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

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



Case Details (Reverse Sorted by Onset Date)

This is page 27 out of 8,010

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VAERS ID: 1768103 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Condition aggravated, Extra dose administered, Fatigue, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), 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: Phizer 01/08/2021 (symptoms of chills, body ache, fever) lasting 24hrs
Other Medications: Benafalacien, Cixcinda, Levathoroxien
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Arithamicine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd dose of Booster Phizer 10/05/2021, started experiencing symptoms 10/06/2021 of chills, body aches, fatigue, headaches, and muscle aches. Self-treating with Tylenol and improving. No noted Primary visit.


VAERS ID: 1768104 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-10-06
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Fall, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 325 Mg Oral Tab Atorvastatin (Lipitor) 10 Mg Oral Tab Calcium Carb/Vit D3/Minerals (Calcium-vitamin D Oral) Carbidopa 25 Mg/Levodopa 100 Mg (Sinemet) 25-100 Mg Oral Tab Cyclosporine Modified (Neoral) 25 M
Current Illness:
Preexisting Conditions: Anemia Atrial fibrillation Cardiomyopathy, s/p LVAD and heart transplant CKD stage 3 Hypertension Hyperparathyroidism Lumbar spinal stenosis Osteopenia Parkinson''s diease Seizure Sleep apnea Tinnitus Tremor
Allergies: Morphine
Diagnostic Lab Data: POSITIVE COVID TEST 10/6/21
CDC Split Type:

Write-up: FREQUENT FALLS AND ACUTE CONFUSION.


VAERS ID: 1768105 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5AJ3B / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL HFA) 90 mcg/actuation inhaler benzoyl peroxide 10 % cream busPIRone (BUSPAR) 10 MG tablet clotrimazole (LOTRIMIN) 1 % cream fluconazole (DIFLUCAN) 150 MG tablet fluticasone propionate (FLONASE) 50 mcg/actuation nasal sp
Current Illness: N/A
Preexisting Conditions: Benign essential hypertension Type 2 diabetes mellitus without complication, without long-term current use of insulin (HCC) Asthma Abnormal uterine bleeding Anxiety Conductive hearing loss, bilateral Obesity (BMI 35.0-39.9 without comorbidity) Sensorineural hearing loss (SNHL) of both ears
Allergies: Aspirin Miconazole Nitrate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was in clinic for a flu shot, nurse got flu shot out and laid shot on computer. after verifying name and DOB picked up a covid shot off of table where covid shots held and gave covid vaccine. nurse explained to pt that wrong shot was given. Flu shot given in opposite arm. Nurse asked pt if it has been six months since last covid shot , and she said yes. nurse asked for shot record. Pt stated she got her covid shots at a pharmacy and did not have card. nurse asked pt if she had Pfizer or moderna. she stated moderna. nurse filled out the vaccine card with lot number and told pt to keep both cards and let pharmacy know she has had a Pfizer booster. Pt verbalized that she understands.


VAERS ID: 1768116 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768119 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-10-06
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Breakthrough COVID case.


VAERS ID: 1768126 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses administered 0.3mL doses instead of 0.5mL. Patient notified 10/06/2021 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768133 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768141 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered wrong dose Patient was notified 10/06/21 and offered to received the additional mL to receive the full dose.


VAERS ID: 1768148 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768159 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768161 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

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

Write-up: Experienced fatigue at 09:30PM on 06OCT2021, then hot flashes, chills and 100.6F fever at 1:35AM on 07OCT2021. Headache and fatigue experienced at 8:00AM 07OCT2021. Symptoms relieved by 9:30AM on 07OCT2021.


VAERS ID: 1768164 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768170 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Hypotension, Pupillary reflex impaired, Skin discolouration, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: placed on comfort measures relted to sigmoid colon cancer
Preexisting Conditions: COPD,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 10/6/2021 at approximately 2:00 PM- Pt became sick to his stomach- vomited; unresponsive; pupils sluggish; legs discolored-more on let side that right; blood pressure barely audible. .5 mg of epinephrine administered by RN; resident started to arouse. Blood pressure low 60/40; attempting to speak; some discoloration remained present on the left side but much better; IM zofran and IV fluids started. Today, 10/7/21- eating some, able to respond to questions.


VAERS ID: 1768174 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered wrong dosage. Patient was notified 10/06/21 and offered to received the additional mL to receive the full dose.


VAERS ID: 1768180 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-10-06
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / -

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

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

Write-up: Patient Covid + on 10/06/2021 and hospitalized Per Ed Note: 89-year-old male past medical history significant for HTN, A. fib, BPH is presenting to the emergency department from ECF via EMS for Covid positive x2. Patient was found to be Covid positive at the ECF and they are not able to care for him at the care facility if he is Covid positive. Patient has no symptoms including shortness of breath, chest pain, productive cough, rhinorrhea or other URI symptoms. Patient denies any abdominal pain, vomiting, focal paresthesias or weakness, headache, dizziness, fevers or chills, change in bowel or bladder habits, leg pain or edema or history of blood clots, or changes in medications. He denies any other modifying precipitating or relieving factors. PMH: HTN, A. fib, BPH


VAERS ID: 1768191 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768193 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2021-10-06
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Constipation, Cough, Dehydration, Diarrhoea, Dizziness, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram normal, Extrasystoles, Fatigue, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient Covid + on 10/06/2021 and vaccinated. Patient hospitalized Per Ed Note: 98-year-old male with past medical history of hypertension, hyperlipidemia, hypothyroidism, and anemia presented to the emergency department with complaint of weakness. He describes the weakness as a lack of energy and generalized fatigue. He states he saw his cardiologist 2 weeks ago because he had an abnormal EKG, stating he was told he had a "missed beat." He states he had a follow-up appointment on Thursday, 9/30/2021 with his cardiologist. He was told that his EKG is normal and that there is nothing to worry about. During that appointment he noticed that he was having some constipation. He was told to take magnesium citrate, and he did take that. He states over the next 2 days he had multiple episodes of loose stool, and feels as if he may be dehydrated. He now complains of some myalgias as well as some lightheadedness. He states he does have a cough, this is nonproductive. He also states some shortness of breath. He denies any associated headache, vision changes, neck pain, back pain, chest pain, palpitations, syncope, abdominal pain, nausea, vomiting, dysuria, hematuria, extremity numbness or tingling, or focal weakness. Patient''s daughter was at the bedside and also stated that she believes he could be dehydrated because he has had similar issues when using laxatives; when he is been hydrated in the past he is presented similarly and has required IV hydration eventually goes home.


VAERS ID: 1768195 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768198 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768201 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse event, Condition aggravated, Cystitis, Fatigue, Headache, Pain in extremity
SMQs:, 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: IUD, Zinc/Vitamin C
Current Illness: Sick (heavy cold?) prior to first dosage
Preexisting Conditions: Interstitial Cystitis
Allergies: Sulfa, Shell Fish
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: common reactions such as head ache, sore arm, tired, etc. Additional adverse event/reason for reporting is flare up of cystitis that has otherwise been under control.


VAERS ID: 1768203 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768204 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-26
Onset:2021-10-06
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, COVID-19, Chills, Productive cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated and Covid + on 10/06/2021. Patient hospitalized Per ED Note: The patient is a 59-year-old male past medical history significant for insulin-dependent diabetes, HTN, HLD, COPD who is presenting to the emergency department with chief complaint of elevated blood pressure. Patient is non-English speaking and interpreter was offered through the Martti system however patient''s brother is at bedside and patient would prefer his brother to translate. Went to his primary care physician because he was having subjective fevers and chills patient states that he was sent in by his primary care physician after being seen in clinic for elevated blood pressure. Patient states that he and a productive cough for approximately 24 hours prior to arrival in the emergency department. Patient states that he got a dose of his metoprolol at the clinic which she had not taken earlier in the day. Patient states that he is overall feeling feverish and "weak." Patient did receive his Covid vaccinations approximately 3 months prior to arrival in the emergency department. Patient denies any sick contacts. Patient denies any other acute complaints at this time. Patient denies any chest pain, abdominal pain, vomiting, focal paresthesias, headache, blurred vision, decrease in urine output, dizziness, change in bowel or bladder habits, leg pain or edema or history of blood clots, or changes in medications. He denies any other modifying precipitating or relieving factors.


VAERS ID: 1768206 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Underdose
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: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768208 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Burning sensation, Dyspnoea, Erythema, Paraesthesia oral, Skin warm, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Nothing was done
CDC Split Type:

Write-up: I developed facial swelling and hives all over my body. My body felt like it was on fire. My skin was red and hot. I begin to have SOB and my tongue was tingling


VAERS ID: 1768209 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose.


VAERS ID: 1768217 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Nurse drawing up Moderna doses drew up and administered 0.3mL doses instead of 0.5mL. Patient was notified 10/06/21 and offered to received the additional 0.2mL to receive the full dose. Alert about age was bypassed, patient was 15 years old.


VAERS ID: 1768223 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Unknown       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: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1768229 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Unknown       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: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1768231 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Unknown       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: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1768235 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Unknown       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: Administration error: Mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1768254 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Breast swelling, Pain
SMQs:, Angioedema (broad), Lipodystrophy (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 described shooting pain in left breast and swelling of the breast the day following vaccine administration. Patient applied ice to the area and reports that there was no pain in the arm the vaccine was received in.


VAERS ID: 1768261 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Chills, Headache, Pain, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metphormin, glipizide, lotensin, omeprazole, amlodipine, magnesium, potassium, tamsulosin, crestor
Current Illness:
Preexisting Conditions: diabetic
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden chills with almost incontrollable shaking, headache, temp to 100.8, aches and joint pain


VAERS ID: 1768288 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Unknown       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: Administration error: Mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1768295 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-03
Onset:2021-10-06
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a positive COVID PCR test on 10/06/2021 after receiving both vaccine doses


VAERS ID: 1768316 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-05
Onset:2021-10-06
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1768321 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypersensitivity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was administered Pfizer and after about 5 minutes, she had an allergic reaction ( hives on most of her body and generalized weakness. I gave her Benadryl and she was later taken to the nearest ER by paramedics personal.


VAERS ID: 1768322 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

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

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

Write-up: Patient came in and asked to be placed on the schedule for her second dose of Moderna. She filled out the Covid 19 vaccine Consent/contraindication form. She marked she had Moderna on 09/08/21 and also verbally confirmed it when I asked because her husband also got the Moderna and had came in with her. I confirmed that she did get a Covid shot on the 09/08/21 and per database she was due for her second dose. I got their shot signed off and placed stickers on the cards. Administered the vaccine, gave their cards back, and placed a timer for 15 minutes. After the 15 minutes they felt fine and were let go. At about 4:30 once I was done seeing patient for the day I was entering vaccines into our system and noticed that actually had Pfizer charged out in her chart and not Moderna. I looked into our images of her previous consent form for her first Covid shot and it was in fact Pfizer. I informed my supervisor and she helped me look up the CDC Covid 19 errors and deviation. I called patient and asked how she was feeling. She stated she felt fine. I informed that I noticed as I was charging out her Covid shot that I gave her the wrong vaccine. She had Pfizer last month and I gave her Moderna since thats what she was scheduled for on her visit and it was written on her paper but it was my fault and I should have looked at her card better. Pt mentioned that she thought she had Moderna the first time. I mentioned that in the chart we had paperwork from the first one stating she got Pfizer but that it was fine and she is still considered fully immunized according to the CDC, but she is eligible to receive a 2nd Moderna after 6 months if she would like. Pt stated understanding and I told her she could go onto the CDC website and look up under the Covid vaccine errors and deviations, that is where she can find this information. She would like me to send this information to doctor so he is aware as well. I am ok with doing this and will send him this information through fax.


VAERS ID: 1768338 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-10-06
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1768339 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-03
Onset:2021-10-06
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

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

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

Write-up: Patient hospitalized after positive COVID. Patient was fully vaccinated


VAERS ID: 1768349 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 2FF2589 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dementia (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: aspirin,
Current Illness:
Preexisting Conditions: uterine fibroids
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On the way home she started feeling funny. Very tired, vagainal bleeding like a menstral cycle but very heavy.


VAERS ID: 1768358 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK LA / IM

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

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

Write-up: vaccinator gave employee pfizer instead of moderna for 2nd vaccine. Employee was monitored and no adverse reactios noted.


VAERS ID: 1768366 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK RA / IM

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

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

Write-up: vaccinator gave employee pfizer 3rd dose/booster when employee previously had completed dose of moderna.


VAERS ID: 1768372 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-10-06
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fall, Nucleic acid test, SARS-CoV-2 test positive
SMQs:, Accidents and injuries (narrow), 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: HTN, MS, DM, ARF, stroke
Allergies:
Diagnostic Lab Data: SARS-COV-2 (COVID-19, Micro 10/6/2021 Detected
CDC Split Type:

Write-up: tested positive routinely when presented to hospital after a fall


VAERS ID: 1768378 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Extra dose administered, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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: Triggered vertigo 50yrs old 01/14/2021 Pfizer covid vaccine
Other Medications: Tylenol
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Headache mild fever body ache


VAERS ID: 1768387 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 3 LA / SYR

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

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

Write-up: Jand J was erroneously administered instead of Pfizer.


VAERS ID: 1768397 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Pruritus, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient experienced a golf-ball sized rash at the injection site and itching and also experienced some sinus congestion the night of receiving the vaccine.


VAERS ID: 1768406 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 4 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, Incorrect product formulation administered
SMQs:, Medication errors (narrow)

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

Write-up: This patient was scheduled to receive her flu vaccination on 10/6 and as the result of a clinician error received a Pfizer COVID-19 vaccination. Prior to this vaccination the patient had already received her "third dose" from another provider on 9.2.21. As a result this ended up being her 4th dose"


VAERS ID: 1768413 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Erythema, Nodule, Pain in extremity, Pyrexia, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large 4cm red, patch with heat to it, and two hugs knots under arm. Got chills, little fever, arm painful, and fever on left arm


VAERS ID: 1768422 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-29
Onset:2021-10-06
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1768427 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

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

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

Write-up: Health District held booster vaccine clinic for Residents and staff of Facility where patient was a staff member. Staff member attested to receiving 2 doses of Pfizer vaccine previous. When entering information into database, patient had actually received 2 doses of Moderna vaccine.


VAERS ID: 1768432 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

Write-up: Vaccine was incorrectly mixed with 1.5ml of normal saline and not 1.8ml, resulting in a slightly higher dose


VAERS ID: 1768441 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

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

Write-up: Red, swollen and painful lump of scar tissue at lipoma removal site on medial aspect of left bicep muscle. Size of a quarter Swollen axillary lymph node on left side headaches body aches


VAERS ID: 1768454 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-06
Onset:2021-10-06
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / -

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

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

Write-up: Positive covid test in hospitalized patient


VAERS ID: 1768460 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 3 RA / IM

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

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

Write-up: Janssen erroneously administered instead of Pfizer.


VAERS ID: 1768472 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-10-06
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / -

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

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

Write-up: positive covid test


VAERS ID: 1768489 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 3 RA / IM

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

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

Write-up: J&J erroneously administered instead of Pfizer.


VAERS ID: 1768494 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-10-06
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1768496 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Influenza like illness, Injection site pain, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (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: Vitamin C, daily multivitamin, fish oil, adderall, and Wellbutrin
Current Illness: None
Preexisting Conditions: ADD & Anxiety
Allergies: Codeine and Lexapro
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Getting the covid vaccine was worse than having covid itself for me. I experienced flu like symptoms. Body aches, chills, profuse sweating without a fever, soreness in arm at the injection site occurring 20 minutes after injection and is still sore, and a headache. All symptoms started, besides left arm soreness, early morning on oct 6 around 6 AM and continued until I went to bed around 9pm on oct 6.


VAERS ID: 1768501 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-01
Onset:2021-10-06
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested NAAT positive for COVID 10/6/21 after being fully vaccinated.


VAERS ID: 1768506 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FS2587 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Pruritus, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 2nd day after taking the vaccine her arm started to swell. Arm became itchy, feverish and swollen.


VAERS ID: 1768515 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-10-06
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1768517 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Flushing, Hyperhidrosis, Lethargy, Loss of consciousness, Nausea, Paraesthesia, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Weakness-Severe, Additional Details: Patient felt really dizzy and passed out. 911 was called and EMS came to assess the patient. after assessment and vitals, patient was suggested to be taken to hospital for further assessment. Patient was escorted by ems to emergency department


VAERS ID: 1768526 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-10-06
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: None
Allergies: Codine
Diagnostic Lab Data: C-19 Test 10/06/2021 Positive Results.
CDC Split Type:

Write-up: Pt presented with a cough and fatigue on 10/06/2021. Aspeirin, Lipitor, Captopril, Rocephin. Pt remians in the hospital.


VAERS ID: 1768528 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blindness, Chills, Dizziness, Flushing, Hyperhidrosis, Hypertension, Hypoaesthesia, Nausea, Pain, Tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypertension (narrow), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (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: Abdominal Pain-Medium, Systemic: Body Aches Generalized-Mild, Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Hypertension-Mild, Systemic: Nausea-Medium, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tachycardia-Medium, Systemic: Visual Changes/Disturbances-Medium, Systemic: Vomiting-Medium, Additional Details: EMS called. Pt tachycardia, profuse sweating, numbness of limbs,loss of vision and vomiting. EMS arrived took vitals and vitals back to normal. PT has hx of anxiety. Pt didn''t want further tx. Pt recovered within 30 minutes


VAERS ID: 1768535 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-10-06
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1768552 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: fainted after admin of fist dose of modern vaccine. recovered quickly. ems arrived and checked her out. she was fine


VAERS ID: 1768559 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-10-06
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Diarrhoea, Disorientation, Dyspnoea, Memory impairment, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is oriented to person and place; but not to time. He is febrile here at 39.6 degrees Celsius. The patient has a difficult time participating in history but endorses a cough, shortness of breath, diarrhea and fever that all began within the past day. 3rd vaccine 09/28/2021.


VAERS ID: 1768562 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-10-06
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Dizziness, Fall, SARS-CoV-2 test positive
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: presents after a fall at home in the setting of lightheadedness and weakness, now with confirmed positive COVID-19 infection. Fortunately, his vital signs have been stable and he is saturating well on room air. However, weakness in the setting of the infection likely resulted in the fall.


VAERS ID: 1768563 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 304458A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Additional Details: Patient stated they felt like they were going to pass out and felt very nauseous, was also visibly sweating a lot. Called 911 and rescue treated patient on scene, patient walked out of store with EMTs after being monitored/treated for around half an hour.


VAERS ID: 1768568 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (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), 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: Site: Bruising at Injection Site-Mild, Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1768575 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O48F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Mouth swelling, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Additional Details: I gave vaccine and watched for 15 minutes. Patient was wearing a mask so couldnt see but later she came back in like 30 minutes and showed me her swollen tongue. I gave her immediately 2 benadryls and water and she came back before she left store to show me swelling went down. shw was with a friend and counseled her not to drive because drowsiness from benadryl. she was ok before she left.


VAERS ID: 1768585 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Private       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt. received Moderna vaccine 03/24/2021. Pfizer vaccine was given 10/06/2021.


VAERS ID: 1768589 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Face injury, Fall, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Additional Details: pt got pfizer covid shot on left arm and fluzone on right felt light headed and dizzy fainted fell and hit his chin and was unresponsive for a few minutes paramedics came to check pt out was fine


VAERS ID: 1768593 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 RA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1768642 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN FF2587 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: Error: Wrong Route (SC, IM, etc.)-


VAERS ID: 1768646 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-16
Onset:2021-10-06
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Antigen COVID-19 test with a positive result
CDC Split Type:

Write-up: Patient was vaccinated on 12/28/20 and 1/16/21, so was fully vaccinated when testing positive for COVID-19 on 10/6/21.


VAERS ID: 1768652 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 RA / IM

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

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

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


VAERS ID: 1768664 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Mild, Site: Swelling at Injection Site-Mild


VAERS ID: 1768674 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-24
Onset:2021-10-06
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1768689 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: sulindac 150 mg lisinopril 20 mg famotide 20 mg all daily
Current Illness: none
Preexisting Conditions: none
Allergies: eggs
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Terrible chills, my teeth were chattering, could not keep hands still without holding myself, lasted 6 hours, second night I had body sweats throughout the night lasting 8 hours


VAERS ID: 1768696 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-09
Onset:2021-10-06
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient was vaccinated on 1/12/21 and 2/9/21, so was fully vaccinated when testing positive for COVID-19 on 10/6/21.


VAERS ID: 1768702 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: amoxicillin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Moderna Covid vaccine administered in error to pediatric 13yo patient.


VAERS ID: 1768715 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-25
Onset:2021-10-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan-HCTZ 100-25mg Allopurinol 300mg Venlafaxine ER 37.5mg Gabapentin 600mg Janumet XR 100-1000 Mg Levothyroxine 75mcg Aspirin 81mg
Current Illness: none
Preexisting Conditions: Erythromelalgia Hypothyroidism High Blood Pressure - maintained with medication
Allergies: neomycin thimerisol
Diagnostic Lab Data: none. I checked with the pharmacist that gave me the vaccine and they said to just report the adverse reaction.
CDC Split Type:

Write-up: On the 11th day following my first dose, I have a knot come up at the injection site. The site is swollen, you can feel the knot under the skin. It is hard. The skin is read and has heat in it.


VAERS ID: 1768717 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Discomfort, Headache, Hypoaesthesia, Muscle tightness, Musculoskeletal stiffness, Neck pain, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Inhaler
Current Illness: Asthma, hypertension, and COPD
Preexisting Conditions: Asthma, hypertension, and COPD
Allergies: sulfa drugs and erythromycin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Female client received the 2nd Pfizer vaccine (lot # 30145BA exp 10/30/2021) at 11:05AM, in her left arm. Client arrived in observation area at 11:09 to complete her 30-minute observation period. Client was offered water bottle and drank it during her 30-minute wait. At 11:40 AM, client reports to EMT stiff neck and headache that began two minutes ago. EMT advised client to stay in observation to be assessed. PHN arrives and offers client juice. At 11:42AM client states that additionally her jaw is ?numb and feels tight? and her left shoulder is ?tingling and radiating to the left side of her neck.?. Client denies dizziness, blurry vision, shortness of breath, and chest pain. Client?s skin is dry and appropriate for ethnicity, is alert and oriented, and is able to swallow. At 11:44AM vital signs were taken. Client had a blood pressure of 150/90 on her left arm, oxygen saturation of 98%, and heart rate of 62bpm. Client states that she has a past medical history of anxiety and headache was up to an 8 out of 10. At 11:50 AM, client takes her routine inhaler. Client states that her headache is down to a 3 out of 10 and her shoulder is at 7 out of 10 on pain scale. At 11:53 AM vital signs are taken again, this time on the client?s right arm. Blood pressure is at 172/90, heart rate is regular at 60bpm, oxygen saturation is at 97%, and respirations are at 16. At 11:55AM client states her neck pain is at 5 out of 10, and that her jaw is ?feeling better? and that ?the feeling is dissipating.? Client past medical history includes allergy to sulfa and erythromycin, hypertension, asthma, and chronic obstructive pulmonary disease. During vaccination, client told vaccinator that after having sulfa and erythromycin by mouth, she had difficulty breathing and chest tightness but did not require epinephrine. The medical team was consulted at 12:00PM. Per CDC and medical consult, no intervention is needed at this time. Client was educated on when to call 911 and was advised to follow up with her primary care provider in 24 hours. At 12:10 PM, client stood up and states she feels ?heavier,? and pain is continuing to decrease. Client states that pain is currently at 4 out of 10. Client declined transport to hospital via ambulance. At 12:25 PM, client reports pain is now at a 2 out of 10 and her shoulder is now ?like a deep ache but is not radiating anymore.? Client denies dizziness and has stable gait. Client leaves in stable condition.


VAERS ID: 1768731 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tdap-fever, fatigue
Other Medications: Montelukast Claritin Flonase
Current Illness: N:a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fatigue


VAERS ID: 1768749 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Disturbance in attention, Dizziness, Dyspnoea, Hyperhidrosis, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Feels anxious, sweating, shortness of breath, dizziness, unable to concentrate, and nausea.


VAERS ID: 1768767 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Dizziness, Electrocardiogram, Electrocardiogram ambulatory, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sotalol, eliquis, fish oil, multivitamin, decongestant ,
Current Illness: Common Cold
Preexisting Conditions: A fib Hoshimotos Alopecia totalis
Allergies: None
Diagnostic Lab Data: EKG HOLTER MONITOR
CDC Split Type:

Write-up: Rapid heart beat, a fib, and dizziness


VAERS ID: 1768779 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

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

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

Write-up: Swelling lips, hives all over body


VAERS ID: 1768790 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Haematochezia, Hot flush, Muscle twitching, Nausea
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Dyskinesia (broad), Dystonia (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

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

Write-up: twitching in left arm and left back under shoulder blade. Face hot and flushed like face had sun burn or fever. Gastrointestinal cramping and gurgling in stomach resulting in diahrea and blood in stool and nausea.


VAERS ID: 1768795 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Feeling hot, Malaise, Mobility decreased, Nasal congestion, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingles. Swollen arm, hot, rash. About 2012
Other Medications: Diltiazem 120 mg; Xarelto 20 mg; Spironolactone. 25 mg; Norco with Acetaminaphin 325; Basaglar KwikPen Insulin; Fluticasone Prop Nasal Spray 50 mcg 1/day;
Current Illness: Prior Bronchitis. Diabetes. ILD, Sarcoidosis, Heart
Preexisting Conditions: Sarcoidoses, ILD, Degenerative arthritis
Allergies: Aspirin, Sulpha, Penicillins & Sporins, Preservatives AZO group,
Diagnostic Lab Data: None. I called my Dr.''s office and they said I was just experiencing side effects.
CDC Split Type:

Write-up: Began with tiredness and intermittent chills in the late afternoon, early evening. Felt very ill, very hot around 9.30 pm, and took my temperature. It was 99.0 degrees (normal for me is 93 to 94 degrees). I began to feel very slightly nauseous off and on during the night. Continued to take temperature during the night and finally, it dropped to 97.5 at 5 am in the morning. I felt very bad at 11.30 pm on the 6th. I still feel very tired and ache-y. Need to stay in bed. I also had a lot of stuffy-ness in my nose.


VAERS ID: 1768809 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Neuralgia, Periarthritis, Screaming, Sleep disorder, Vaccination site pain
SMQs:, Peripheral neuropathy (narrow), Parkinson-like events (broad), Hostility/aggression (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 06/29/2021 - arm heaviness/soreness/inability to move after receiving Pneumovax 23 and Shingrix in the same arm (same as the on
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Codeine
Diagnostic Lab Data: Unknown at this point in time
CDC Split Type:

Write-up: Mrs requested a walk-in Pfizer-Biontech COVID-19 booster dose on 10/06/2021. She filled out the COVID-19 Immunization consent form and after the administering Pharmacist (myself) reviewed her paperwork, Mrs. was called back into the immunization room. Mrs. and I discussed her career as a nurse and I understood she was aware of side effects for the booster Pfizer Biontech COVID-19 immunization. I asked which arm she preferred the vaccine to be administered in, and she stated she preferred her right arm in case her arm is sore afterward. She mentioned she previously received two injections in her right arm (June 2021: Pneumovax and Shingrix at the same time) and she experienced heaviness/pain/inability to lift her arm, and in case she has pain/soreness again she wanted it in the right arm. I confirmed she was here to receive the Pfizer Biontech COVID immunization, swabbed her arm with alcohol, and administered the vaccine into the right deltoid using the triangle technique. Immediately, the patient yelped and expressed the vaccination was painful. No bleeding occurred at the injection site. She shook/moved her arm around as I was discarding the needle in the sharps container. I massaged the area with a cotton swab and placed a bandage. I asked if she was okay and she mentioned she had nerve pain like this before due to a car accident which resulted in nerve pain in her neck. She denied wanting to wait in the immunization monitoring area, reminded me she was a nurse, and stated she would be in the near area if anything were to happen. She mentioned again she felt pain in her arm, so before she left the immunization room, I raised her sleeve and examined the vaccination site. I confirmed I administered the vaccine in the appropriate area on her deltoid, and she agreed, and again mentioned has a history of nerve issues/nerves being in the wrong area, and she was okay, and she left the pharmacy to shop. On 10/07/2021 I received a phone call from Mrs. regarding pain in her arm. She stated she could not sleep the night prior and is unable to lift her arm. She feels like the injection hit a nerve and she has "frozen shoulder", but "doesn''t believe the needle went into the bursa". She wants to see her PCP regarding her arm and wanted to know if she would be reimbursed. She again stated she has prior neck/nerve issues due to a car accident and previous vaccines administered. She stated she took Naproxen and it did not provide any relief. When asked if she tried applied hot/cold compress she stated she was currently in a hot tub. She stated she was going to try to take a muscle relaxer that she had gotten from an ER doctor after her car accident. After reviewing my employer''s policy/procedures with management, I followed up with the patient and recommended she follows up with her PCP, as it is outside my scope of practice to diagnose and she has tried to alleviate the pain with my suggestions without success. She agreed and understood and is following up with her PCP. I expressed my apologies, and wished her well-being.


VAERS ID: 1768811 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Vitamins
Current Illness: None.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: With both the second and third Pfizer shot I developed chest pains 8 to 10 hours after the shot. The first shot I had not adverse reaction. I also had a fever of 102 degrees. The chest pains were scary but did not last long.


VAERS ID: 1768815 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-05
Onset:2021-10-06
   Days after vaccination:274
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 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? 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: breakthrough case


VAERS ID: 1768837 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2010-10-06
Onset:2021-10-06
   Days after vaccination:4018
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 4 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308476 / 1 RA / IM

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

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

Write-up: Pt arrived to get her influenza vaccine and was given a 4 COVID vaccine. Patient reports feeling okay on the following day 10/7/21


VAERS ID: 1768868 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358H / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Body temperature increased, Chest X-ray normal, Cough, Dyspnoea, Electrocardiogram normal, Headache, Pain in extremity, SARS-CoV-2 test negative, Urine analysis normal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: milder reaction that passed within 24 hours of vaccination. Patient was 67 years old. Vaccation date March 26, 2021. Covid-19 se
Other Medications: Gabapentin Meloxicam Loratadine Melatonin D-3 Mature multivitamin
Current Illness: none
Preexisting Conditions: arthritis
Allergies: bee pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 10.06.21 at 00:30 hours woke with headache, temperature of 101.4F, dry cough, legs aching, shortness of breath, O2 level 89 - 90,. Went to local clinic for Covid-19 test at 08:00 hours. PCP called around 13:00 hours who recommended go to hospital. After waiting 90 minutes only to find out that there were 40 patients ahead of us, went to urgent care. Put on O2, EKG taken. Was there about one hour.Sent to Medical Center by ambulance. Blood and urine samples taken. X-ray of lungs taken. Nothing was noted to be of concern. At hospital about 3 hours. Left at 19:00 hours.


VAERS ID: 1768871 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Anticoagulant therapy, Limb discomfort, Peripheral swelling, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lantus, Trulicity, metformin, bystolic, clonidine, lovastatin, pioglitazone, glimeperide, losartan, jardiance, unithroid, vitamin B12 and D3
Current Illness: None
Preexisting Conditions: Diabetes, hypothyroidism, HBP
Allergies: Penicillin, sulfa, niacin, prenavil, dilziatem
Diagnostic Lab Data: Ultrasound in ER 10/6/21. Two blood clots determined. 30 day Eliquis prescribed.
CDC Split Type:

Write-up: Received #3 injection on 10/5/21. Woke up the next morning and right leg was noticably swollen and uncomfortable. Went to ER and after ultrasound it was determined I had two blood clots between my upper thigh and ankle.


VAERS ID: 1768876 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Lymphadenopathy, Myalgia, Neck pain, Paraesthesia, Tinnitus, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Arthritis (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: None.
Current Illness: Migraine 24 hrs prior. No other illnesses.
Preexisting Conditions: Palpitations.
Allergies: None.
Diagnostic Lab Data: Awaiting appt.
CDC Split Type:

Write-up: Tingling right arm and fingers right arm. Pain/ache right wrist. Swollen, painful lymph node right armpit. Sore muscles right side chest, neck, shoulder. Tinnitus right ear intermittently louder. Shaky full body. Awaiting doctor''s appointment. First available appt 12 Oct. If pain/discomfort persist, will make appt at Urgent Care.


VAERS ID: 1768916 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Angina pectoris, Chest discomfort, Insomnia, Malaise, Palpitations, Restlessness
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Hypoglycaemia (broad)

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

Write-up: Rescue Ambulance Report: ON SCENE TO FACILITY FOR A 35 YEAR OLD M IN MILD DISTRESS, AOX3 GCS 15 W CC CHEST PRESSURE THAT BEGAN AT 4AM. PROVIDER IMPRESSION CHEST PAIN CARDIAC. PT STATES HE TOOK HIS FIRST DOSE OF JNJ VACCINATION YESTERDAY NOON. TODAY IN THE AM PT HAD DIFFICULTY SLEEPING AND WAS RESTLESS THROUGH THE NIGHT. PT WAS ABLE TO FALL ASLEEP AT 2AM AND AWOKE AT 4AM WITH CHEST PRESSURE, PALPITATIONS, AND FELT UNWELL. ON ARRIVAL OF RA PT HAS 5/10 CHEST PRESSURE WITH NO LASTING RELIEF FROM 3 SPRAYS OF NITRO. 162MG ASPIRIN ADMINISTERED, SINUS TACH ON 12 LEAD. NO LOC, NO SOB, NO NAUSEA OR VOMITING, NO NEURO DEFICITS, NO ABDOMINAL PAIN, NO OBVIOUS TRAUMA, NO OTHER COMPLAINTS. ALL MEDS AND TREATMENTS DONE BY ON SCENE PARAMEDIC . NO ADDITIONAL TREATMENTS WHILE ENROUTE TO HOSPITAL IN RA3. PT STATES THESE SYMPTOMS ARE IDENTICAL TO HOW HE FELT 6 YEARS AGO WHEN HE WAS DIAGNOSED AND TREATED FOR MYO PERICARDITIS. PT WAS ASSISTED ON TO GURNEY, SECURED IN AMBULANCE, TRANSPORTED TO HOSPITAL 139 PER PT REQUEST. IN STABLE CONDITION, MOVED TO HOSPITAL BED WITHOUT INCIDENT, TRANSFERRED CARE TO RN.


VAERS ID: 1768917 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Insomnia, Lymphadenopathy, Pain in extremity, Tenderness
SMQs:, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Had significant nausea, temp, shills and fever, myalgia following shot 2
Other Medications: spinolactone, mucolukast, vit d supplements and melatonin
Current Illness: have neuro tremors , thalsemia, and recently i have had blood work concerning md about my kidney function so i have to see a specialist. i also have newly diagnosed L5/S1 issues, also waiting to see a specialist
Preexisting Conditions: see above
Allergies: carrots and birch pollen, severe environmental seasonal allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: have this weird symptom that started 10/6. my left arm pit stared to get sore, then swollen, and is now so tender i couldnt sleep and can barely let my arm rest at my side. it is the arm that got the injection. maybe lymph nodes? the outside of my arm is tender as expected but the arm pit and my left breast is where it has settled


VAERS ID: 1768931 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Peripheral coldness, Peripheral swelling, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus
Other Medications: Multivitamin, calcium, vitamin e, metoprolol, lossartin, hydrochlorothiazide, duloxetine, turmeric, vitamin c
Current Illness: None
Preexisting Conditions: High blood pressure, diabetes
Allergies: Cfedinir, tetanus, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of hands and face. Cold feet


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