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

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



Case Details (Reverse Sorted by Onset Date)

This is page 268 out of 8,010

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VAERS ID: 1674545 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dizziness, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations: flu vaccination
Other Medications: DIphenhydramine 50mg 1 hour prior to vaccination
Current Illness:
Preexisting Conditions: hypertension, mood (depression), cancer survivor,
Allergies: flu shot, codeine, penicillin, cephalosporins
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient started to get dizzy immediately after receiving the vaccination, made him stay seated and talk to me- he stated his throat was starting to close and I immediately administered one epi pen into his thigh. He started coughing and breathing a little better. Few minutes later he was having difficulting breathing and indicated he needed another epipen. I administered the epipen. He could breathe but was experiencing severe side effects from 2 epipens. We called EMS and sat with him til they arrived. All occurred with in 10 minutes after administration. EMS walked him to their ambulance.


VAERS ID: 1674555 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Myalgia, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: simvastatin 10mg, alprazolam 1mg 4x, zyrtec, promechazine, anoro ellipta, ipratropium bromide nasal spray,
Current Illness: squamous cell cancer,syncope, unstable angina, hematuria, ibs, migraine, actinic keratosis,hpv, cyst pancreas, hyperlipdemia, ocd, copd
Preexisting Conditions: squamous cell cancer,syncope, unstable angina, hematuria, ibs, migraine, actinic keratosis,hpv, cyst pancreas, hyperlipdemia, ocd, copd, anxiety ,ptsd
Allergies: pennicillin, sulfamethozole, buspar,zoloft , neomycin, lovastatin, paroxetine,buspar, bupropion,
Diagnostic Lab Data: no tests done, self quarantined at home , unreported till now
CDC Split Type:

Write-up: right arm muscle pain from hours after shot to present time, ache, pain when using arm for any activity from injection site to elbow. chronic nearly constant if using, leaning or raising arm. A.ppears to be permanent, not worse


VAERS ID: 1674579 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-09-04
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

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

Write-up: breakthrough case on 9/4/21


VAERS ID: 1674598 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-09-02
Onset:2021-09-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: na
Current Illness: common cold that started on August 13th.
Preexisting Conditions: na
Allergies: shellfish allergy
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Swollen, slightly painful armpit on right arm. Same arm as the injection site in shoulder.


VAERS ID: 1674613 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Malaise, Muscle rigidity, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No known allergies
Diagnostic Lab Data: Paramedics performed EKG and blood pressure monitoring.
CDC Split Type:

Write-up: Patient began to experience muscle rigidity, uncontrollable shaking, light headed, and a general sense of feeling ill. Paramedics were called and arrived to treat patient promptly. Patient was not taken to hospital and was cleared by paramedics to leave the pharmacy to return home.


VAERS ID: 1674618 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-01
Onset:2021-09-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Swelling at Injection Site-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Additional Details: lip itch, felt like "spider walking across lip"


VAERS ID: 1674621 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Seizure, Skin abrasion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (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: none
Current Illness: nonw
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received his Janseen vaccine approx. at 10:50 AM; he was in the waiting area and had (2) witnessed small seizures. Small abrasion to right backside of the head (slight bleeding/no swelling). In between seizures was alert and oriented able to answer all questions. 911 was called, wife was called arrived on scene. He was transported to the hospital for further observation. His vitals were stable when transported.


VAERS ID: 1674625 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-02
Onset:2021-09-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Afinitor, Crestor, Xanax, exemestane, metoprolol Vitamin C, Vit D, Tylenol
Current Illness: Cancer, breast metastasis to liver
Preexisting Conditions: Cancer, lung (resected), breast with metastasis to liver, elevated blood pressure (Treated), hyper cholesterol,
Allergies: All local anesthetics, all contrast dyes, sensitivity to propofol, morphine and possibly IV preservatives.
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash (beginning 9/4/2021)


VAERS ID: 1674630 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Nausea, Pallor, Presyncope
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: patient reports feeling nauseous about 5 minutes after his vaccine. He then reports feeling sweaty and as if he was going to pass out. Patient appeared pale and diaphoretic. Taken back to exam room, layed flat and given cool wash rag on forehead. Symptoms subsided after approx. 3 minutes. He was slowly raised up to siting position and given water. Patient reports feeling "back to normal". Had him stay in waiting room an additional 15 minutes, normal color and skin tone/temp, left ambulatory with family.


VAERS ID: 1674634 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately after being given the shot, the patient fainted. She woke up about 10 seconds later and I got her to sit back up in her chair. I gave her some ammonia to help with the fainting. About a minute or so after she woke up, she started to faint again, and had a small seizure that lasted about 5 seconds.


VAERS ID: 1674645 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Hyperhidrosis, Nervousness, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Patient reported nervousness/anxiety prior to shot. Started feeling nauseous and sweating after the shot. Two compression packs were used to try and cool the patient. Patient ended up throwing up. Vitals were taken with a reading of 130/78 Temp 97.7 89 BPM. Patient was cleared


VAERS ID: 1674654 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: patient received vaccine and into 5 minutes of waiting I noticed he began to jerk and slump down on his chair. when going over to him he was pale and drenched in sweat. EMT arrived 10 minutes later and took him to the hospital for follow up.


VAERS ID: 1674655 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

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

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

Write-up: PT DEVELOPED A WELT/RASH ON HER RIGHT FOREARM ABOUT 10 MINUTES AFTER THE VACCINE. NO DIZZINESS, NO TROUBLE BREATHING. GAVE HER 50MG DIPHENHYDRAMINE ORALLY. PT WAITED FOR 45 MINUTES, NO ADDITIONAL WELTS OR RASH DEVELOPED. THE ORIGINAL ONE WAS STILL THERE. PT INSISTED ON LEAVING AFTER 45 MINUTES


VAERS ID: 1674661 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A LA / IM

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

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

Write-up: We were in the middle of a rush of vaccines. I inadvertently gave the patient the J & J vaccine instead of her second dose Pfizer. I called the patient to notify her of my error. She was understandably upset. I asked her reasoning for not wanting the J & J and it was due to the risk of blood clots. I asked her if she had a history of blood clots to which she denied.


VAERS ID: 1674662 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, metoporol, valacyclovair, protonix, estrogen, atorvastatin, multi vitamin, D3, zinc, magnesium, C, B-12, B- Complex, B-1, A, MSM, Quercetin
Current Illness: Acute Pancreatitis, unregulated thyroid levels
Preexisting Conditions: GERD, TIAs, hypothyroidism, proximal AFib, PFO Closure 2010
Allergies: Codeine, adhesive
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, body aches, nausea, fever, fatigue


VAERS ID: 1674663 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR, Fluoxetine
Current Illness: None reported
Preexisting Conditions: No Known Health Conditions
Allergies: NKDA
Diagnostic Lab Data: Blood pressure checked by 911: 130/90. Heart Rate: 60`
CDC Split Type:

Write-up: Patient fainted onto the floor minutes after receiving the vaccine. According to bystanders nearby, they observed seizer like appearance. When pharmacist came towards patient, patient was awake and alert without seizure symptoms. 911 was called, blood pressure and heart rate were normal. Patient was seated and allowed time to rest. After resting, he was fine to go home.


VAERS ID: 1674665 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: n/a
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: second dose administered on day 21 after first dose; 3 days earlier than approved


VAERS ID: 1674676 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Severe left arm pain. injection site swelling. Headaches.


VAERS ID: 1674679 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Crying, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (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: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 5 minutes after vaccine administration, pt began crying and complaining about being unable to see. Shortly after she began vomiting which she said made her feel better. EMS arrive and took vitals, BP was on the lower end of normal. Pt regained color and was able to walk out on her own.


VAERS ID: 1674684 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

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

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

Write-up: GAVE PATIENT MODERNA COVID VACCINE FOR THIRD SHOT(PATIENT STATES IMMUNOCOMPROMISED). PATIENT RECEIVED PFIZER COVID VACCINES FOR FIRST 2 SHOTS


VAERS ID: 1674687 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hypotension, Nausea, Presyncope
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm, headache and fatigue after previous Moderna vaccines. Duration 2-3 days.
Other Medications: Premarin, Amlodipine 5mg, stool softener, vitamins, HA supplement, eye drops for dry eyes
Current Illness: None
Preexisting Conditions: Sciatica; dry eyes
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Presyncope, feeling dizzy, cold sweat, followed by nausea. I was feeling faint and sat down in a chair. My husband helped lift my legs, but I was still feeling faint and he and my daughter helped steady me to go lie down on the couch in the living room. My husband took my blood pressure which was low for me at 107, and my pulse was steady at 72.. I fell asleep on the couch and woke up two hours later, feeling better.


VAERS ID: 1674688 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling cold, Hyperhidrosis, Loss of consciousness, Presyncope
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Patient had a several vagal down response almost right at the 15 minute wait time mark. She started sweating, going cold, light headed, and nearly passed out. She was assisted in lying down and was given cold water. She recovered from the reaction shortly after and was able to go home on her own with no continued issues.


VAERS ID: 1674689 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Feeling abnormal, Hunger, Hyperhidrosis, Immediate post-injection reaction, Muscular weakness, Thirst
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (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: Not taking any medications at the moment
Current Illness: Patient verbalizes not having any conditions or diseases
Preexisting Conditions: Patient indicates not having any.
Allergies: At the moment no allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 29 year old male patient. Immediately at the time of vaccination, he refers "feeling bad" he is sweaty, he refers to feeling dizzy. Manifests musculoskeletal weakness refers to feeling thirsty and hungry. He is oriented x3. Paramedic is called immediately to take vitals. Glucose 71, BP 128/77, Sat 99%, Pulse 87. He is transported in a wheelchair to the evaluation area.


VAERS ID: 1674691 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 2 LA / IM

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

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

Write-up: None stated.


VAERS ID: 1674695 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-27
Onset:2021-09-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb discomfort
SMQs:

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

Write-up: Covid arm


VAERS ID: 1674696 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: Patient already had 1st dose done elsewhere. We administered a second dose and had patient wait 15 minutes. No reaction.


VAERS ID: 1674697 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Loss of consciousness, Nasal congestion, Palpitations, Rhinorrhoea
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 (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient received Covid shot at 6pm yesterday. She had to wait 30 mins due to previous allergic reactions. (1st covid shot) Called pharmacy today to report that she passed out and was having trouble breathing. I advised her to hang up and call 911. I then called 911 and gave them her name and address. I called her back about 1 hr later with no answer. 1 hour later, she called me back. She told me she did not go to ER and refused care. She was feeling better. She had a runny/stuffy nose after her shot yesterday. She has an infection on her foot and was changing the dressing and passed out. She has a "bad heart". When she woke up her heart was racing and had shortness of breath. She has also been told by dr she may have seizures. Since she had not passed out in a while, she thought it might be due to her covid vaccine. I told her these were not normal side effects from a covid vaccine but if she had anymore trouble to go to er and let me know. I also told her to follow up with her heart dr.


VAERS ID: 1674700 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Feeling hot, 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: flu vaccine (last dose was 4 years ago)
Other Medications: unknown
Current Illness:
Preexisting Conditions: diabetes
Allergies: tylenol, strawberries, nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortly after administration, pt began feeling hot, turned red on her arms, chest and back and felt itchy. we placed a cold pack on the back of her neck but itching persisted so we gave her one 25mg capsule of diphenhydramine (Benadryl) and continued to monitor, pt did state that she gets itchy with flu shots (last took 4 years ago) but never a severe reaction. we monitored her for a total of 45 minutes and she felt better after taking the benadryl. we cautioned her that it could cause drowsiness but she had no one to pick her up. she did state she was very familiar with benadryl as she takes it regularly. called patient about 2 hours later to check up on her and she was fine. feeling alot better.


VAERS ID: 1674710 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 04ZAZIA / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Received a first dose of the the Pfizer Covid Vaccine on 8/14/2021. Came in on 9/4/2021 to receive my second dose and the pharmacist gave me the J&J shot instead of the second Pfizer dose.


VAERS ID: 1674711 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

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

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

Write-up: Dizziness after vaccine- resolved


VAERS ID: 1674713 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Panic attack
SMQs:

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

Write-up: pt has panic attack after receiving covid vaccine. pt was with her spouse. we gave her water to drink and tried to calm her down. after 10-15 minutes she was ok and walked out of store with her spouse.


VAERS ID: 1674719 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-02
Onset:2021-09-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysstasia, Gait inability, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)

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

Write-up: Pt woke up in morning (7:30am) 2 days after 2nd dose of pfizer covid-19 vaccine unable to stand or walk. Pt reported to pharmacy and 4:00pm and could then stand, but still unable to walk due to weakness in legs.


VAERS ID: 1674720 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-08
Onset:2021-09-04
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid test collected 9/1, resulted positive 9/4.
CDC Split Type:

Write-up: Asymptomatic. Community exposure from positive (8/27/21) grand-nephew.


VAERS ID: 1674729 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Parent said he had seemed to "zone out" once when he had received school shots previously. He did not tell us this when asked
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: Paramedics took vitals and blood sugar and said everything was normal
CDC Split Type:

Write-up: Patient was very nervous/ anxious about vaccine. When it was given , patient seemed to have a seizure and lost consciousness for a few seconds. We called 911. They checked vitals and everything was ok .They told the parent to watch him . They said this happens fairly often when patients get really nervous about vaccines.


VAERS ID: 1674731 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Patient received a 3rd dose of Pfizer after 1st and 2nd doses were Moderna.


VAERS ID: 1674738 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling cold
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: Syncope when childhood vaccine received.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to receive 2nd dose of Moderna Covid Vaccination. Had identified as no problem with the 1st dose. Patient was nervous/apprehensive about vaccine and had a childhood history of Syncope with vaccinations/needles. Patient received vaccine and was ok, while waiting in observation pt. had expressed that he was feeling cold, light headed and dizzy. I was notified and stabilized pt. to prevent falling/sliding from passing out, pt. never lost consciousness and provided pt. with cold compress which relieved pt. symptoms and transported pt. onto floor incase of loss of consciousness, which never occurred. Patient recovered and felt fine.


VAERS ID: 1674741 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-09-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Chest pain, Headache, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

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

Write-up: Patient alert and oriented x4 complained of back pain, headache, chest pain, left leg feeling numb. Vital signs taken, bilateral lower extremities elevated, water, crackers offered, cooling packs applied. At 4:13 patient complained of persistent chest pain; EMS activated by . EMS arrived on site at 4:28, and the patient reported feeling better, and left with the EMS.


VAERS ID: 1674746 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Pallor, Tremor
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), Parkinson-like events (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: pt is taking fluoxitine 10mg
Current Illness: pt did not report any other illnesses
Preexisting Conditions: Pt did not report any long standing or chronic vaccination
Allergies: none
Diagnostic Lab Data: Blood pressure was taken with was 114/65 pulse 65bpm
CDC Split Type:

Write-up: Pt started turning pale and sweaty. Pt started to shake a little and was laid of the floor gently by the pharmacist. The paramedics were called right and blood pressure was taken while pt was on the floor. The patient came to while laying on the floor and said he did not remember going onto the floor. The paramedics came and checked out the pt but denied them going to the hospital. Pt was told to follow up with md to make sure he doesn''t have any issues with seizures.


VAERS ID: 1674757 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product substitution
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 Patient asked to be injected for the second dose of Moderna (1st shot was taken out of the country) however, by mistake, I injected Pfizer. I informed my district manager and I was told that the patient does not need additional dose,
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient requested Moderna as her 2nd shot (1st was done out of the country), however, I injected her with Pfizer by mistake. I only realized my mistake after the fact. Patient seemed fine after the shot (10 min after administration). I gave my name and I assured her that she does not need additional dose as per conversation with my district manager.


VAERS ID: 1674763 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-09-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

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

Write-up: Patient called on 09/04/21 and stated she had redness and swelling at the injection site and itching around the site


VAERS ID: 1674764 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin injection B12 botox injections
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: N?A
CDC Split Type:

Write-up: Waited in clinic 15 minutes, after returning to car felt parathesia on Left side of face. In clinic also c/o some on Right. Stayed another 15 minutes without progression of symptoms. Per pharmacist patient notified healthcare provider and is to use wet compresses and ibuprofen prn. If symptoms escalate instructed to call 911. Only previous issue was swelling from high dose prednisone. Very anxious over shot. Signed in then left clinic to mull over type of vaccine and desire for vaccination. Returned to get J&J.


VAERS ID: 1674768 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

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

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

Write-up: PT VOMITTED AND FELT DIZZY DURING POST VACCINATION PERIOD.


VAERS ID: 1674774 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad)

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

Write-up: Patient reported he felt a sensation that traveled from his left arm to his neck. Denies shortness of breath, closing of throat, swelling tongue. No rash or hives noted. Initially 72/35, 68, O2 sat 97% and last reading 112/58, 63 and O2 saturatyon 99%. Patient drank 4 small bottles of water ( 8 oz each bottle). Patient tolerated well. Patient was administered 20ml of childrens benadryl 50mg dose. Patient tolerated it well. Patient left approximately 25 minutes later with mother whom is a nurse and she decided to leave. Patient appeared in no distress and advised mother of patient if patient worsens go to urgent care.


VAERS ID: 1674780 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: PATIENT FELT FAINT AFTER THE INJECTION, THEN USED ICE PACK AND WATER TO HELP COOL DOWN


VAERS ID: 1674783 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 023A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate decreased, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient was feeling fine initially after vaccine and started feeling dizzy and light headed and faint at about 11 minutes post vaccination. Called 911. Patient never lost consciousness but felt very faint, then started feeling better for about 2 minutes and then felt faint again. Paramedics arrived and assessed the patient. They took his BP and HR which they stated were low but I couldn''t see the numbers. They then had him try lying down on the gurney and reassessed him, he felt better and they had him stand and they reassessed again. He stated he was feeling better but his BP was still a little low, they advised to take him to the ER for additional follow up but he declined several times.


VAERS ID: 1674790 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

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

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

Write-up: patient said a few minutes after getting moderna covid 2nd dose the right side of her head hurt then went away shortly after, checked blood pressure at 12 pm 147/94, patient said usually runs high, bottom number usually in the 80s, said she wanted walk around, stopped back to fill an emergency fill of her blood pressure medication at 12:35pm and said felt okay


VAERS ID: 1674791 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: No known adverse effects


VAERS ID: 1674793 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: gave second dose 14 days after first dose. patient got first dose 8/23/21 and second dose 9/4/21


VAERS ID: 1674795 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I accidently gave 2nd dose of Pifizer vaccine instead of Moderna to a patient today . I should have caught it when I confirmed with him before I gave the Pfizer vaccine, but the patient doesn''t speak English at all. It was a very busy day
Current Illness: NO
Preexisting Conditions: NO
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: UNKOWN. NO SIGNS AND SYMPTOMS


VAERS ID: 1674798 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-01
Onset:2021-09-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Left eyelid swollen.


VAERS ID: 1674800 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Dry mouth, Malaise, Nausea, Slow speech
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: None known.
Current Illness: None known.
Preexisting Conditions: None known.
Allergies: None known.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was sitting in the post-IMZ waiting area for the 15 minute observation period after his second dose of Moderna (COVID vaccine). About 10-15 minutes later his wife came and told me the patient didn''t feel well. I went to check on him; he was in a cold sweat, dizzy, lightheaded, and feeling faint. I got him some water and wet paper towels to put on the back of his neck. I checked on him a minute or two later and he wasn''t feeling better (he looked a little worse). At this point his speech had slowed some because he was having a hard time preventing himself from fainting (he kept pausing his sentences when he pulled himself back awake). He was nauseated (said he needed to dry heave) and had dry mouth. I called a code white (injury) on the walkie and got the patient an ice pack from our freezer for his neck. When management arrived I brought them up to speed. As they started checking in with him, it became apparent he felt even worse. At this point management and I agreed to call emergency services to have someone come check him out. I let the patient know we were going to get someone to come take a look at him and see if he needed to go to the hospital. Management brought our bench over to the patient so he could slide over from his chair and have more room (patient is large and was struggling to balance in the smaller chair). I held his outstretched (to me) arm and helped him scoot over to the bench. Soon after EMS arrived and we handed off to them. During this I was also keeping an eye on/in the pharmacy since I was the only pharmacist.


VAERS ID: 1674802 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

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

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

Write-up: Patient reports feeling lightheaded and hot. Patient noted to be sweating on his head. Denies sob, tongue swelling, or closing of throat. No rashes or hives noted. Patient initially denied pain. Initially BP is 144/96, HR99, O2 saturation is 95% on room air. Patient reports being diabetic and last time eaten was this morning. He states he also took Metformin and Glipizide. No glucometer available at this site. Patient given 3 bottles of 8oz water and small hard candy. Patient lightheadedness did not improve. And now he''s feeling sleepy. 911 called. Paramedics and fire department arrived after a few minutes. Fire department checked patient''s blood sugar and it was 280. Patient left via gurney with paramedics afterwards.


VAERS ID: 1674807 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

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

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

Write-up: patient passed out within a couple of minutes of receiving the vaccine and remained unconscious and stiff for several minutes


VAERS ID: 1674808 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Two years ago, unknown vaccine, similar event but less mild
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Shellfish Peanut Eggs Penicillins
Diagnostic Lab Data: EKG normal sinus rhythm, normal blood glucose
CDC Split Type:

Write-up: Patient received Pfizer vaccine at pharmacy. Per patient and his father, went out to car immediately after vaccine. Sitting in car during 15 minute waiting period. While sitting, became pale then per father passed out and became responsive. Preceding had abdominal pain and vomiting, but no rash, lip/tongue swelling, or difficulty breathing. On EMS arrival, patient with BP 80/30. Transported to ED, where vitals normal on arrival. Still felt shaky but symptoms had otherwise resolved. Did not receive treatment with EMS.


VAERS ID: 1674810 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / IM

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

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

Write-up: Patient was administered the Moderna vaccine. patient is 15 years of age and should have received Pfizer vaccine. No adverse events or symptoms reported by patient.


VAERS ID: 1674817 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Hypoaesthesia, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Sore arm that went numb for about an hour. Nausea the day after vaccine Headache for an hour day after vaccine


VAERS ID: 1674829 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient came to the pharmacy with his family and requested that he will be getting the first dose of the Moderna COVID-19 EUA Vaccinewhile members of his family will be getting the first dose of the Pfizer-BioNTech COVID-19 Vaccine. He completed the consent form and the No Insurance Coverage Attestation form. after screening and administration of the vaccine. The technician told him to ensure that he gets his second dose in 28 days time. He now volunteered the information that he had gotten the first dose of the Pfizer -BioNTech COVID-19 EUA Vaccine in April 2021. We asked him if he got a proof and he went to his car after 30 minutes of observation and came back with a COVID-19 Vaccination Record Card showing that he had gotten the first dose of Pfizer -BioNTech on April 22nd 2021.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: There is no reported issues at the moment but patient requested and got the first dose of the Moderna COVID-19 EUA Vaccine without telling the Pharmacy that he had also gotten the first dose of the Pfizer-BioNTech COVID-19 EUA Vaccine in April 2021.


VAERS ID: 1674831 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Apri birth control, cbd 500mg, ibuprofen
Current Illness: Sinus infection and upper respiratory infection at the beginning of august
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest tightness and pain as well as shortness of breath. Started mid day two after being vaccinated


VAERS ID: 1674838 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Cough, Injection site pain, Nasal congestion, Sinus operation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, 60 mil.
Current Illness: Stuffy nose
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm is sire where shot was given. But nothing bad. I have a dry cough, lots if drainage down my throat, my nose is more stuffed up than before. I feel like I do when I get the onset of a chest cold.


VAERS ID: 1674863 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO185 / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Fatigue, Headache, Injection site pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fatigue, soreness
Other Medications: Remicade (infusion) 5 vials/6weeks Amlodipine Besolate 10mg/daily Vitamin D gummies 4000mg/daily
Current Illness: None
Preexisting Conditions: Crohn?s disease
Allergies: Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 9-4-21 Within an hour of the vaccine, my left shoulder near the injection site was hurting. By the evening , the area of pain grew. 9-5-21 my arm hurt down to my fingers by 8 am. Around 6:09 pm, I felt tired. By 10 pm I was overwhelmingly tired and a headache was forming. It?s currently about 1240am and I?m trying to sleep, but the headache is terrible and my left arm is very sore and burning. My temperature is normal for me, reading 96.9 F.


VAERS ID: 1674867 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Left Arm/hands was numb and felt tingling sensation in ~20 mins from time of vaccine shot. Left Arm was also bit cold. These conditions prolonged until 3 hours from vaccine and then recovered.


VAERS ID: 1674870 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

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

Write-up: Client received Janssen COVID vaccine lot # 202A21A exp. 09/21/2021 on his left deltoid. At 1320, client reported to RN/vaccinator feeling ?dizziness and sweaty?. EMT put client in the zero-gravity chair near the vaccination table and provided client with a water bottle and a juice who finished drinking both the juice and the bottle of water at 1324 and an ice pack for his forehead. Lead nurse came over to assist EMT found client sitting a semi-fowler?s position in the zero-gravity chair. EMT assessed client who was alert and oriented x 4. Client reports no medical history, no known allergies, or medications. He reported he drank a tea with his lunch before coming to get his vaccine to help with his anxiety of getting vaccination. EMT took client?s following vitals at 1324: pulse (P) 87, respiration rate (RR) 14 with skin clammy, cold, and still experiencing dizziness; 1332: BP 152/86, skin cold, dry, and reported no more dizziness; 1340: BP 132/74, P 78, RR 16, oxygen saturation rate (O2) 96, skin warm, dry, and reported no more dizziness; and 1350: BP 128/76, P 85, RR 16, skin warm, dry, and reported no more dizziness. Lead nurse gave education about adverse reactions, ER precautions, and V-Safe. Client left the Center at 1355 alone in a steady gait who said, ?I am fine to drive home?.


VAERS ID: 1674873 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling cold, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypoglycaemia (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received 1st Pfizer COVID vaccine dose lot # FD0809 exp. 10/2021 on his left deltoid. At 1400, client reported to EMT feeling ?dizziness and fast heartbeat?. EMT put client in the zero-gravity chair and provided client with water and chips/Capri Sun who drank only half a bottle of water at 1410 because client told he didn?t eat lunch before coming to get his 1st Pfizer COVID vaccine. Lead nurse came over to assist EMT found client sitting a semi-fowler?s position in the zero-gravity chair, pale and sweaty noted. EMT assessed client who was alert and oriented x 4. Client reports no medical history, no known allergies, or medications. EMT took client?s following vitals at 1400: blood pressure (BP) 125/69, pulse (P) 61, respiration rate (RR) 20 with skin clammy and cold, dizziness and fast heart beat; 1410: BP 146/83, P 73, RR 18, skin cold and dry, reported no more dizziness or fast heart beat; 1415: BP 150/88, P 67, RR 18, skin cold, dry and reported no more dizziness or fast heart beat; 1420: BP 138/82, P 67, RR 20, skin warm and dry, and reported no more dizziness or fast heart beat; 1425: BP 140/84, P 68, RR 18, skin warm, dry and reported no more dizziness or fast heart beat; 1430: BP 138/86, P68, RR 18, skin warm, dry, and no more complaint of dizziness or fast heartbeat. Lead nurse gave education about adverse reactions, ER precautions, and V-Safe. Lead nurse referred client to seek medical care for his high blood pressure and gave him resource to apply for health insurance and connect to a medical home. Client left the facility at 1435 alone in a steady gait to board the city bus home.


VAERS ID: 1674895 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: About 10 minutes after receiving the J&J vaccine, patient started to feel lightheaded and clammy. NP at patient''s side, helped her to lay on the ground and elevated legs on a chair. After about 5 minutes patient reported feeling much better, drank water and felt normal again. She reports this happened to her in the past with flu vaccine.


VAERS ID: 1674897 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

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


VAERS ID: 1674898 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Flushing, Hyperhidrosis, Nausea, Tinnitus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Mild, Systemic: Tinnitus-Medium, Additional Details: Patient described feeling hot and sweaty, ears ringing, slight nausea and light-headed. I had her lie down and elevate her legs above the heart until she felt better. She left with her daughter after 30 minutes stating she felt better.


VAERS ID: 1674902 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-02
Onset:2021-09-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Lymphadenopathy, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Patient complained of inflamed clavicle and pain when lifting the arm. I advised the patient to see her healthcare provider to get checked out.


VAERS ID: 1674903 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Chills, Fatigue, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The day after I received the shot I had a headache body aches cold chills fever lower back pain exhaustion the next day I felt better still had a headache and lower back pain


VAERS ID: 1674904 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, 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), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: patient received the 2nd covid vaccine, and 5 minutes later, I witnessed the patient fall to the floor near the pharmacy. she regained consciousness within a couple of minutes, but we called 911 to be sure. the paramedics assessed the patient, but patient and her mother declined visit to er. blood pressure taken by paramedics was 100/60.


VAERS ID: 1674907 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Muscle spasms, Seizure, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Seizure-Severe, Additional Details: Within a few seconds after administration, the patient started having seizure-like activity, including spasms of extremities, dizziness lasting 10-15 seconds. After the event, patient was cognitively aware of everything that happened immediately before and after event, but not DURING the event. Also, upon regaining function, he was sweating profusely all over his body, and thirsty. EMS was notified who checked patient thereafter.


VAERS ID: 1674909 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Feeling cold, Flushing, Hyperhidrosis, Hyperventilation, Malaise, Nausea, Tremor, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hyperventilation-Medium, Systemic: Nausea-Severe, Systemic: Shakiness-Severe, Systemic: Vomiting-Severe, Additional Details: Patient was monitored for the required 15 minutes, notified pharmacy staff she was not feeling well at the end of the 15 minutes, rushed to the bathroom where she felt that she had to vomit. She was shaking and breathing hard, and was visibly upset. She stated that she was cold and that she just wanted to leave and go home. Pharmacist advised the patient that EMS should be called, patient refused. Pharmacist asked if patient would allow the on-site nurse practitioner to evaluate her, she refused


VAERS ID: 1674910 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Fatigue, Hyperhidrosis, Loss of consciousness, Tinnitus, Urinary incontinence, Vision blurred, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Tinnitus-Mild, Systemic: Visual Changes/Disturbances-Medium, Systemic: Vomiting-Medium, Systemic: Weakness-Severe, Additional Details: after vaccine admin pt felt dizzy/lightheaded. told pt take slow, deep breath & applied cold compress. pt stated sweaty, clammy, ringing in ears, blurred vision, went to take pulse & pt passed out. yelled to coworker ny name to call 911. when moved pt to floor, pt came to, pt was unaware and lost urinary control, pt out approx 5-10 sec. asked pt how feeling & pt started vomitting and 911 arrived in approx 5 - 10 mins


VAERS ID: 1674911 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Chills, Confusional state, Dizziness, Fatigue, Flushing, Headache, Hyperhidrosis, Hypotension, Lethargy, Tachycardia, Tremor, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Abdominal Pain-Severe, Systemic: Chills-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Headache-Medium, Systemic: Hypotension-Severe, Systemic: Shakiness-Medium, Systemic: Tachycardia-Medium, Systemic: Vomiting-Severe, Systemic: Weakness-Medium, Additional Details: 3-5 minutes after receiving vaccine, pt experienced severe abdominal pain, hypotension (BP 75/58, HR 86), vomiting. Called 911, emergency services arrived and administered IV fluids. Pt was taken to ER. Followed up with mother of patient via phone and he was discharged from ER about 3 hours after arrival feeling better but still tired.


VAERS ID: 1674912 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fall, Hypoacusis, Joint injury, Nausea, Presyncope, Skin abrasion, Syncope, Unresponsive to stimuli, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Systemic: Nausea-Mild, Systemic: Visual Changes/Disturbances-Mild, Systemic: Weakness-Medium, Additional Details: Almost fainted, but was still responsive. Stood up from chair after vaccine, got dizzy and fell on her knee, vision and hearing went in and out for a second. Knee got scraped, not badly, a little bit of blood, gave her a bandaid. Helped her sit on the floor, gave her water and snack, she was weak, but recovered within 30 minutes.She thought it was because she had been so anxious about the vaccine. She eventually left once she felt a lot better and was walking normally with her friend.


VAERS ID: 1674918 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Lethargy, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Sore arm. Mild fever. Extreme Fatigue and lethargic.


VAERS ID: 1674926 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

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

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

Write-up: Rash on both legs


VAERS ID: 1674929 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-09-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Clyndamiacin Eurothymiacin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hard, hot, itchy red bump at shot site


VAERS ID: 1674932 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-01
Onset:2021-09-04
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature abnormal, Cough, Fatigue, Headache
SMQs:, Anaphylactic reaction (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: Lipitor, bp med, metoprolol
Current Illness: No
Preexisting Conditions: Ankylosing spondylitis
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, couch, dry cough, very tired, mild temperature


VAERS ID: 1674969 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hypoaesthesia, Tinnitus, Visual impairment
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: PFIZER 2nd dose. After waiting 15 minutes, started feeling dizzy, feeling a ringing sound in the ear and dots. Manager was told and I sat her down in the vaccination office with legs raised in another chair and with a cold pack in the back of her head. She said that her arm felt sleep and that she has a strong headache. White code was thrown, and the assistant arrived at the pharmacy. Patient was conscious, alert and would respond to all my questions all the time. We called her husband to come and pick her up. Mean while she was not feeling better so I laid her down on the floor with legs elevated using a chair and a cold pack on the back of her head. She started to feel better (the ringing in the ear went away and vision dots). She did not have a numb arm anymore, only a strong headache but was able to sit and walk to the exit with the assistant, until her husband came (garden exit). All this happened between 5:50 and 6:40pm.


VAERS ID: 1674991 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Crying, Fatigue, Feeling cold, Malaise, Mobility decreased, Pain, Rhinorrhoea, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Arm went numb for a few hours, this was after first dose of Pfizer.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had covid at the end of July, but I never actually took a test until I was feeling better a couple weeks later. I was unvaccinated at the time. At around 10:pm the day of the 2nd vaccine, I had slight runny nose and was tired, slight body aches. I woke up around 1am and literally started crying, I felt so sick, I couldn?t move, I had the chills so bad it felt like my blood was being mixed with dry ice and on fire, boiling. I was shaking profusely, and could not get warm. This was way worse than when I was unvaccinated and had covid, way worse. My body aches are double the intensity of when I had covid, I can barely move. There was some talk I got vaccinated too early after having covid. In fact, pharmacy down the street refused me, and said I had to wait longer. They asked me who told me to get vaccinated so early after having covid, and I told them the county health department, and he just shook his head and said I should wait at least 1 month from testing positive or for a negative test. Meanwhile I?m receiving emails and texts from the county to get vaccinated ASAP, if I need help scheduling appointment or need transpo, reach out to them. The whole thing was confusing, do I wait, do I get vaccinated ? So I got vaccinated somewhere that didn? t ask me if and when I?ve had covid. Now I?m thinking I?m feeling this sick because I?ve had covid too close to the vaccination and my body is way over reacting, and I feel miserable and more sick than actually being unvaccinated and having covid.


VAERS ID: 1674998 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-01
Onset:2021-09-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

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

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

Write-up: swollen armpit, painful to touch


VAERS ID: 1675002 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-01
Onset:2021-09-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / IM

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

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

Write-up: first dose resulted in hives 2 hours after receiving vaccine, second dose resulted in full body rash of tiny red raised bumps that are very itchy and not responding to any sort of antihistamine meds


VAERS ID: 1675023 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-02
Onset:2021-09-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM
FLUA3: INFLUENZA (SEASONAL) (FLUAD) / NOVARTIS VACCINES AND DIAGNOSTICS 312841 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Poor quality sleep, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (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: Plavix, rest is unknown
Current Illness: unknown
Preexisting Conditions: CHF, CAD, hypertension, subclavian steel syndrome
Allergies: Percocet, tramadol, meloxicam, morphine
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient has head to toe itching, her right arm is swollen and red, restless sleep. Started overnight on 9/4/21 and has continued today 9/5/21


VAERS ID: 1675032 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-09-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Epistaxis, Haemoptysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: none
Preexisting Conditions: no
Allergies: n/a
Diagnostic Lab Data: He will be going to Dr. on the 9th, unless we can get him in earlier.
CDC Split Type:

Write-up: He hasn''t had a nose bleed since he was a young teen. Pt took the injection on the 27th of August. The morning of Sept 4, 2021 at approx. 6:30am he suffered a 15 min long nose bleed. That the end result was a large blood clot that he was able to get out. We have documentation of it. The morning of Sept 5, 2021 at approx. 4:11am he suffered another nose bleed that lasted about 5 min. After a couple of medium sized blood clots came out the the bleeding stopped. Then, the nose bleed started again at 8:40am where a few smaller clots came out proceeded by him spitting a clot out through his mouth. We have video and pictures.


VAERS ID: 1675050 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Propranolol; Xanax; Paxil
Current Illness: No
Preexisting Conditions:
Allergies: Gabapentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever; body aches; chills; sharp leg pains; sore arm; fatigue.


VAERS ID: 1675054 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-17
Onset:2021-09-04
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Hypoxia, Myocardial infarction, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol, colchicine, lipitor, hytrin, hyzaar, asa, vitamin d, allopurinol
Current Illness: NA
Preexisting Conditions: CKD4, DM2, HTN, HLD, diverticulosis, gout, BPH, CVA
Allergies: lisinopril
Diagnostic Lab Data: covid pcr + 9/4
CDC Split Type:

Write-up: hospitalized for MI and noted to be covid positive with hypoxia


VAERS ID: 1675061 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / UNK - / -

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

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

Write-up: Patient''s guardian was wrongly informed the date for second dose and received a second dose 10 days sooner than it should be. The first dose was given on 8/24/21 then second dose was given on 9/4/21 instead of 9/14/21. Patient''s mother didn''t report any adverse effect.


VAERS ID: 1675071 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1675074 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysmenorrhoea, Feeling cold, Headache, Menstruation irregular, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Extreme menstral cramping and bleeding (not time and very out of ordinary), bad headache, fever, chills, nausea and vomiting


VAERS ID: 1675075 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1675077 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 RA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1675079 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1675086 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse event, Injection site paraesthesia, Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: No
Current Illness: NO
Preexisting Conditions: High blood pressure, overweight
Allergies: Allergic to Sulfa drugs and eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was injected in her left deltoid and reported 10 minutes later swelling in her left arm and tingling down from the injection site to her finger tips. I administered her a 25 mg benadryl and patient reported feeling better in less than 5 minutes. Was determined that she experienced an adverse event not an allergic reaction as the benadryl would not have had time to work in the time it took for the swelling to subside. Patient also reported after another 20 minutes that the tingling went away.


VAERS ID: 1675089 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown
CDC Split Type:

Write-up: patient felt dizziness after the vaccine stayed in the store for over 20min for observation. She said she felt fine and went home. She called stating that a few hours after leaving the pharmacy she felt difficulty breathing and chest pain. I informed patient to see a doctor to have her symptoms evaluated by a doctor. she stated she would go to the er after getting off the phone with me but it is unknown if she actually went. Tried calling patient to follow up no answer.


VAERS ID: 1675093 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1675095 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0048B21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Fever started at 2:30 am fever of 103.4 headachea and chills. Muscle aces and soreness.


VAERS ID: 1675105 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthma, Condition aggravated, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Urticaria, Urticaria chronic
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus
Other Medications: Tagamet, metoprolol, levothyroxine, hctz, metformin, Singulair
Current Illness:
Preexisting Conditions: Chronic urticaria, hashimoto''s thyroiditis, asthma, pre-diabetes, high blood pressure, raynauds syndrome
Allergies: Keflex, penicillin, peanuts, tree nuts, soy protein, egg, tetanus vaccine, mepergan, pears, potato, oats
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initially, pain, swelling, redness at injection site. Itching at injection site began on 9/4/2021 in the morning. Eased after taking Tagamet for chronic urticaria. Mild asthma symptoms around 3 pm. Itching at injection site returned around 6 pm and spread to entire body (face, ears, arms, legs, back, stomach) with a few small hives. Itching eased after taking Singulair and Tagamet at 8 pm. Itching at injection site, mild itching of face and body, and mild asthma returned about 10 am on 9/5/2021. Eased with administration of Tagamet. Swelling and redness at injection site spread to approximately 2 in in diameter by afternoon on 9/5/2021.


VAERS ID: 1675110 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Injection site pain, Lethargy
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: Sertraline, vitamin a c d lunesta cholesterol meds
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache injection site pain dizzy lethargic


VAERS ID: 1675125 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, 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: Syncope, 29, 08/14/2021, covid, Pfizer
Other Medications: Not known
Current Illness: Not known
Preexisting Conditions: Not known
Allergies: amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: light headedness and chills


VAERS ID: 1675126 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Headache, Insomnia, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Optivite, folate, fish oil, Vitamin D
Current Illness: Mild sore throat
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever of 103 F, mild nausea, mild headache, mild muscle aches. Difficulty keeping temperature down with ibuprofen. Sleeplessness.


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