to floor stated she felt light headed and was going to pass out. Pt commented that she was fasting. Vital signs obtained, pt was hypotensive BP 65/52 P 63, R 16 pusle ox 98% RA. Pt was transported by wheelchair to a private observation room and was seen by Dr. who encouraged pt to drink fluids and eat some crackers. Pt was observed for another 30 min, vital signs at discharge BP 97/63 P 71 R18 pulse oximetry 100%. Pt stated that she was no longer light headed.


VAERS ID: 1365274 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal
SMQs:, Anticholinergic syndrome (broad), Dementia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10-15 minutes after injection felt lightheaded/loopy--similar to 1st dose. vitals stable water given observed in car for an additional 20-30 minutes


VAERS ID: 1365283 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: Patient felt faint, dizzy right after vaccine given


VAERS ID: 1365286 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO178 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall, Hyperhidrosis, Malaise, Pallor, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (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: unk
Current Illness: asthma
Preexisting Conditions: asthma
Allergies: multiple allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Immediately following vaccine, client c/o not feeling well, broke out in a perfuse sweat, started to lean into mom, c/o dizziness and light headedness, pins and needles, pale. EMS to pod : BP 85/44 HR 64 o2 sat 94-96. Client observed for one hour by EMS, vs''s returned to baseline, fluids encouraged. Client transitioned home as per EMS.


VAERS ID: 1365315 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

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

Write-up: 13 year old patient became diaphoretic and lost consciousness. He immediately woke up and vitals were normal. Parent denies any previous health conditions or syncopal episodes.


VAERS ID: 1365331 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Florinol 0.1mg Cortif 10mg, synthroid 50mcg
Current Illness: none
Preexisting Conditions: bilateral hearing loss, hypothyroidism, diabetes
Allergies: Dust mites
Diagnostic Lab Data: N?A
CDC Split Type:

Write-up: After injection pt stated he was light headed and dizzy. Pt assessed BP92/55 P63 R 16 pulse oximeter 99% room air. Pt laid down with feet elevated, pt stated he had not eaten today. MD notified, continue to observe pt after eating a snack. Pt was observed by RN for 30 min. at time of discharge pt BP 95/55 p 61 pulse oximeter 98%. with no further complaints


VAERS ID: 1365339 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient got the first dose somewhere else and came to us for 2nd dose. He stated it was time for his 2nd dose. He didn''t the vaccine card with him. We gave the shot and advised him to return to the first location to get the card. He came back later with the card and we found out that he wasn''t due for the 2nd one yet (7 days earlier).


VAERS ID: 1365340 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Skin of right inferior medial mid back; biopsy by punch method - Subacute spongiotic dermatitis with eosinophilia (see below) erythematous scaly patches CLINICAL IMPRESSION Dermatitis Unspecified vs. Hypersensitivity Reaction vs. Contact Dermatitis Other GROSS DESCRIPTION Received in formalin fixative is a 0.4 cm punch x 0.2 cm which is inked black and bisected for histologic evaluation. GROSS DISCLAIMER (Gross Description measurements may be up to 1/3 smaller than actual size due to contraction during the fixation process) MICROSCOPIC DESCRIPTION The specimen reveals hyperkeratosis, parakeratosis, and spongiosis. A perivascular infiltrate of lymphocytes, histiocytes, and eosinophils is encountered. The histologic findings are those of a subacute spongiotic dermatitis with eosinophilia. The histologic findings support the clinical impression of allergic contact dermatitis. Atopic dermatitis, irritant dermatitis, as well as other causes of subacute spongiotic dermatitis with eosinophilia are all possibilities. Clinical correlation is required.
CDC Split Type:

Write-up: Received first COVID Vaccine in May 2nd; Rash developed post vaccine May 9th. Biopsy collected on 5/34, findings consistent with Cutaneous reactions reported after MODERNA and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. Journal of the American Academy of Dermatology. April 2021 (Online ahead of print).


VAERS ID: 1365342 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, 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:
Current Illness:
Preexisting Conditions: shogrens , high bloiod pressure, baby aneurysm
Allergies: sulfur, amoxicillin, cephalexin, nizoral, doxycycline, household cleaners, dogs, cats, pollen, distmites, corticosteroids, benedryl, zyrtec, claritin
Diagnostic Lab Data:
CDC Split Type:

Write-up: itching on scalp, back of neck, red arm


VAERS ID: 1365349 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site indentation
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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient says she is having no pain or redness at the injection site, but there is a divot where the vaccine was administered. She says it is like the muscle tissue is gone. it is a small area and is only found upon feeling the area. patient is going to monitor the area and keep us updated.


VAERS ID: 1365360 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

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

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

Write-up: VACCINE GIVEN AFTER 42 DAYS AT PATIENT REQUEST


VAERS ID: 1365362 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / UNK LA / IM

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

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

Write-up: 6/1/2021 Pt was observed post Covid-19 immunization for 15 minutes . During the observation period, she experienced an adverse reaction with the following symptoms: " feeling faint". Assessment : Time of assessment 355p. Complains of feeling faint, chest tightness, anxious. Actions taken: Vitals sign taken VAERS form obtained and completed by RN. VS at 3:55p- BP- 139/92, P- 83, O2- 100%, 4pm- BP- 131/89, P- 87, O2-- 100%, voices that she does have a history of anxiety, 4:05p BP- 132/80, P- 68, chest tightness resolved per patient, 4:10p BP- 133/80, P- 68, sitting up with no complaints, family here with patient Medications administered: No medication administered. Disposition: Reports no further symptoms of adverse reaction after observation for 30 minutes. Discharged home. Immunizations Administered Name Date Dose VIS Date Route Pfizer COVID-19 Vaccine 6/1/2021 3:35 PM 0.3 mL 2/25/2020 Intramuscular Manufacturer: Pfizer, Inc Lot: ER8736 NDC: 59267-1000-2


VAERS ID: 1365369 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine 20 mg capsules, bio 3bg, black elderberry thousand mg, strand of men, black Spanish radish, hemp oil complex, vitamin C 1000mg, vitamin D3 50000 IU one time a week, magnesium threonate, calcium lactate, Aller Tec antihistamine, l
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Dairy sensitivity.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy lump in elbow crease.


VAERS ID: 1365374 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: "Pt feels throat closing, reports mild shortness of breath. Patient is alert and able to communicate clealry- Speech is clear. No stridor. Lungs clear. Patient is not in apparent distress. Patient is accompanied by her father. 11:14 am patient reports slight improvement of throat swelling. Reports resolution of dyspnea. Discussed after care with patient and father-- follow up with PCP and ask for referral to allergist to clear patient for 2nd dose of Pfizer vaccine. 11:22 patient left via wheelchair with her father. Patient reports "less tightness of throat"" and resolution of dyspnea."


VAERS ID: 1365375 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: Needle hub detached from the syringe, pt received at least 50% of vaccine, no additional vaccine given


VAERS ID: 1365386 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Eye movement disorder, Feeling drunk, Feeling hot, Nausea, Neck pain, Nervousness, Posture abnormal
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), 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:
Current Illness:
Preexisting Conditions: Asthma Calcification of coronary artery Calcification of coronary artery Chronic low back pain Fatigue Gastritis IBS
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented today for first covid 19 vaccine. At 11:59 am (14 minutes) pt reports feeling nauseated and having sharp pain on left side of shoulder that radiates to neck. Pt indicated that this pain was new. Pt then tilted head back and eyes rolled. Pt reported feeling hot and stated she felt drunk. Pt also reports sob. Denies any constriction of throat. No labored breathing noted. Respirations normal, O2 at 2 liters applied. Doctor made aware and presented at pt''s side. Vitals obtained. Pt reported to Doctor that pain is gone. Continues to report feeling weak and shaky. Blood sugar 126. Doctor offered pt juice and crackers if needed. Pt indicated she is okay at this time. O2 remained in place. Will continue monitoring pt.


VAERS ID: 1365394 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Heart rate increased, Hyperhidrosis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Paramedics called 6/1/21
CDC Split Type:

Write-up: Increased blood pressure, increased HR, sweating, numb hands


VAERS ID: 1365397 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Sensation of foreign body
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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 30minutes after injection having a sensation in back of throat--lump--no difficulty talking, swallowing, breathing no itchiness vitals stable 97%, HR84 gave oral benadryl, patient refused. observed in car for 45 minutes


VAERS ID: 1365398 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Head injury, Headache, Syncope, Tinnitus, Vital signs measurement
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None Reported
Diagnostic Lab Data: EMTs assisted and reported his vitals, including blood sugar, were normal
CDC Split Type:

Write-up: Pt received 1st Moderna covid vaccine at approx 10:25am with no apparent issue. He was sitting outside pharmacy in observation area playing on cell phone and approximately 10 minutes after receiving vaccine fell in the floor, hitting his head. EMTs were called immediately as a precaution. He was conscious when pharmacist reached his side. He reported remembering a buzzing in his ears and then woke up in floor. Pt reported no hx of seizures or fainting. He remained in floor for several minutes, reporting his head hurt, but was able to tell his name, location, and date with no issue.


VAERS ID: 1365402 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

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

Write-up: Patient received vaccine and after a few minutes patient had seizure.


VAERS ID: 1365417 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-04-16
Onset:2021-06-01
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

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

Write-up: Patient was beyond the 6 week deadline to receive vaccine.


VAERS ID: 1365418 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-14
Onset:2021-06-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol 0.05mg, Singulair 10mg, Citalopram 20mg, ProAir HFA 90mcg, Fluticasone 50mcg, Advair diskus 250mcg/50mcg
Current Illness:
Preexisting Conditions: Depression, Anxiety, Intermittent Asthma
Allergies: Mold, Pollen, Animal Dander
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received a total of 5 vaccines given at multiple sites


VAERS ID: 1365423 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysphagia, Heart rate, Oropharyngeal discomfort, Oxygen saturation, Tongue disorder, Vital signs measurement
SMQs:, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl OTC
Current Illness:
Preexisting Conditions: Celiac Disease
Allergies: Gluten, Macrobid, Topamax
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was into clinic for dose 2 of moderna vaccine. Patient reports allergies to Topamax, Macrobid, and gluten. Patient states that after first vaccine she had tingling in the arm but desires to continue for dose 2. Patient was given vaccine using aseptic technique to left deltoid at 2:27 pm. Around 2:30 patient reports that was hard to swallow and tongue was beginning to feel thick. Vitals signs 116/82, heart rate 100, sats 98% on room air. Around 2:43 vital signs 122/82, heart rate 91, and sats 98%. No shortness of breath noted. Patient reports that was getting harder to swallow and that tongue was still feeling thick. Epinephrine was given to left anterolateral thigh via EpiPen and 50 mg Benadryl to R arm. EMS was activated. At 2:48 vitals signs were: 128/74 108 98% on room air. At 2:53 vitals 135/78, heart rate 99, sats 98% on room air; patient reports that "throat still feels fuzzy but tongue feel better". At 2:54 EMS arrived. Vital signs per EMS staff were 138/79, 101, and 93% on room air. At 2:59 with assistance with EMS staff patient was stood up and vitals were 126/90, no hives were noted. At 3:02 patient refused to be treated via ambulance to ER but will have friend who had accompanied patient to the appointment take her to ER. It was stressed by all nursing staff and EMS that this is recommended. Patient never lost consciousness.


VAERS ID: 1365435 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

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

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

Write-up: patient had a headache, felt very dizzy and "jittery" after her vaccine - did wait the 15 minutes but after about 15 more minutes needed to sit down again


VAERS ID: 1365439 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Patient started having generalized itching over whole body


VAERS ID: 1365444 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-12
Onset:2021-06-01
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray normal, Dizziness, Electrocardiogram normal, Loss of consciousness, Magnetic resonance imaging normal
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), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ovarian Cysts (one ovary has been removed)
Allergies: None
Diagnostic Lab Data: I had an MRI, EKG, and chest X-rays done at the hospital but they said everything looked fine.
CDC Split Type:

Write-up: I went to the bathroom and realized I had gotten my period and was feeling lightheaded, I went to go get water and passed out while walking, my moms found me and called an ambulance, I had an MRI. EKG, and chest X-rays done at the hospital, they said I was fine but I have never passed out before, especially from my period.


VAERS ID: 1365446 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Feeling hot, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: influenza 2 years ago
Other Medications: none
Current Illness: none
Preexisting Conditions: "mild" cerebral palsy, mom states not sure, mom states not treated
Allergies: lamotrigine
Diagnostic Lab Data: na
CDC Split Type:

Write-up: 10 minutes after vaccine patient stated she felt warm and clammy, gave her sip of water and cold rag, after 25 minutes she stated she felt a little better and wanted to go to bathroom, had syncope event on way to bathroom and passed out. 10 minutes vomitted. did not want to go to er and mom did not want her to. mom took her home.


VAERS ID: 1365451 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

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

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

Write-up: The patient received Pfizer for their first dose and Moderna for the second dose. No signs/symptoms reported yet.


VAERS ID: 1365453 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-30
Onset:2021-06-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Metabolic function test, Pericarditis, Troponin
SMQs:, Systemic lupus erythematosus (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? No
Previous Vaccinations:
Other Medications: NA
Current Illness: No known pmh
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG, BMP, Troponin
CDC Split Type:

Write-up: chest pain starting at 7:30 AM, not relieved by Tylenol. Went to pediatrician office where EKG showed ST elevations in II, III, aVF. On arrival to ED EKG findings more consistent with pericarditis.


VAERS ID: 1365469 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Neck pain, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (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:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient fainted and urinated. He said he was feeling pain briefly in his neck. He also said he had pain in his right chest. He laid down for 40 minutes. He did not want us to call an ambulance. He had someone pick him up and he said he was going to the emergency room.


VAERS ID: 1365477 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fainted before, not aware from which vaccine. (has major vaccine anxiety)
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was getting their 2nd covid immunization. They marked that they once had fainted from a previous immunization and had needle anxiety. I asked her if she had fainted anytime recently or during the first covid vaccine and she said no. Gave her the vaccine and let her remain in the chair. She then had gotten a little dizzie for a moment, and then told us she had just fainted. We called store management code white. We got her history, some soda, and ice pack. She didn''t fall out of the chair but thought it would help her feel better. She stated she hadn''t eaten much today and just got done working out at the gym and had low blood sugar. We checked her pulse Ox and heart rate and everything was within normal limits. We had her remain to she felt comfortable to leave. She didn''t have any HX of seizures and and no signs of allergic reaction. Staff Said when she was here first time she had immunization anxiety and hung out for 40ish minutes but didn''t faint first time.


VAERS ID: 1365491 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, 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), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Anxeity
Allergies: None
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient received 2nd dose of Moderna. About 5 mins post vaccination patient felt hot, dizzy and faint. She motioned for help to her mother and mom notified the pharmacist on duty. Patient appeared to loose consciousness for a few seconds and then came back to. Pharmacy assisted in lowering patient to floor so she did not fall. We applied cool compress as she was very hot and we called 911. Ambulance arrived and took patient to hospital.


VAERS ID: 1365495 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: Patient appear to have seizure just after receiving the vaccination. After apparent seizure or loss of consciousness patient appear weak and had a hard time answering questions. 911 was called and patient transported for medical care.


VAERS ID: 1365498 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-04-13
Onset:2021-06-01
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

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

Write-up: Patient is receiving second dose more than 6 weeks after 1st dose.


VAERS ID: 1365499 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

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

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

Write-up: Second Moderna vaccine given at 22 days.


VAERS ID: 1365506 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Hyperhidrosis, Hypotension, Pallor, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: EKG on 6/1/21
CDC Split Type:

Write-up: Pt was given second dose of Pfizer vaccine on 6/1/2021 at 1050, pt complained of feeling dizzy, lightheadedness, and diaphoretic at 1057. Pt was observed- pt was pale, diaphoretic, drowsy but arousable, pt oriented x4. Vital signs were taken immediately: BP 62/33 (44), HR41, SpO297% RA, vital signs were repeated at 1105 as followed BP 68/28 (41), HR 41, SpO2 97% RA. RN STAT and 911 were called. Ice pack was applied to back of neck, ammonia was used for pt to smell, pt states he had breakfast in the morning but did not drink a lot of water. RN tried to take manual BP, attempted twice, unable to obtain bp. RN STAT nurse arrived, report given to RN STAT, pt placed in gurney to be taken down to treatment room. At treatment room, pt looked "regained his color, not as pale as before" according to patient''s mother. Mother at bedside throughout whole event. Vital signs were taken once arrival to treatment room at 1116: 117/41 (72), HR50, SpO2 97%. EMS arrived to treatment room, EKG taken- sinus bradycardia shown on screen, pt''s mother unable to verify pt''s resting HR. Pt states he is an athlete, runs track in school. Blood glucose 98. Pt stated he felt back to normal, mother said she would monitor him from home.


VAERS ID: 1365514 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluxatine, Vitamins
Current Illness: Anxiety
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: VS. BP 110/79, 71, 20, o2 98%
CDC Split Type:

Write-up: 32 yo WM approach staff member with c/o dizziness and light headiness ten minutes after receiving 1st dose of Pfizer vaccine. Patient stated he went to stand and felt like he was going to fall to the floor. Staff member notified EMS and NP of the complaint. PT was evaluated by on-site by EMS and NP. Patient stated he always experience some dizziness after receiving any shot. Initial VS were taken. BP 92/5967, 20. Patient was given a snack and a bottle of water as requested. PMH, Anxiety D/O. NKA. After eating snack and drinking water, patient stated he was feeling better and ask to leave. Final VS were taken. BP 110/79, 71, 20, o2 98%. Patient left facility without further incidents.


VAERS ID: 1365520 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not taking any medications
Current Illness: none
Preexisting Conditions: Migraines, "high heart rate", and Anxiety
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient DOB: 11/13/1979 received Janssen Lot # 1808980, expiration 6/20/2021 at 1353 in the left arm sitting in a chair. At 1354 Client stated ? I just feel a little dizzy like I?m floating.? instructed client to lie down in clinic room. Vitals taken: 1356: BP 11/79, HR 110, SpO2 97%, RR 18. Client Alert and Oriented x4. Client has no known allergies, no known prior history of vaccine reactions. History of anxiety, Migraines, and ?high heart rate? (per client). At 1401 client reported ?I feel good, I feel normal.? While still lying supine. Vitals? BP 110/90, HR 104, SpO2 97%, RR 16. Skin dry, color normal for Ethnicity, no skin color changes noted. At 1404 instructed client to sit up. Client stated ?I feel fine? in sitting position. Vitals: BP 120/88, HR 111, SpO2 98%, RR 16. At 1410 Client stood up, stated again ?I feel fine.? Alert and Oriented x4, denied dizziness or nausea. Vitals: BP 120/70, HR 110, SpO2 98%, RR 16. PHN?s educated client related to need to lay down before shots. Reviewed s/s allergic reactions, when to see PMD. At 1415 client walked off with steady gait, exited building, stated ?felt normal.?


VAERS ID: 1365524 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0186 / 1 RA / IM

Administered by: Work       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: Constipation;
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Prior to the vaccine patient and parent were given teaching about concerns for fainting. She was questioned if she had something to eat and drink prior to coming to the clinic and both indicated that she had. It was volunteered that patient has never had a fainting spell from receiving injections/vaccines. She was administered 0.3 ml of the Pfizer vaccine at 4:47 p.m. while seated securely in a chair. At about 4:50 p.m. she lost consciousness and assumed a prone position. She was held by both the R.N. and her mother and never fell or injured herself. She was unconscious for approximately 8-10 seconds and regained consciousness. She was alert and oriented. She was reassured and given some apple juice and a graham cracker which she consumed. Charge nurse and nurse manager appeared on the scene. EMT was summoned who brought a wheel chair and patient was transported to the observation area in the wheel chair. She was conversing and appeared oriented prior to going to the observation area.


VAERS ID: 1365525 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / -

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

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

Write-up: PT PASSED OUT. HAD HX OF PASSING OUT AT SCHOOL WHILE IN CLASS. PARAMEDIC CAME, HYDRATION OFFERED. SX RESOLVED, NO TRANSPORT.


VAERS ID: 1365532 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-31
Onset:2021-06-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Pain in extremity, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: facial swelling, chills left leg pain, severe headache


VAERS ID: 1365535 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, 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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Patient and his Mother were in the vaccination room. appox 30 sec to 1 min following Vaccination patient stated he feels like he is going to pass out and before his mother or administering pharmacist could respond the patient fainted/ lost consciousness for approximately 30seconds


VAERS ID: 1365541 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unknown, mom said patient has felt dizzy in past with vaccinations
Other Medications: unknown
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient reported feeling dizzy shortly after receiving his vaccination. Tech notified pharmacist and remained with patient. Pharmacist grabbed water and a wet towel to put on patient''s neck. Patient''s mom got some gatorade for the patient. Patient said his vision was "going". Got patient seated on floor and put the cool towel on his neck and told him to take some deep breaths. He started to feel better within a minute or so and had some gatorade. His color returned and was little sweaty, but reported feeling better. He remained under observation with his mom for another 30 minutes before leaving without issue. Mom stated he has felt dizzy in past, but wasn''t noted on VAR.


VAERS ID: 1365542 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: FELT DIZZY AND HAD A WITNESSED SYNCOPAL EPISODE, TRANSPORTED TO COT, APPEARED DIAPHORETIC AND PALE. PARAMEDIC CAME, BP 86/51, HR 49, OFFERED HYDRATION, SX RESOLVED, NO TRANSPORT, AMA SIGNED.


VAERS ID: 1365543 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-29
Onset:2021-06-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: myopericariditis


VAERS ID: 1365551 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

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

Write-up: Patient lost consciousness ten minutes after receiving shot with a reduced pulse and losing all color in face. Patient denies any history of adverse reaction to previous injections or immunizations.


VAERS ID: 1365560 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 - / IM

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

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

Write-up: dizziness vitals taken stable 109/76, pulse 81, 98.3 , spo2 98% alert, water given. monitored for 30 min. pt has a family member , took client home


VAERS ID: 1365561 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Erythema, Nausea, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen (MOTRIN) 800 mg Oral Tab Gabapentin (NEURONTIN) 100 mg Oral Cap Fluticasone (FLONASE ALLERGY RELIEF) 50 mcg/actuation Nasl SpSn Ibuprofen (MOTRIN) 800 mg Oral Tab Levothyroxine (LEVOTHROID/SYNTHROID) 25 mcg Oral Tab Norethindrone
Current Illness:
Preexisting Conditions: Asthma, Hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt experienced nausea within 4 minutes of vaccination. Pt denied itchiness or hives. Symptoms quickly progressed to difficulty swallowing, redness, and notable upper airway swelling. Pt given Epi 0.3 mg IM and taken to ER via wheelchair.


VAERS ID: 1365565 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: After receiving the injection the patient fainted. Patient was offered juice and after taking a sip she had a small amount of emesis. A cold towel was placed on patient''s forehead and then observed by EMS.


VAERS ID: 1365574 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Respiratory arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none mom says patient has fainted before with exercise and not enough food intake
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt passed out turned while and grey stopped breathing received on dose of epi pen 0.3 mg came to and a sugar drink, emt called and came, blood pressure was good


VAERS ID: 1365684 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-04-10
Onset:2021-06-01
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

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

Write-up: more than 6 weeks between 1st and 2nd vaccine dose.


VAERS ID: 1365686 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Seizure, Thirst, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Pt received his first dose of the Moderna Covid-19 vaccine. Immediately following the injection the pt began convulsing. Convulsions lasted for less than 30 seconds. Upon completion of convulsions pt was awake and alert. He stated he was thirsty. Before we could provide water to pt, the pt began vomiting. Pt was placed on his side and paramedics were called. Pt remained in a laying position until emt''s arrived. Pt was examined and released. Pt was encouraged to follow up with his pcp.


VAERS ID: 1365699 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Pfizer vaccine was reconstituted with the wrong amount of diluent. 1.4ml was added to vial instead of 1.8ml. Patient received a higher concentration then required.


VAERS ID: 1365700 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Hyperhidrosis, Immediate post-injection reaction, Mobility decreased, Muscle rigidity, Pallor, Panic reaction, Paraesthesia oral, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Almost immediately after receiving the vaccine pt went rigid and was unresponsive. He came to within a minute. He was very panicked and stated he thought it was a dream. He was extremely pale and very sweaty. We gave him some water and an ice pack to cool down. We checked his blood pressure. He then lied down on the floor and we elevated his feet. He then stated he could not move his hands and his lips were tingly. We then gave him some liquid benadryl and continued checking his blood pressure and called EMS. They arrived and he left with them. I tried contacting him later without success. Will try again tomorrow.


VAERS ID: 1365701 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Hyperhidrosis, Movement disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 5 minutes after receiving vaccine patient "zoned out" and felt like he could not move. Looked like he was on the verge of fainting or blacking out but never lost consciousness. Patient was sweating after as if he fainted or had a panic attack. This event only lasted 1 minute and patient denied an ambulance.


VAERS ID: 1365702 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

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

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

Write-up: became nauseous , light headed and started sweating


VAERS ID: 1365707 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Dyskinesia, Dyspnoea, Hyperventilation, Musculoskeletal stiffness, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: not aware of any
Current Illness: seasonal allergies
Preexisting Conditions: not that we are aware of
Allergies: strawberries
Diagnostic Lab Data: none received thus far. Patient said they would contact us on any changes.
CDC Split Type:

Write-up: Patient was very anxious and breathing heavy. About 5 minutes after the vaccination they started to hyperventilate and ended up throwing up. After letting them sit and relax for 5 minutes, the patient then had to throw up again and told their mother they felt like they were going to faint. Mother and myself stood by, while patient did end up fainting. We slowly lowered them to the ground, and on the way down their body got stiff and patient had uncontrollable movements and was hardly responsive. Mother and myself finally got her safely to the floor as they came to and was responding to verbal ques and stimulation from mother. Mother went to get water and i stayed with the patient to ensure no other things happen. Patient ended up doing alright after relaxing for a few and then i walked them and mother to their car and ensured they were feeling good enough to go home. I then advised the mother to seek medical attention.


VAERS ID: 1365708 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

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

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

Write-up: Patient developed itching and hives minutes after second pfizer dose. 50 mg IM benadryl given. No SOB, no swelling. O2 at 100% HR 80s and BP 140/90. Lungs CTAB. No wheezing. Patient improved sx after Benadryl. Monitored for 30 minutes after benadryl.


VAERS ID: 1365709 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pharyngeal paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (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: Latex and cleaners
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Patient stated her throat started tingling and she thought it was feeling like it was ready to start closing and she usually takes Benadryl. Administered 25mg of liquid Benadryl. The patient waited 30 minutes and stated she felt fine.


VAERS ID: 1365715 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Pfizer vaccine was reconstituted with the wrong amount of diluent. 1.4ml was added to vial instead of 1.8ml. Patient received a higher concentration then required.


VAERS ID: 1365717 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

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

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

Write-up: Pateint received dose 1 of COVID 19 Pfizer vaccine on 5/19/2021. Appointment for 2nd dose was made on incorrect day and patient received 2nd dose on 06/01/2021. Earliest dose should have been 06/05/2021. Patient''s mother was notified and told of error on 6/01/2021 by telephone. Patient vaccine record had an appointment on wriiten backside for 6/9/2021. Mother will closely moniter the patient for any adverse affects.


VAERS ID: 1365722 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JNJ 207A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Eye irritation, Headache
SMQs:, Corneal 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: Soma Genetic for Xanax Synthroid
Current Illness:
Preexisting Conditions: Hoshimotos Thyroiditis Fibromyalgia Asthma Periodic check up on heart Circulatory issues in feet/toes
Allergies: Amoxicillin Keflex Gabapentin NyQuil Ativan Ciprofloxacin Zoloft Mosquitos
Diagnostic Lab Data: To be continued... Just received vaccine today ****I WANT to file a formal grievance against the facility that adminster my vaccine****
CDC Split Type:

Write-up: 1.) Severe constant headache top of head - Time onset @ 16:15 to present time Took Tylenol 500mg no relief 2.) Burning of eyes like if you are developing fever - Time onset between 17:44 to 18:30 Apply cold compress to eyes 3.) Headache covering top of head now to back of head. Treatment already took Tylenol so no other recourse Will drink plenty of Gatorade and water and rest the night


VAERS ID: 1365725 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-01
Onset:2021-06-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Dizziness, Feeling hot
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I take super complex b, multi gummies and metformin and spirulina
Current Illness: Just got itchy on chest and back and little on neck
Preexisting Conditions: I have type two diabetes
Allergies: Allergic to penicillin and also have seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: I was fine ,but then it felt like I had an peanut allergy and felt woozy( suddenly it stopped for five minutes and was sort of hot and then my temperature went normal but it stopped and then I was fine and just stay hydrated. But today I got where my back was itchy and the bottom of.my rib cage was sore but I''m okay now cause I took benedryl.


VAERS ID: 1365728 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Pfizer vaccine was reconstituted with the wrong amount of diluent. 1.4ml was added to vial instead of 1.8ml. Patient received a higher concentration then required.


VAERS ID: 1365735 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fall, Head injury, Skin abrasion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: Assessment completed Upon mrs arrival BP and pt was placed on heart monitor
CDC Split Type:

Write-up: Pt received vaccine at 5:55 pm At 6:00pm Pt had syncopal episode fell out of chair and hit head on concrete Pt had abrasion to right head right wrist and right knee Ot was able to answer questions A&Ox 4 No vomiting No blurred vision 911 called and ot was transported to hospital via Ambulance


VAERS ID: 1365750 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-10
Onset:2021-06-01
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Audiogram abnormal, Deafness unilateral, Tinnitus, Tympanometry abnormal
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: No preexisting health conditions
Allergies: None
Diagnostic Lab Data: I have been evaluated by my primary physician and an ENT specialist which confirmed my hearing loss and tinnitus via audiogram and tympanogram. I am now forced to purchase a hearing aid for my hearing loss (which is not covered by my insurance). I wont ever get another Covid vaccine because of my symptoms which is problematic since I am an emergency room nurse.
CDC Split Type:

Write-up: Approximately 6 to 8 weeks after receiving my second Pfizer Covid-19 vaccine, I developed tinnitus and hearing loss in my left ear.


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