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

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



Case Details (Reverse Sorted by Onset Date)

This is page 27 out of 5,069

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VAERS ID: 1464622 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Unknown  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Oropharyngeal discomfort
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient taking immunosuppressive medication.
Current Illness: thyroid cancer
Preexisting Conditions:
Allergies: allergic to Ibuprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Covid vaccine and after 5 minutes developed throat discomfort. She was given 25 mg of Benadryl po. Tolerated well. She was kept for 45 min in observation and symptoms subsided. Patient was discharged in no apparent discomfort. Family member drove her home.


VAERS ID: 1464623 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 RA / IM

Administered by: Senior Living       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: Unknown-Residing in long term living facility.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Health Department was contacted, who asked staff to come to facility to vaccinate bedbound patient. Once staff returned with signed consent after administering the 1st dose of the Moderna series, it was inputted into Shots. Upon inputting the information into shots we realized that the patient has already been fully vaccinated with Pfizer within the facility. Nurse advised, and she stated she didn''t realized that patient had already been fully vaccinated.


VAERS ID: 1464633 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS KB97C / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: According to patient''s wife, patient has passed out 3-4 times in the past year. This was disclosed AFTER patient passed out today.
Allergies: Lorazepam, Ragweed
Diagnostic Lab Data: BP 142/128 , then 3 minutes later 96/68
CDC Split Type:

Write-up: Approximately 15 minutes after patient received a Pfizer Covid-19 and Shingrix vaccine, he lost consciousness, but was visibly breathing. I called 911, then patient stopped breathing . He regained consciousness before I could begin CPR. While waiting for EMS, we took 2 BP readings (142/128 & 96/68) and I questioned patient''s wife about medical history... she said that he had passed out 3-4 times in the past year. (Pt had not disclosed this on his vaccination Questionnaire)


VAERS ID: 1464644 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-02
Onset:2021-07-12
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN3518 / 2 LA / IM

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

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

Write-up: Patient tested positive for COVID 7/12/21. She is fully vaccinated. Asymptomatic.


VAERS ID: 1464650 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: rash all over body


VAERS ID: 1464661 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
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: Women?s daily, hair skin and nails
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numb hands


VAERS ID: 1464675 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FAB780 / 6 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nicotine 2mg gum
Current Illness:
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None


VAERS ID: 1464686 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dysgeusia, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (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: NO MEDICATION
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: IMMEDIATELY HAD METALLIC TASTE IN HIS MOUTH AND BEGAN TO SWEAT PROFUSELY. WAS PALE AND FELT DISORIENTED. AFTER SEVERAL MINUTES OF A COLD CLOTH AND WATER HE BECAME CHILLED. HE LEFT WITH HIS WIFE AFTER 30 MINS AND NOW SAID THAT HE FEELS BACK TO NORMAL AGAIN.


VAERS ID: 1464689 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 00C12A / 2 - / IM

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

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

Write-up: Patient was given covid -19 vaccine 6 days earlier the minimum vaccination period. pt waited after vaccination 20 mins without any complications. patient was examined by two health care providers. Providers cleared patient to go home and to go to the nearest emergency room if any symptoms present.


VAERS ID: 1464693 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega 3
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine about 1415 and felt "dizzy" at about 1440pm. Pt was able to follow basic commands, appeared pale, and mother stated she "fainted." Pulse and o2 level were 70 and 97% on RA. Pt observed for 20 more minutes and was able to walk, A&O X4. Mother stated she usually feels dizzy when she gets lab work done; per mother, pt had not had anything to eat since last night.


VAERS ID: 1464708 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-11
Onset:2021-07-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysgeusia, Insomnia, Oropharyngeal pain, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Metallic taste 20 hours after second dose of Pfizer vaccine. Other side effects: mild fever, some sore throat, body pain. During the first night: chills to the point of shaking and insomnia.


VAERS ID: 1464717 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-21
Onset:2021-07-12
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dizziness, Heart rate irregular, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad)

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

Write-up: patient came in today 07/12/21 and mentioned since he got the vaccine on 06/21/21 he has been feeling side effects , he mentioned his hear beat feels different , numbing , some chest pain, dizziness , I mentioned to the patient to schedule a visit to his doctor , in order to do more tests , and make sure everything is ok, patient he will reach out to the Dr today


VAERS ID: 1464728 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-01
Onset:2021-07-12
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Migraine, generalized anxiety disorder, ADHD, recurrent major depressive disorder in partial remission.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient visited Urgent Care for cough. Antigen test performed and came back positive. Case investigation with client has not been performed as of this note.


VAERS ID: 1464737 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Nervousness, Tension
SMQs:, Accidents and injuries (narrow), Hypoglycaemia (broad)

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

Write-up: Pt was receiving 1st dose of Moderna vaccine. I noticed he seemed very tense and nervous. I had difficulty getting him to relax his arm. Seconds within giving him the shot he fell forward hitting his head on the ground. He came to within a few seconds with no recollection of what happened. I gave him some water and had him sit down. I asked if he had any previous reactions to a vaccine, he said he hasn''t but he does get lgih


VAERS ID: 1464744 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-14
Onset:2021-07-12
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       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:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given vaccine at 17 when it is only approved for 18 and older. He did not have an adverse reaction.


VAERS ID: 1464787 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT CAME UP TO THE PHARMACY COUNTER AND SAID HE FELT LIKE THROWING UP. THIS WAS ABOUT 5 MINUTES AFTER THE VACCINE WAS ADMINISTERED. I TOLD THE PATIENT TO SIT DOWN I TURNED AROUND PATIENT LOOKED DIZZY AND SWEATING PROFOUNDLY. HE FELL OVER AND HIT HIS HEAD FELL ON THE FLOOR. HE WAS CONSCIOUS.


VAERS ID: 1464791 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-12
Onset:2021-07-12
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Exercise tolerance decreased, Immediate post-injection reaction, Joint range of motion decreased
SMQs:, Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: WP Thyroid, D3, B12
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none. Dr''s office said they couldn''t do anything for me
CDC Split Type:

Write-up: shoulder was sore right after the shot, which i believed to be normal. After a couple of weeks I was getting concerned, as my range of motion was not there without pain while working out or swimming. i have had to give up several arm exercises and overarm (crawl) swimming as a result of the pain. things that i have been doing for several years. I reached out to the Dr''s office for an appointment and they said that there was nothing they could do for me and that i could report this myself. Please advise as to what i can do for this as it has been about 12 weeks and has not gotten any better.


VAERS ID: 1464799 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MONTELUKAST 10MG
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT GO MODERNA FOR FIRST DOSE. SHE CAME FOR 2ND DOSE. GAVE PFIZER BY MISTAKE.


VAERS ID: 1464801 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal 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:
Current Illness:
Preexisting Conditions:
Allergies: pcn allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: the patient felt very hot and sweaty shortly after receiving the vaccine. She also noted some visual impairment as well. We provided an ice pack and some water and she felt better. She stayed in the pharmacy for 30 minutes after administration.


VAERS ID: 1464827 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CONCERTA 54MG FLUOXETINE 10 MG
Current Illness:
Preexisting Conditions: HYPERTENSION
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT CAME FOR 2ND DOSE OF MODERNA. HE WAS GIVEN PFIZER BY MISTAKE.


VAERS ID: 1464829 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Fall, Immediate post-injection reaction, Lethargy, 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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: After patient was responsive and gained consciousness, paramedics and ambulance transported patient to hospital.
CDC Split Type:

Write-up: Immediately after receiving this vaccine the patient felt weak and lethargic. They lost balance and fell on floor and lost consciousness for a few minutes. After a couple of minutes they gained consciousness and recovered.


VAERS ID: 1464840 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 stated he started to feel itchy about 7 minutes after shot was administered. Stated his neck and upper arms felt itchy. Patient was given 25 mg oral Benadryl, observed for 23 additional minutes, and left the pharmacy feeling well. No visible redness was observed by responding RPh


VAERS ID: 1464850 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, 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), Dyskinesia (narrow), 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: n/v felt like was going to pass out
Other Medications: Yaz (per Mom)
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loss consciousness for a few seconds- had jerk type movements


VAERS ID: 1465114 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / IM

Administered by: Public       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: Fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness 5 minutes after vaccination and again approximately 15 minutes after vaccination.


VAERS ID: 1465116 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg Alteplase 2 mg Artificial Tear (Dxtrn-HPM-Gly) 0.1-0.3-0.2 % Drop 1 Drop Ascorbic Acid 500 mg Atorvastatin 40 mg Bisacodyl 10 mg Calcium Carbonate 200 mg Chlorhexidine Gluconate 15 mL Cyclobenzaprine 5 mg DiazePAM 10 m
Current Illness:
Preexisting Conditions:
Allergies: Buspar [Buspirone Hcl], Duloxetine Hcl, Fluoxetine, Lexapro [Escitalopram Oxalate], Sertraline, Trazodone, Venlafaxine, Lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose of Moderna on 7/6/21. Patient then received first dose of Pfizer on 7/12/21.


VAERS ID: 1465129 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), 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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced vasovagal syncope 2 to 3 minutes post vaccine. He passed out for about 20 seconds and his dad states he was convulsing. He was assisted to the clinic where he was provided 2 glucose tablets and had his vitals checked. Vitals were within normal limits. Throughout the next 30 minutes, patient continued to display cognitive awareness and finished about 12 oz of water. He was able to stand up on his own without feeling light headed. About 40 minutes post vaccine, he left to eat dinner. The family intends to see a physician prior to his second dose.


VAERS ID: 1465144 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

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

Write-up: Client received Pfizer for the first series on 4/30/21 and received Moderna for second series on 7/12/2021. Monitored for 15 and no adverse reaction noted.


VAERS ID: 1465149 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypertension, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: About 30 min after being vaccinated with second dose Pfizer, patient reported feeling dizzy with tingling sensation in fingers. Ice pack applied to back of neck, BP taken x2 (high with no known history of HTN)- patient refused a third reading, and juice/water was refused by patient as well. He stated his current symptoms were similar to what happens prior to anaphylaxis with shellfish. Transported to


VAERS ID: 1465339 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache
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: Headache


VAERS ID: 1465343 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: none known at this time altho the patient did go to the hospital not sure what happened in the hospital after he left the pharmacy.
CDC Split Type:

Write-up: patient received the vaccine. patient was just fine for like 10-15 mins or so. When it was about time for them to leave, he stood up and thats when his mother called for help that he wasnt feeling well. he laid down on the floor for a little bit but then sat back up and sat back on the chair and said he was feeling better. i asked if they wanted us to call 911 and the mom said no. then, the patient said he had to vomit so we asked where he would like to vomit the bathroom is right next to him. patient chose to walk to bathroom and threw up a couple times. patient felt more dizzy/faint in the bathroom so the mother said please call 911 so we did. we sat with patient sitting on a chair for a couple mins and offered little cup of water. tried to talk to the patient and see if he was conscious. patient was responding to questions mom asked in another language. then, the paramedics arrived and put patient on a stretcher and said he seemed ok but was going to take him to hospital just in case. patient was breathing fine and not shaking.


VAERS ID: 1465362 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-12
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Painful, very sore throat


VAERS ID: 1465370 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: The patient was given the first dose of the Pfizer covid vaccine, subsequently he was standing waiting with his mother for his younger sibling to receive his vaccine and after I had administered that, I turned around and saw that he was starting to lean over and his mother and I went to grab him as he went down and he fainted momentarily. We slowed his descent, but he had a small abrasion on his head (I think from the carpet). He said he felt dizzy and nauseous. I''m not sure if he was also watching while I was giving his sibling the shot and that exacerbated the situation. We had him checked out by EMT and he was fine after the initial fainting.


VAERS ID: 1465371 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Oral pruritus, Pruritus
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MMR vaccine- patient mentioned entire arm swells
Other Medications: Benadryl 25mg
Current Illness:
Preexisting Conditions:
Allergies: wheat, mango, mosquito, and leak
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has history of anaphylaxis with wheat, mango, mosquito, and leak. She was told to wait post vaccination for 30 minutes. After vaccination I checked on the patient around 20 minutes mark and she said she said she felt itchiness on the injection site and itching in her chin/mouth area. I recommend and administered benadryl 25mg and observed for another 30 minutes. Patient said she felt better so I sent her home.


VAERS ID: 1465372 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Patient had seizures for an unknown time and urinated in his seat. Pharmacy is next to an urgent care so the doctor from urgent care checked him in to make sure vitals were stable. Unknown outcome.


VAERS ID: 1465377 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram cerebral, Balance disorder, Computerised tomogram head, Echocardiogram, Hemiparesis, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: multivitamin, fish oil ,D3
Current Illness: none
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data: CT head Stroke protocol July 1, 2021 Angiogram cerebral July 1, 2021 Echocardiogram July 2, 2021 Echocardiogram TEE, July 3,2021
CDC Split Type:

Write-up: loss of balance, left arm and left leg weakness


VAERS ID: 1465389 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-07-12
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Antinuclear antibody, Blood creatine phosphokinase, Dysarthria, Laboratory test, Muscle contractions involuntary, Muscular weakness, Red blood cell sedimentation rate
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 10 mg daily Amlodipine 5 mg daily Tamsulosin 0.4 mg daily Flonase spray Allopurinol 100mg daily
Current Illness: none
Preexisting Conditions: hypertension, BPH, allergic rhinitis, fatty liver, hyperuricemia
Allergies: none
Diagnostic Lab Data: 06/14/2021: Creatine Kinase Sedimentation Rate ANA Acetylcholine receptor binding antibody Acetylcholine receptor modulating antibody Acetylcholine receptor blocking antibody striated muscle AB screen
CDC Split Type:

Write-up: 2-3 weeks after vaccination patient started with weakness in both legs, general fatigue, progressive weakness in both arms, progressive dysarthria, and fasciculations in both upper arms. Patient followed up with neurologist but did not improve. Patient now has pending appointment with Neurology.


VAERS ID: 1465571 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure like phenomena
SMQs:, Convulsions (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: n/a
Current Illness: None
Preexisting Conditions: obesity
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: At 6pm, one hour after recieving her vaccine patient states they experienced what she could only describe as a seizure. She felt herself shaking and like an out of body experience. After about 2 minutes she was able to regain awareness and after about 10 minutes the whole episode had passed.


VAERS ID: 1465574 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Anxiety, Dyspnoea, Heart rate increased, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 2:25pm patient c/o SOB, increasing heart rate, hard to breathe, numbness all over body, and high level anxiety. Nurse took his blood pressure and tried to help patient stabilize his breathing in brown bag. Requested EMS immediately and patient was transported to hospital. HR: 170 BP: 150/100 Resp: 26


VAERS ID: 1465577 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-01
Onset:2021-07-12
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Axillary pain, Breast pain, Injection site pain, Lymphadenopathy, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Lipodystrophy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: If it doesn''t subside in a few days or gets worse I will go to the doctor or hospital . Somewhere to see a medical professional.
CDC Split Type:

Write-up: Day of injection there was some slight site pain. Next day (today) my whole arm is sore. I can not even move it without severe pain. My lymph nodes in the left underarm is swollen and painful with the pain even in the left breast some. Then, also this evening my left lower abdomen started having cramps and pain too.


VAERS ID: 1465579 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D321A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Dizziness, Feeling hot
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Vestibular disorders (broad), Arthritis (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: Not sure
Current Illness: Sarcoidosis
Preexisting Conditions: Sarcoidosis
Allergies: No
Diagnostic Lab Data: Blood Pressure of 80/60
CDC Split Type:

Write-up: Pt reported feeling hot ,light headed and pain in hips/back


VAERS ID: 1465582 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: First dose administered 5/17/21, second dose administered outside recommended 6-week interval on 7/12/21 (56 days). No adverse events reported by patient.


VAERS ID: 1465588 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra
Current Illness: None
Preexisting Conditions: None
Allergies: Allergies to pineapple, apples, pears and tomatoes
Diagnostic Lab Data: Blood pressure--118/88
CDC Split Type:

Write-up: Patient reported sore throat and feeling warm


VAERS ID: 1465591 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-27
Onset:2021-07-12
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Nausea, Pyrexia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe fatigue, headache, nausea dizziness, throat tightness, fever all started within 12 hours. Severe headache Knife like remained for 3-4 weeks. Mild to moderate daily headaches continue.


VAERS ID: 1465764 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WE0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Somnolence, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient fainted for 15 seconds and was feeling groggy after gaining conscienceness


VAERS ID: 1465989 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Paraesthesia oral, Pharyngeal paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: 17:50 - mild tingling on tongue. Denies any itching, tightness, or other symptoms. Gave water 18:00 - Mild tingling in throat and tongue. Gave Benadryl 50 mg PO at 18:02. O2 sats 97%, heart rate 89 18:24 - vomited, no other GI complaints. No progression of tingling on tongue or throat. Gave crackers. 18:46 - Slight tingling in throat and tongue resolving 18:55 - symptoms all resolved. No distress or further symptoms noted. Discharged with instructions to call 911 if any signs of respiratory distress, or new/worsening GI, or cardiac symptoms.


VAERS ID: 1466001 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-11
Onset:2021-07-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FAU780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Hypertension, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Alprazolam , Vitamin D, Vitamin C
Current Illness:
Preexisting Conditions: Asthma and Hashimoto''s Disease
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: High blood pressure and left side of the chest pain, tingling in the face and tingling tongue . Continued on throughout the day, was discharged from the emergency room as a presumed vaccine reaction around 8pm.


VAERS ID: 1466006 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Condition aggravated, Cooling therapy, Discomfort, Eye irritation, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal 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: Fever, malaise, burning eyes, nausea.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, bodily discomfort, chills, burning eyes, nausea. Cold towels were placed to lower his fever.


VAERS ID: 1466467 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None the provider is aware of.
Current Illness: None the provider is aware of.
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: This vaccine was given outside of the approved age range related to the Moderna COVID-19 vaccination. The patient is only 15 years of age and did not meet the minimum requirement of 18 years old. The patient has not demonstrated any abnormal outcomes related to this vaccination. We will follow current CDC recommendations to give the second dose at the appropriate interval of 28 days from the first dose since this child is between 12 and 18 years of age.


VAERS ID: 1466484 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient was given 2nd COVID-19 vaccine yesterday 7/12/2021 at age of 17. This was at the direction of IDPH to go ahead and give the second at 17 since he got the first at 17 as long as he had no s/s with the first one and if the parents gave permission. Patient had no adverse reaction to the first vaccine and parents did give permission for the second vaccine. Tolerated with no reaction during wait time. No adverse reaction noted as of yet.


VAERS ID: 1466578 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. S033308 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Nausea, Presyncope, Vomiting
SMQs:, Acute pancreatitis (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: Unknown
Current Illness: None
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client received HPV & Pfizer vaccine during immunization clinic @ 0830. Client was in observation area when he started c/o nausea. He had one vomiting episode, per RN. He was given an ice pack, blue emesis bag, water, and fan for supportive measures. He was in the observation area w/ his grandmother & sister. At approximately 0900, he reported feeling better and walked out of the clinic with his grandmother. EMS was not called. Client had vasovagal reaction.


VAERS ID: 1466589 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-20
Onset:2021-07-12
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CLL, asthma, Parkinson
Allergies:
Diagnostic Lab Data: COVID-19 w/INFLUENZA A&B PCR positive 07/12/2021
CDC Split Type:

Write-up: Vaccine #2 04/20/2021 Lot # EW0164 Pt currently has Covid 19 vaccine


VAERS ID: 1466610 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hallucination, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe fever, throbbing headache, dizziness, mild hallucinations. Started about 9 hours after vaccination, fever diminished after about 2 hours. Other symptoms lasted most of the night.


VAERS ID: 1466615 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 AR / IM

Administered by: Public       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: none
Current Illness:
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client had been sitting almost 15 minutes when she alerted EMT she was feeling dizzy at 2005. EMT provided client with water and goldfish snack. Client drank and ate. PHN arrived at 2012, client sitting upright in chair, alert and oriented x4. Client stated she was on her phone and when she looked up she "felt dizzy for a few seconds". Vitals at 2012 by EMT: blood pressure 116/76, pulse 83, oxygen 98%. Client denied blurry vision, headache, nausea, chest pain or shortness of breath. Per client no pertinent medical history, no current medications and no known allergies. Per client ate prior to getting vaccine. PHN advised client to complete 30 minute observation, per client would try to stay as long as she could. PHN advised client to follow up with provider and gave ER precautions. EMT stayed with client remaining of observation. At 2019 client stated dizziness had resolved. Vitals at 2019 by EMT: blood pressure 110/66, pulse 83, oxygen sat 98%. Per client "feeling fine". EMT had client stand and take a few steps, per client no dizziness. Client accompanied by Mother who would drive client home. Client left facility at 2025 with steady gait.


VAERS ID: 1466627 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-03
Onset:2021-07-12
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / UN

Administered by: Other       Purchased by: ?
Symptoms: Arthropod sting, Erythema, Fatigue, Pain, Pain in extremity, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lipitor, pantaloc
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: There was no issue from the vaccination itself; sore arm, a bit tired and achy the next day only. I was stung multiple times by hornets yesterday, and the reaction to the stings was much more severe that what I have experienced in the past. My wife has also experienced the same thing with stings she has received since getting our second shot. basically swelling, redness in ~2" radius from the sting location, itchy as heck. Typically I would have ~0.3-0.5" redness radius. Took Benadryl (25mg) no other issues other than the reaction to this still is much worse than in the past, and i was wondering about the vaccine (pfizer) possibly influencing this and figured i''d report my experience.


VAERS ID: 1466629 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-05-13
Onset:2021-07-12
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Injection site pain, Lethargy, Malaise, Nasopharyngitis, Pain, Skin warm
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Received series #1 of 2 on 13MAY2021, received series #2 on 01JUN2021. first dose received in left deltoid causing moderate soreness for several days following vaccination. On 12JUL2021 I began experiencing severe left shoulder pain at or around 10/11am. The pain was persistent becoming more moderate as the day went on. Around 6/630pm I began to feel extreme fatigue, the soreness in my left shoulder throbbing at this time, I began to feel body ache, lethargic. I felt warm to the touch all over my body. All I could manage to do was lie down at this point. I am a healthy individual otherwise. I have not felt ill until having received this COVID vaccine. I could not tolerate laying down as my body was in a lot of pain. I got up took 1 tablet of ibuprofen 800mg and laid back down eventually falling asleep. I awoke in the morning for work feeling better. Ever since receiving this COVID vaccine, I keep experiencing cold like symptoms off and on, that were not a problem prior to receiving this vaccine. I am concerned that this vaccine has had an ill effect on my body. I find it odd that the pain in my left shoulder would be accompanied by the body ache, temperature, lethargy after receiving the vaccine in that very shoulder. I am wondering if the medication has not caused damage to my shoulder or has this medication suspended in the location of my left shoulder and will it continue to cause these side effects of feeling ill, cold-like symptoms for a prolonged amount of time, if not permanently.


VAERS ID: 1466636 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-10
Onset:2021-07-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Chest pain-- suspected myocarditis


VAERS ID: 1466677 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-09
Onset:2021-07-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0199 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Angiocardiogram, Catheterisation cardiac normal, Chest pain, Echocardiogram, Magnetic resonance imaging heart, Troponin T increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: First dose Pfizer COVID 19 vaccine 6/16/21. Patient stated that chest pain onset soon after 2nd dose of Pfizer COVID 19 vaccine given at the Pharmacy on 7/9/21. Patient presented to Hospital on 7/12/21 with complaints of chest pain. Troponin T 435ng/L. Urgent cardiac catheterization revealed normal coronary arteries. Possible myocarditis. Historical note: Patient stated that possible COVID 19 infection 12/20. Not tested for the COVID 19 virus at that time.
Preexisting Conditions: none
Allergies: codeine
Diagnostic Lab Data: Troponin T 435nl/L, Cardiac Catheterization with coronary angiography, echocardiogram, MRI cardiac
CDC Split Type:

Write-up: Patient stated that chest pain onset soon after 2nd dose of Pfizer COVID 19 vaccine given at the Pharmacy on 7/9/21. Patient presented to Hospital on 7/12/21 with complaints of chest pain. Troponin T 435ng/L. Urgent cardiac catheterization revealed normal coronary arteries. Possible myocarditis.


VAERS ID: 1466686 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NKA
Preexisting Conditions: Patient mentioned after incident that she has history of passing out when feeling anxious. Patient did not seem anxious at time of vaccination
Allergies: NKA listed on consent form
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Encountered patient on the ground in the waiting room blacked out after receiving Johnson and Johnson vaccination at 11AM 07122021. Patient regained consciousness while I was on the phone with 911. Patient immediately said that she was OK. She said she felt like she was going to black out so decided to lay on the ground to prevent any injury. She mentioned at that time that she had a history of blacking out. Patient was assessed for breathing, color changes, injury as per 911 instructions while awaiting paramedics. Paramedics assessed patient and concluded that patient had normal vital signs and no other issues of concern and was allowed to go home. Patient did not receive any treatment


VAERS ID: 1466768 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine, Blood electrolytes, Blood glucose, Blood urea, Chest X-ray, Differential white blood cell count, Electrocardiogram, Fall, Full blood count, Head injury, Hypotension, Pregnancy test, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations: Patient reports syncope with HPV
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: In ED, Chest xray 12 lead EKG Pregnancy test IV fluids CBC, Electrolyte Panel, BUN, Creatinine, Glucose, WBC Auto Diff
CDC Split Type:

Write-up: Patient with syncope event 5 minutes post vaccination. Patient falling forward out of chair and hit forehead. Immediately aroused and neurologically appropriate. Placed in recumbent position, given juice and water. Sat up about 10 minutes later and hypotensive requiring being placed in recumbent position for another 10 minutes. Escorted to ED.


VAERS ID: 1466776 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-07-12
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL92261 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac failure chronic, Laboratory test, Weight increased
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, losartan, metroprolol, protonix, crestor, Warfarin, Vit D
Current Illness: CHF exacerbation
Preexisting Conditions: CHF, Atrial Fib, Hypertension, CKD, Depression, anxiety
Allergies: Ace Inhibitors, Penicilin G, Cephalexin
Diagnostic Lab Data: Labs done 7/12 and 7/13 at hospital
CDC Split Type:

Write-up: Went in to to weight gain caused by CHF- tested at ED- Positive


VAERS ID: 1466787 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Eye swelling, Feeling abnormal, Immediate post-injection reaction, Pain, Pruritus, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRN albuterol, Vit D3, Flonase, ibuprofen, Liletta IUD, metformin, montelukast, Retin-A gel
Current Illness: intermittent diarrhea
Preexisting Conditions: obesity, papillary thyroid carcinoma, low Vit D
Allergies: NKDA
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Patient received vaccine at a Pharmacy. She immediately felt itchy but did not notice a rash or hives, 3.5 hours later she reported feeling SOB and chest heaviness. She also felt/feels achy, foggy, weird and with a swollen face and eyes. SOB and swelling are improving


VAERS ID: 1466805 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-04
Onset:2021-07-12
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / UNK - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / UNK - / IM

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

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

Write-up: COVID + post vaccination


VAERS ID: 1466809 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: Pfizer Lot EW0185 time Vax received: 3:29pm - Adverse Reaction - 3:40pm dizziness, nauseated. vitals taken at 3:41pm B/P 142/88 H: 91 R18 Oxy 99 - 3:46 B/P: omitted H:93 R: 18 Oxy 99%. Discharged 3:52pm left on her own allergic of penicillin- ate breakfast 8:30am missed lunch.


VAERS ID: 1466817 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-20
Onset:2021-07-12
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 RA / IM

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

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

Write-up: This EE received two Covid vaccine, Pfizer. But he became Covid Positive on Juy 12.


VAERS ID: 1466833 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Faeces soft, Muscle spasms, Nausea, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient reported sleepiness and dizziness, camps and soft stool, has been nauseous


VAERS ID: 1466901 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blepharospasm, Confusional state, Dizziness, Flushing, Headache, Hyperhidrosis, Hypertension, Immediate post-injection reaction, Loss of consciousness, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium, Systemic: Hypertension-Medium, Systemic: Nausea-Severe, Additional Details: Patient was given the Pfizer Covid-19 Vaccine. About 2-5 minutes after receiving the patient stated he felt a "headache" and immediately lost consciousness. Patient was seated and slowly slid out of chair. When I got to the patient it looked as though patients eyes were fluttering and he was not responsive the first 5-10 seconds of me laying patient on back and elevating feet. Patiend suddenly came to after about 15 seconds total and was responsive to all questions. vitals were taken.


VAERS ID: 1466905 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-30
Onset:2021-07-12
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Injection site pain, Lymphadenopathy, Vaccination complication
SMQs:, Extravasation events (injections, infusions and implants) (broad), Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Pain at Injection Site-Severe, Systemic: SWOLLEN LYMPH NODES-Severe, Systemic: Lymph Node Swelling-Severe, Additional Details: PATIENT VISITED HER DR SINCE SHE HAS BEEN EXPERIENCING PAIN IN HER BREAST AND WAS TOLD THAT HER LYMPH NODES ARE SWOLLEN DUE TO COVID VACCINE.


VAERS ID: 1466918 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

Administered by: Senior Living       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: PATIENT RECEIVED THE MODERNA VACCINE BUT WAS UNDER THE AGE OF 18. PATIENT IS CURRENTLY 16 YEARS OLD


VAERS ID: 1466941 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

Administered by: Senior Living       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: PATIENT PREVIOUSLY RECIEVED 1 DOSES OF PFIZER VACCINE AND THEN RECEIVED TWO DOSES OF MODERNA VACCINE.


VAERS ID: 1466948 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-10
Onset:2021-07-12
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray abnormal, Feeling abnormal, Infection, Loss of personal independence in daily activities, Pneumonia, SARS-CoV-2 test positive, Urinary tract infection
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: brimonidine, dorzolamide, dutasteride, ferrous gluconate, insulin aspart, insulin glargine, latanoprost, levetiracetam, melatonin, montelukast, multivitamin, pregabalin, rosuvastatin, umeclidinium-vilanterol
Current Illness:
Preexisting Conditions: Hx of AKI, arthritis, asterixis, BPH w/ urinary retention, cataract, chronic anemia, chronic pain, chronic subdural hematoma, CKD stage 3 (d/t DM2), claudication, COPD, DM2 with insulin and history of DKA, diastolic dysfunction, HTN, essential tremor, Hard of Hearing, hyperlipidemia, lipoma, myoclonus, nonrheumatic aortic valve stenosis, primary open angle glaucoma, recurrent falls while walking, spinal stenosis of lumbar region, thrombocytopenia, hx tobacco use,
Allergies: Gabapentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received both doses of the Pfizer COVID-19 vaccine, on 2/18/2021 and 3/10/2021. On 7/12/2021, pt presented to our ED for "feeling crumy" with a decline in ADLs. Pt tested positive for COVID 19 via PCR. Chest Xray positive for pneumonia, suspected UTI also contributing. Pt admitted to inpatient due to weakness and suspected underlying infection.


VAERS ID: 1466962 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Loss of consciousness, Seizure, Syncope, Tremor, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Parkinson-like events (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), Cardiomyopathy (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Seizure-Severe, Systemic: Vomiting-Mild, Additional Details: shortly after receiving vaccination, the patient became unconscious, fell out of his chair and to the floor, and began to seize. Body shaking lasted around 15-20 seconds. Patient then immediately became alert and concscious. Stated after this episode that he has a history of fainting and having seizures after he receives vaccinations. Patient vomited ~15-20 minutes after this episode.


VAERS ID: 1466964 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1466972 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1466979 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

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


VAERS ID: 1466985 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Nausea, Neck pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: atenolol 100mg -1 daily
Current Illness: none
Preexisting Conditions: High Blood Pressure
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme tiredness, nausea, no fever but had chills, joint pain neck and hips


VAERS ID: 1466987 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NAC, multi-vitamin, coQ-10
Current Illness: not sure
Preexisting Conditions:
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: slight dizziness, Nausea and Headache the night after injection soreness in the injection site (arm)


VAERS ID: 1466990 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

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


VAERS ID: 1467010 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Hypotension, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Severe


VAERS ID: 1467014 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-13
Onset:2021-07-12
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: bendamustine/rituximab on 02/04-02/05
Current Illness:
Preexisting Conditions: Lymphoma, T2D
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: first vaccination given 02/13/21 and second 03/13/2021. Positive 07/09, admitted 07/12 to hospital


VAERS ID: 1467019 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01081 / 2 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild


VAERS ID: 1467028 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / UNK - / IM

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

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

Write-up: Patient COVID-Vaccination Registration form indicates patient has not received a different covid vaccine product. Given Pfizer vaccine today. When documenting, noted to have received Janssen vaccine on 3/13/2021 Patient states she was advised by her cardiologist and Dr. to receive Pfizer vaccine as a booster. Patient advised this is not the recommended practice and she will not receive another covid vaccine here. No adverse side effects noted


VAERS ID: 1467030 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

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


VAERS ID: 1467034 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-02-23
Onset:2021-07-12
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Headache, Influenza A virus test negative, Influenza B virus test, Oropharyngeal pain, Pyrexia, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxicillin
Current Illness: None
Preexisting Conditions: Malignant Neoplasm of right kidney, Nephrectomy,
Allergies: Sulfa drugs
Diagnostic Lab Data: Jul 12, 2021@17:19:48 FLU A (CEPHEID) NEGATIVE , FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE, COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Patient complains of fever, chills, coughs, headache and a sore throat X 2 days.


VAERS ID: 1467035 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

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


VAERS ID: 1467044 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Confusional state, Dizziness, Flushing, Hyperhidrosis, Injection site pain, Loss of consciousness, Nausea, Pallor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Abdominal Pain-Mild, Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: passed out for 3-5 seconds-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Mild, Systemic: Vomiting-Mild, Additional Details: she passed out for 3-5 seconds, came to. Was very pale, maybe 5 minutes later threw up. Then she regained some color and was less confused. She was very anxious about getting the shot prior to getting the injection.


VAERS ID: 1467051 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN C-041AZ1A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Fatigue, Headache, Hypoaesthesia, Injection site pain, Injection site warmth, Myalgia, Paraesthesia, Presyncope, Pyrexia, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam Omneprazole
Current Illness:
Preexisting Conditions: Migraines and headaches
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received shot around 3:15pm. A few minutes later the area around the injection site got really hot and painful, and then I started getting really hot from the abdomen up to my chest neck and face. I called out for the nurse who came in to check on me and I almost fainted. I stayed at the facility for almost an hour until I was able to leave. I was not anxious or faint feeling before the shot so anxiety did not cause this. Once at home I was really tired. Today, July 13, I have had a fever, muscle aches, chills, headache, stomach issues, and a random numbness and tingling in my lower left leg that I?ve never had before.


VAERS ID: 1467070 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1467076 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dysphagia, Dyspnoea, Hyperventilation, Nausea, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Hyperventilation-Medium, Systemic: Nausea-Medium, Systemic: Vomiting-Medium


VAERS ID: 1467082 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Fatigue, Flushing, Hyperhidrosis, Injection site swelling, Lethargy, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Swelling at Injection Site-Mild, Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadedness-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Medium, Systemic: Weakness-Medium


VAERS ID: 1467096 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-27
Onset:2021-07-12
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Hypoaesthesia, Paraesthesia, Peripheral swelling, Sensory disturbance
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: I checked the patients BP which was elevated I advised the patient to visit his dr asap
CDC Split Type:

Write-up: the patient reported that after he received his second done he stated experiencing numbness and tingling in his face and his legs feel "funny" and get swollen from time to time


VAERS ID: 1467102 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-17
Onset:2021-07-12
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0217 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal hernia, Activated partial thromboplastin time, Alanine aminotransferase normal, Albumin globulin ratio, Angiogram, Aspartate aminotransferase, Atrial fibrillation, Basophil count decreased, Basophil percentage decreased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bicarbonate increased, Blood bilirubin normal, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase normal, Blood creatinine normal, Blood gases, Blood glucose normal, Blood magnesium normal, Blood pH increased, Blood potassium normal, Blood sodium normal, Blood test, Blood thyroid stimulating hormone, Blood urea normal, Carbon dioxide decreased, Chest X-ray, Computerised tomogram abdomen, Computerised tomogram thorax, Condition aggravated, Cough, Differential white blood cell count abnormal, Dyspnoea, Electrocardiogram, Eosinophil count decreased, Eosinophil percentage decreased, Fibrin D dimer increased, Full blood count abnormal, Glomerular filtration rate, Glomerular filtration rate decreased, Haematocrit normal, Haemoglobin normal, Immature granulocyte count, Influenza A virus test negative, Influenza B virus test, International normalised ratio normal, Lymphadenopathy, Lymphocyte count decreased, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume increased, Metabolic function test abnormal, Monocyte count, Monocyte percentage increased, Neutrophil percentage, Nucleated red cells, PCO2 decreased, PO2 decreased, Platelet count normal, Pleural effusion, Protein total decreased, Prothrombin level increased, Pulmonary fibrosis, Red blood cell count decreased, Red cell distribution width, Red cell distribution width normal, SARS-CoV-2 test negative, Scan with contrast, Troponin I normal, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (narrow), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? ferrous sulfate 325 (65 Fe) MG tablet, Take 325 mg by mouth daily (with breakfast), Disp: , Rfl: ? fluticasone-umeclidin-vilant (TRELEGY ELLIPTA) 100-62.5-25 MCG/INH inhaler, Inhale 1 puff by mouth dail
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: Troponin Series [255668882] Collected: 07/13/21 0550 Order Status: Completed Specimen: Blood Updated: 07/13/21 1122 Troponin I 0.00 0.00 - 0.06 ng/mL Comment: 0.1 to 0.5 ng/mL shows an increased risk of AMI. 0.6 to 1.5 or greater is suggestive of AMI. CKMB [255668884] Collected: 07/13/21 0550 Order Status: Completed Specimen: Blood Updated: 07/13/21 1122 Creatine Kinase-MB 1.6 0.0 - 3.6 NG/ML TSH Third Generation [255668885] Collected: 07/13/21 0550 Order Status: Completed Specimen: Blood Updated: 07/13/21 1122 TSH 0.38 0.30 - 3.04 uIU/mL EKG [255668886] Resulted: 07/13/21 0636 Order Status: Completed Updated: 07/13/21 0645 Basic metabolic panel [255668881] (Abnormal) Collected: 07/13/21 0550 Order Status: Completed Specimen: Blood Updated: 07/13/21 0624 Glucose 151 High 65 - 100 MG/DL Blood Urea Nitrogen 19 High 7 - 18 MG/DL Creatinine 0.8 0.5 - 1.0 MG/DL Sodium 142 136 - 145 MMOL/L Potassium 4.4 3.5 - 5.1 MMOL/L Chloride 108 High 98 - 107 MMOL/L Co2 22 21 - 32 MMOL/L Calcium 8.4 Low 8.5 - 10.1 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR 75 Low $g90 ML/MIN/1.73sq.m CK (CPK) Creatine Phosphokinase [255668883] Collected: 07/13/21 0550 Order Status: Completed Specimen: Blood Updated: 07/13/21 0624 Creatine Kinase Total 49 26 - 192 U/L CBC with Auto Diff [255668880] (Abnormal) Collected: 07/13/21 0550 Order Status: Completed Specimen: Blood Updated: 07/13/21 0615 White Blood Cell Count 4.2 Low 4.3 - 10.5 THOUS/uL Red Blood Cell Count 4.13 3.93 - 5.07 MIL/uL Hemoglobin 12.1 11.8 - 14.8 GM/DL Hematocrit 37.8 35.6 - 45.0 % Mean Corpuscular Volume 91.5 83.5 - 95.9 FL Mean Corpuscular Hemoglobin 29.3 27.4 - 32.0 PG Mean Corpuscular Hemoglobin Conc 32.0 31.5 - 34.7 G/DL Rdwcv 13.8 11.8 - 14.2 % Rdwsd 46.5 37.2 - 47.8 FL Platelet Count 312 167 - 402 THOUS/uL Mean Platelet Volume 11.1 8.8 - 12.0 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 69.8 High 34.0 - 67.9 % Lymphs 20.0 Low 20.4 - 48.6 % Monocytes 9.8 5.0 - 11.5 % Eos 0.0 Low 1.0 - 5.4 % Basos 0.2 0.2 - 1.3 % Neutrophils Absolute Count 2.9 2.1 - 6.6 THOUS/uL Lymphocytes Absolute Count 0.8 Low 1.2 - 3.9 THOUS/uL Monocytes Absolute Count 0.4 0.3 - 0.8 THOUS/uL Eosinophils Absolute Count 0.0 Low 0.1 - 0.4 THOUS/uL Basophils Absolute Count 0.0 0.0 - 0.1 THOUS/uL Imm Gran 0.2 0.1 - 0.7 % Abs Imm Gran 0.01 0.0 - 0.1 THOUS/uL Protime (Prothrombin Time) [255625549] (Abnormal) Collected: 07/12/21 1209 Order Status: Completed Specimen: Blood Updated: 07/12/21 1419 PROTIME 13.1 High 10.3 - 12.6 SEC INR 1.1 0.9 - 1.1 Comment: Recommended therapeutic ranges or oral anticoagulant is and INR of 2.0 to 3.0. An INR of 2.5 to 3.5 is recommended to prevent recurrent MI. APTT [255625550] Collected: 07/12/21 1209 Order Status: Completed Specimen: Blood Updated: 07/12/21 1419 APTT 33.2 25.4 - 38.4 SEC CTA Chest For Pulmonary Embolism w Contrast [255625568] Collected: 07/12/21 1342 Order Status: Completed Updated: 07/12/21 1418 Narrative: EXAMINATION: CTA Chest, Abdomen, and Pelvis with Intravenous Contrast, Axial Imaging with Coronal and Sagittal 2-D multi- reconstructions. 80 mL Omnipaque 350 was administered intravenously for the post-contrast images. INDICATION: Elevated d-dimer. Shortness of breath. COMPARISON: Portable AP chest x-ray 7/12/2021 and CTA chest 11/23/2015 CTA CHEST FINDINGS: Moderate bilateral pleural effusions. Partially consolidative or compressive atelectasis posteriorly in the lower lobes and mild atelectasis in the inferior lingula. Mild atelectasis and/or subpleural scarring posteriorly in the upper lungs. A 0.5 cm noncalcified subpleural nodular opacity in the lateral right upper lobe on axial series 2 images 57-61 previously measured 0.4 cm on exam of 11/23/2015, favoring a benign etiology. A smaller 0.2 cm noncalcified subpleural nodular opacity slightly further anteriorly in the lateral right upper lobe and a minimally spiculated 0.3 cm nodular opacity further anterior to this also in the lateral right upper lobe on axial series 2 images 57 and 58 are unchanged to very minimally enlarged by 1 mm compared to the prior exam. Additional tiny micronodules are seen in the posterior subpleural right upper lobe on axial series 2 images 72-73. Mild chronic pleural parenchymal scarring in bilateral lung apices. Remaining lungs are clear. No pneumothorax. No acute vascular injury or contrast extravasation. No gross pulmonary emboli. Main pulmonary artery measures approximately 2.7 cm. Aorta is age-appropriate without aneurysm, with calcifications in the aortic arch and descending aorta and in the coronary arteries. Heart size is normal with no pericardial effusion. Partially included thyroid gland appears unremarkable. Slightly enlarged lymph node in the left aorticopulmonary window on axial series 2 image 84 measuring approximately 1.3 cm. Slightly enlarged precarinal lymph nodes are also seen, new from the prior exam. No hilar adenopathy is identified. No acute infiltrate, consolidation, pleural effusion, or pneumothorax. No acute osseous abnormality. CT ABDOMEN AND PELVIS FINDINGS: No acute vascular injury or extravasation. Aorta is age-appropriate without aneurysm or dissection, with scattered atherosclerotic calcifications. Decreased density of the liver relative to the spleen is likely related to phase of contrast, with superimposed hepatic steatosis is not entirely excluded. Liver, spleen, gallbladder, and bilateral adrenals are otherwise unremarkable. Small cystic lesions in bilateral kidneys. Bladder and prostate are normal. No significant bowel wall thickening or obstruction. What is thought to be the appendix appears unremarkable without evidence of appendicitis. Tiny miniscule fat-containing ventral periumbilical hernia. Atherosclerotic calcifications in the abdominal aorta and its distal branches without aneurysm. Slight degenerative anterior listhesis L4 on L5 and L3 on L4. Concentric annular bulge at all levels from L2 to L5 with borderline or mild central canal narrowing at L2-3, moderate central canal narrowing at L3-4 and moderate to severe central canal narrowing with at least mild-to-moderate right foraminal narrowing at L4-5. No acute osseous abnormalities. IMPRESSION: 1. Very minimal if any enlargement of up to 0.5 cm noncalcified pulmonary nodules laterally in the subpleural right upper lobe since 11/23/2015, likely postinfectious/postinflammatory. If patient is low risk for malignancy, no routine follow-up imaging is recommended; if patient is high risk for malignancy, a non-contrast Chest CT at 12 months is optional. If performed and the nodule is stable at 12 months, no further follow-up is recommended. Reference: Radiology. 2017; 284(1):228-43. 2. Small bilateral pleural effusions with bibasilar atelectasis and mild atelectasis in the inferior lingula. 3. Mild adenopathy in the chest, new since 11/23/2015, likely benign reactive, but recommend follow-up CT chest in 6 months. 4. No acute abnormality in the abdomen or pelvis. 5. Slightly decreased density of the liver may be related to phase of contrast or less likely superimposed hepatic steatosis. 6. Degenerative changes in the lumbar spine with canal and foraminal narrowing as noted above, greatest at the L4-5 level. 7. Please see above report for the other chronic findings in the chest, abdomen and pelvis. This CT exam was performed using one or more of the following dose reduction techniques: automated exposure control, adjustment of the mA and/or kV according to patient size, and/or use of iterative reconstruction technique. Radiation Dose: 273.88 mGy*cm total DLP Electronically signed by:MD 7/12/2021 2:17 PM CDT Workstation: 109-1334 Comprehensive metabolic panel [255625544] (Abnormal) Collected: 07/12/21 1209 Order Status: Completed Specimen: Blood Updated: 07/12/21 1246 Glucose 113 High 65 - 100 MG/DL Blood Urea Nitrogen 12 7 - 18 MG/DL Creatinine 0.6 0.5 - 1.0 MG/DL Sodium 142 136 - 145 MMOL/L Potassium 3.3 Low 3.5 - 5.1 MMOL/L Chloride 107 98 - 107 MMOL/L Co2 22 21 - 32 MMOL/L Calcium 8.9 8.5 - 10.1 MG/DL Protein Total 6.1 Low 6.4 - 8.2 G/DL Albumin 3.0 Low 3.4 - 5.0 G/DL A/G Ratio 1.0 0.8 - 2.0 Alkaline Phosphatase 87 46 - 116 U/L Alt (SGPT) 24 14 - 59 U/L AST(SGOT) 19 15 - 37 U/L Bilirubin, Total 0.3 0.2 - 1.0 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR $g90 $g90 ML/MIN/1.73sq.m Magnesium [255625546] Collected: 07/12/21 1209 Order Status: Completed Specimen: Blood Updated: 07/12/21 1246 Magnesium 1.8 1.8 - 2.4 MG/DL TSH Third Generation [255625547] Collected: 07/12/21 1209 Order Status: Completed Specimen: Blood Updated: 07/12/21 1246 TSH 1.38 0.30 - 3.04 uIU/mL CK (CPK) Creatine Phosphokinase [255625551] Collected: 07/12/21 1209 Order Status: Completed Specimen: Blood Updated: 07/12/21 1246 Creatine Kinase Total 67 26 - 192 U/L CKMB [255625552] Collected: 07/12/21 1209 Order Status: Completed Specimen: Blood Updated: 07/12/21 1246 Creatine Kinase-MB 1.5 0.0 - 3.6 NG/ML Troponin Series [255625553] Collected: 07/12/21 1209 Order Status: Completed Specimen: Blood Updated: 07/12/21 1246 Troponin I 0.00 0.00 - 0.06 ng/mL Comment: 0.1 to 0.5 ng/mL shows an increased risk of AMI. 0.6 to 1.5 or greater is suggestive of AMI. D-dimer, quantitative [255625555] (Abnormal) Collected: 07/12/21 1209 Order Status: Completed Specimen: Blood Updated: 07/12/21 1244 D-Dimer 740 High Panic 0 - 400 NG/ML FEU Lactic Acid, Serum [255625545] Collected: 07/12/21 1210 Order Status: Completed Specimen: Blood Updated: 07/12/21 1238 Lactate 1.5 0.4 - 2.0 MMOL/L Brain Natriuretic Peptide (BNP) [255625554] (Abnormal) Collected: 07/12/21 1210 Order Status: Completed Specimen: Blood Updated: 07/12/21 1235 B-Type Natriuretic Peptide 310 High 0 - 100 PG/ML XR Chest Portable [255625558] Collected: 07/12/21 1217 Order Status: Completed Updated: 07/12/21 1224 Narrative: EXAMINATION: XR CHEST PORTABLE CLINICAL HISTORY: 69 years Female,SOB COMPARISON: 5/27/2020 TECHNIQUE: Single portable semiupright AP radiograph the chest at 1215 hours FINDINGS: Mild bilateral pulmonary vascular congestion and small bilateral pleural effusions with mild interval increase in heart size due to acute congestive heart failure. No pneumothorax. IMPRESSION: Mild acute CHF with small bilateral pleural effusions . Electronically signed by: Sam Youssef MD 7/12/2021 12:23 PM CDT Workstation: 103-1105 CBC w Auto Diff [255625543] (Abnormal) Collected: 07/12/21 1209 Order Status: Completed Specimen: Blood Updated: 07/12/21 1224 White Blood Cell Count 7.4 4.3 - 10.5 THOUS/uL Red Blood Cell Count 4.33 3.93 - 5.07 MIL/uL Hemoglobin 12.7 11.8 - 14.8 GM/DL Hematocrit 38.8 35.6 - 45.0 % Mean Corpuscular Volume 89.6 83.5 - 95.9 FL Mean Corpuscular Hemoglobin 29.3 27.4 - 32.0 PG Mean Corpuscular Hemoglobin Conc 32.7 31.5 - 34.7 G/DL Rdwcv 13.4 11.8 - 14.2 % Rdwsd 43.9 37.2 - 47.8 FL Platelet Count 339 167 - 402 THOUS/uL Mean Platelet Volume 10.4 8.8 - 12.0 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 79.1 High 34.0 - 67.9 % Lymphs 12.8 Low 20.4 - 48.6 % Monocytes 6.2 5.0 - 11.5 % Eos 0.9 Low 1.0 - 5.4 % Basos 0.7 0.2 - 1.3 % Neutrophils Absolute Count 5.9 2.1 - 6.6 THOUS/uL Lymphocytes Absolute Count 1.0 Low 1.2 - 3.9 THOUS/uL Monocytes Absolute Count 0.5 0.3 - 0.8 THOUS/uL Eosinophils Absolute Count 0.1 0.1 - 0.4 THOUS/uL Basophils Absolute Count 0.1 0.0 - 0.1 THOUS/uL Imm Gran 0.3 0.1 - 0.7 % Abs Imm Gran 0.02 0.0 - 0.1 THOUS/uL Novel Coronavirus SARS-COV-2 by NAA [255625560] Collected: 07/12/21 1155 Order Status: Completed Specimen: Nasopharyngeal Updated: 07/12/21 1221 Novel Coronavirus SARS-COV-2 by NAA NEGATIVE NEGATIVE Comment: THIS TEST HAS BEEN AUTHORIZED BY THE FDA UNDER AN EMERGENCY USE AUTHORIZATION (EUA) AND PERFORMANCE VALIDATED BY LABORATORY. THIS TEST IS NOT FDA-APPROVED. THE NAAT METHOD IS RT PCR OR TMA (HOLOGIC EUA ASSAY IS EQUIVALENT TO RT PCR). RESULTS SHOULD BE USED IN CONJUNCTION WITH CLINICAL FINDINGS AND SHOULD NOT FORM THE SOLE BASIS FOR A DIAGNOSIS OR TREATMENT DECISION. TEST PERFORMED AT LABORATORY CLIA 14D0436524 Influenza antigen [255625559] Collected: 07/12/21 1155 Order Status: Completed Specimen: NARES Updated: 07/12/21 1216 Influenza A NEGATIVE NEGATIVE Influenza B NEGATIVE NEGATIVE BLOOD GAS ARTERIAL(AKA ABG) Liter Flow/O2 Percentage: 2 LPM = 28% Fi02 1 Time [255625548] (Abnormal) Collected: 07/12/21 1155 Order Status: Completed Specimen: Blood, Arterial Updated: 07/12/21 1208 ABG Other Settings ALLEN''S TEST PERFORMED pH Arterial 7.47 High 7.35 - 7.45 pCO2 Arterial 29.0 Low 35 - 45 MM HG Po2 Arterial 73.0 Low 80 - 100 MM HG HCO3, Arterial 20.9 Low 22 - 25 MMOL/L Co2 Content 21.8 21 - 277 MMOL/L Base Deficit 1.7 High 0 O2 Sat, Arterial 95.0 95 - 100 % EKG [255625556] Resulted: 07/12/21 1135 Order Status: Completed Updated: 07/12/21 1137
CDC Split Type:

Write-up: 7/12/21 er @ hospital: 69 y.o. female who presents with increasing shortness of breath. Patient reports increasing shortness of breath for the past 3 days. She denies any runny nose or sinus congestion. Patient does report a dry cough but states it is no different from her typical COPD cough. Patient denies any chest pain or palpitations. However, patient on bedside monitor is in AFib with RVR. Patient does voice a history of intermittent atrial fibrillation. Patient denies any current palpitations, chest pain, or edema. Of note, patient reports she sustained a stroke approximately 6 weeks ago. Patient reports she experienced left-sided weakness. She reports that left-sided weakness has since returned to completely normal. She did not seek medical care for her stroke at the time of the stroke. (pt is a retired nurse) Transferred to another healthcare facility where she remains admitted as of 7/13/21


VAERS ID: 1467134 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Gaze palsy, Hyperhidrosis, Loss of consciousness, Presyncope, Seizure, Tremor, Vaccination complication
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Seizure-Mild, Systemic: Shakiness-Mild, Additional Details: Patient began feeling light-headed and dizzy about 1-2 minutes after receiving vaccine while sitting in obs. area. Was given water which helped for a little and then shortly after that patient began lightly shaking- looked almost like a seizure and his eyes rolled back for 3 seconds. Came back to consciousness after 5 seconds- stayed on chair whole time never hurt himself just a vagal reaction to vaccine. Paramedics were called to examine him and brought him to hospital for monitoring with mom.


VAERS ID: 1467151 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-11
Onset:2021-07-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Full blood count, Haematochezia, Metabolic function test, Pregnancy test, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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: CBC, CMP, UA, pregnancy
CDC Split Type:

Write-up: hematochezia with BM x 2. No other symptoms.


VAERS ID: 1467183 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-02
Onset:2021-07-12
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, levothyroxine, seroquil, neproxen, depo-pervera shot, vitamin D, folic acid
Current Illness:
Preexisting Conditions: Chronic pain, hypothyroidism, hypoglycemia
Allergies: Amoxicillin (whole class)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red & raised an inch around injection site


VAERS ID: 1467188 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-15
Onset:2021-07-12
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO175 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Head discomfort, Oropharyngeal pain, Pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Blood pressure medicine, metformin, balsagar,aspirin,tylenol, Aporstati8n
Current Illness: no
Preexisting Conditions: Diabetic, high blood pressure,
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Stuffy head, body aches, sore throat,


VAERS ID: 1467194 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

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

Write-up: Patient received his first Pfizer shot on 7/12/21 around 4:45pm and was sitting down for observation when after a few minutes fainted and fell off from his chair. Patient was already alert and had gotten up himself when pharmacy staff came to assist patient. He said he was fine and did not need further medical care. Patient mentioned he has not gotten a vaccine in a long time and was probably nervous. He finished the rest of his 15 mins observation time (with mom waiting with him) and was feeling good to go home.


VAERS ID: 1467221 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Upon patient shopping with mom after waiting 15 minutes for monitoring, the patient became nauseous and vomited in the store. My pharmacy manager, and I both came right away after being notified. We questioned the patient who stated that she immediately felt better, but just that her stomach had been hurting. She did not feel light headed or nauseous after.


VAERS ID: 1467229 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Dyspnoea, Pruritus, Rash
SMQs:, Anaphylactic reaction (narrow), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Amlodipine 5 mg, Lorazepam 1 mg, Gabapentin 300 mg, Albuterol MDI, Lamotrigine 100 mg (meds last filled by us)
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient'' husband stated patient started having severe itching, slight rash on arms and legs, shortness of breath approximately 45-60 minutes after receiving the vaccine. Patient told husband it was like she could taste the shot. Patient took Benadryl and used her Albuterol MDI at home but according to husband refused to go to a doctor. No symptoms presented during 15 minute waiting period after the patient received the vaccine.


VAERS ID: 1467264 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-12
Onset:2021-07-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Condition aggravated, Dizziness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: Attendee reported dizzyness 15 minutes post vaccination when standing up and walking. Returned to cot, then chair with gradual resolution of symptoms. Attendee reported history of hypertension/anxiety at 20 minute mark and medication history. Symptoms resolved with stable thought slightly elevated blood pressure and Attendee ambulated home with sister and without assistance.


VAERS ID: 1467287 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-11
Onset:2021-07-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left forearm rash (a bit itchy and burning)


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