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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 277 out of 8,010

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VAERS ID: 1670594 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: The patient received her first dose of the COVID-19 vaccine (Comirnaty). Standard dose was administered with at first no adverse reaction. While patient was still in a seated position, she developed a vasovagal response. She was alert after a few seconds, but did experience a syncope episode. After proper patient management, she was alert and conscious.


VAERS ID: 1670601 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-08-27
Onset:2021-09-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Fatigue, Laboratory test, Lethargy, Mass, Mobility decreased, Mononucleosis heterophile test, Neck pain, Oropharyngeal pain, Pain, SARS-CoV-2 test, Streptococcus test, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sprintec
Current Illness: None
Preexisting Conditions: Fibromyalgia
Allergies: Allergic to tomatoes, onions, pepper, shellfish, hazelnut, oranges.
Diagnostic Lab Data: Mono, covid, strep tests done on 9/1/2021. Had labs done and had to get a steroid shot all on 9/1/2021.
CDC Split Type:

Write-up: Sore throat, lethargic/fatigue, lump above my collarbone under the skin, swollen neck, could barely move neck, had pain shooting down and around my upper back and neck.


VAERS ID: 1670605 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-01
Onset:2021-09-03
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
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: CHEMO
Current Illness: RECURRENT LUNG CANCER
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: UNKNOWN VACCINE INFORMATION INCLUDING DATES AND LOT NUMBERS. PATIENT HOSPITALIZED WITH DIAGNOSIS OF BREAKTHROUGH COVID


VAERS ID: 1670612 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-25
Onset:2021-09-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anosmia, COVID-19, Gastric disorder, Headache, Interchange of vaccine products, Nausea, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: headache, nausea, loss of smell, gastric upset...patient tested positive for covid-19 on 09/03/21...this patient recieved Janssen told us it was her first dose, she had recieved a dose of moderna on 3/05/21


VAERS ID: 1670616 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Discomfort, Dizziness, Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth, Paraesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

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

Write-up: About 5 minutes after injection patient injection site started burning, itching and became painful. About 5cm area around the injection site was red, warm and tender to touch. She started to feel dizzy so I had her lay flat on examination table. I placed pulse ox on her it it showed o2 of 98 and pulse of 82. I applied ice pak to injection site to help with discomfort. At about 15 minutes after injection she started to have tingling around her mouth. She denied any SOB or throat irritation. SHe was taking with out any problems. I gave her 25mg IM benadryl. I recommend ambulance being called but she declined as she was starting to feel better. Her husband was with her. She left the clinic about 1010 walking on her own feeling better. Her husband was to drive her home. ER precautions discussed. Patient agreed to proceed as planned. Advised her not to get dose 2.


VAERS ID: 1670635 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Costochondritis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: right side chest pain, costacondritis


VAERS ID: 1670642 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autism spectrum disorder, 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? 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: Pain at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: Patient is autistic. Did not respond well to process of administering the vaccine (jumped away and tried to push me away with his other arm despite efforts to calm him). Vaccine was administered, but will likely be more sore due to how he responded to administration. Patient seemed fine and actually not even in pain at time of leaving 30 minutes after the vaccine was given.


VAERS ID: 1670647 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: Patient stated " I feel like my heart is accelerated, like I just run a lot."


VAERS ID: 1670668 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1670687 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Headache, Lip swelling, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Normal multivitamin, Coq10
Current Illness: None. Allergies to tree and grass pollen but both were listed as low pollen count at the time of allergic reaction to Moderna Covid vaccine shot #2.
Preexisting Conditions: None other than seasonal allergies to ragweed, grass & tree pollen. Use generic Claritin to handle the issue.
Allergies: Miscellaneous food allergies-raw carrots, celery, macadamia nuts, apples, pears, almonds, peanuts
Diagnostic Lab Data: None sought at this time. Presuming swelling of lip will subside.
CDC Split Type:

Write-up: Severely swollen upper lip (estimate twice+ normal size due to swelling) which first started September 3 at 1 am. Body aches, stomach aches, head ache, shivering experienced September 2nd but had subsided by early morning Septermber 3rd. Swollen lip still present as of the date and time of this filing.


VAERS ID: 1670691 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A2A / N/A LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall, Fatigue, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall Gabapentin Nortriptyline No other medications reported to us
Current Illness: No other illnesses reported
Preexisting Conditions: No chronic/long-standing health conditions reported
Allergies: No medication allergies reported
Diagnostic Lab Data: nothing reported
CDC Split Type:

Write-up: Patient was vaccinated at workplace on Thursday, September 2nd at 1pm. Infection nurse contacted facility today, September 3rd at approximately 2pm. Notifying office manager about the event that had occurred. This morning the patient was standing in the laundry room, ?felt faint and tried grabbing onto the folding table for support.? She doesn?t remember falling, but her coworker heard a bang and ran in to find her lying on the floor. The patient seemed fine after a few minutes but we called her family to come pick her up and encouraged her to go to urgent care. Family and patient refused any medical treatment, per the facility. The patient informed the infectious control nurse that her medical history includes dizziness., The patient was fine after the vaccine was administered on September 2nd, and reports that her legs started aching later that night and she felt really tired. This morning she felt achy and tired, but not enough that she had to stay home.


VAERS ID: 1670701 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1670706 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-30
Onset:2021-09-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Herpes zoster, Lymphadenopathy
SMQs:, Fertility disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Pt. states that after receiving the 2nd dose Pfizer 08/20/2021, started experiencing symptoms 09/03/2021 of Shingles diagnosed, auxiliary swelling, and missed periods (x2). Primary visit 09/03/2021, recommendation for anti-viral. Still continuing to experience symptoms.


VAERS ID: 1670719 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-26
Onset:2021-09-03
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, 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: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild


VAERS ID: 1670730 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Feeling jittery, Restlessness
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (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: Protonix - 25 mg Singular Atenolol - 10mg Leprexo 10mg Vit D, Iron,
Current Illness: no
Preexisting Conditions: Afib High Blood Pressure Asthma WPW
Allergies: Novocain - racing heart
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started about an hour after the send shot Feel like I drank 3 pots of coffee, jittery and feel like I cant sit still Heart rate in the mid 80''s sitting still


VAERS ID: 1670747 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Do not know.
Current Illness: Not known
Preexisting Conditions: Not known.
Allergies: None reported to me.
Diagnostic Lab Data: Not known.
CDC Split Type:

Write-up: Patient passed out twice after administration of vaccine. She came back to within a few seconds of each episode. Called EMS to come check her out. She left afterwards on her own and did not go to the hospital with EMS.


VAERS ID: 1670749 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Endotracheal intubation, Throat irritation, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: History of anaphylaxis to carabapenems, cephalexin, ciprofloxacin, gabapentin, hemp seed oil, kiwi, lidocaine, sulfa, vancomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting and itchy throat progressing to an anaphylatic reaction that required 6 epi pens and 2 hours of albuterol eventually requiring intubation


VAERS ID: 1670751 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt dizzy, hand tingling and numbness in her hands, arms, and feet and legs up to her knees. She also felt it in her face. Patient laid down on the ground and we gave her a sip of water. Her symptoms continued to worsen and we called 911. After paramedics got here, she started to feel better and was able to sit up in a chair. The paramedics checked her vital signs and they were all normal. Patient elected to not go on ambulance. She sat in the chair for another 15 minutes to 25 minutes and then left under her own power.


VAERS ID: 1670760 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tofacitinib Citrate ER (XELJANZ XR) 11 MG TB24; Prednisone (DELTASONE) 5 MG tablet; Celecoxib (CELEBREX) 100 MG capsule; Levothyroxine (SYNTHROID) 88 MCG tablet
Current Illness: N/A
Preexisting Conditions: Psoriatic arthritis (HCC); Hypothyroid; Hypothyroidism due to Hashimoto''s thyroiditis; Class 1 obesity due to excess calories without serious comorbidity with body mass index (BMI) of 34.0 to 34.9 in adult.
Allergies: Tigan [KDC: red Dye+ trimethobenzamide+ brilliant Blue FCF]
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was given a Pfizer booster vaccine and previously received Moderna series.


VAERS ID: 1670767 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pruritus, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Doxycycline
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 1.5 hours patient became itchy and then had throat itchiness.


VAERS ID: 1670771 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / UNK - / -

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

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

Write-up: Patient mentioned that she felt "itchy." Patient also mentioned that she had a history of "itchiness" with vaccines.


VAERS ID: 1670772 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN.
Current Illness: UNKNOWN.
Preexisting Conditions: NO.
Allergies: NKDA.
Diagnostic Lab Data: NOT APPLICABLE.
CDC Split Type:

Write-up: PATIENT PASSED OUT FOR FEW SECONDS FOLLOWING THE ADMINISTRATION OF VACCINE. PATIENT''S BP AND HEART RATE WERE NORMAL. PATIENT HAS HAD HEADACHE FOR FEW HOURS FOLLOWING THE INCIDENT.


VAERS ID: 1670780 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

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

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

Write-up: Patient after about 6 minutes felt very light headed/dizzy and felt like fainting. She was sitting the entire time. Gave her water and crackers which steadily made her feel better. She sat there for 30 minutes drinking water and eating, then she felt fine. Dizziness and all other symptoms were gone.


VAERS ID: 1670788 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Presyncope, Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Glaucoma (broad), Lens disorders (broad), Retinal 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: Received her first Pfizer COVID vaccine today around 11:25am. She was very reserved and quiet and seemed nervous but pleasant during the vaccine. Immediately after administering the vaccine, I asked her how she was doing, and she claimed to be fine. She left the consultation room. I went to administer a vaccine to the next patient in line. While I was doing the next vaccine, apparently the patient was attempting to walk to a chair and started to tip over (around 11:27am), on the verge of passing out. Her mother and sisters were there to catch her. She claimed her vision was blurry. When I came out of the consultation room, my other RPh, was on the phone with 911 per the mother''s request. I went out to check on the patient. She claimed to be dizzy and have blurry vision. She was sipping on water and taking deep breaths. I asked if she was having any trouble breathing, and she denied that. Her face was very pale, and her lips were purplish/bluish. My technician brought out a cool cloth for her mother to put on the back of her neck. I asked her a few more times over the next 5-10 minutes if she was having any trouble breathing, and she denied it every time. When the EMTs arrived, they checked the patient''s blood pressure sitting and standing and determined that her reaction/low blood pressure was most likely temporary, related to the vaccine and/or her anxiety about the vaccine. Havilah was not transported to the hospital, and her mother opted to take her home as she was feeling much better about 20 minutes after the initial reaction started.


VAERS ID: 1670790 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-09-03
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 RA / IM

Administered by: Unknown       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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is Covid Positive now and receiving monoclonal antibody as outpatient infusion


VAERS ID: 1670792 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Nausea, Nervousness, Tinnitus
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (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? No
Hospitalized? No
Previous Vaccinations: Per patient, it is a common occurrence for her to pass out when getting vaccinations, IM injections, blood drawn, and even at de
Other Medications: Not known.
Current Illness: Not known.
Preexisting Conditions: Not known.
Allergies: NKDA
Diagnostic Lab Data: Not known.
CDC Split Type:

Write-up: Became extremely hot, sweaty, shaky, nauseous, and had ringing in her ears. She did not lose conscious at all but EMS was called since she has active history of passing out. They came and checked her vitals when she asked them to, she left on her own and declined to be taken to the hospital by EMS.


VAERS ID: 1670799 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

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

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

Write-up: The patient received her first dose of the Moderna Covid-19 vaccine. She was asked to wait for 15 minutes seated in her chair. A few minutes after the vaccine, the patient passed out in the chair and fell to the floor. She woke up as soon as the pharmacist spoke to her. She stayed on the floor until she was no longer dizzy. Then she sat back up in the chair and was given water and orange juice. She stated that she had hit her head. We offered to call an ambulance, but she refused. She refused ice. We offered to call someone to pick her up, but she refused. Once she was feeling better, she stayed another 15 minutes before leaving.


VAERS ID: 1670803 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-21
Onset:2021-09-03
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: PATIENT HAD COVID-19 VACCINE ON Dose 1 date: 12/21/2020, Dose 2 date: 01/11/2021 AND TESTED POSITIVE TO COVID ON 9/3/21


VAERS ID: 1670805 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Erythema
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient has a "compromised immune system". she was unable to verify which one.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The Patient presented to our pharmacy after making an appointment for a booster dose of her Moderna vaccine. The patient stated they had a compromised immune system and their last dose was administered on 2/8/21. Consistent with the law we administered a booster for the patient. Within several minutes the patient''s face became red and they stated they had difficulty breathing. it was at this moment I as the pharmacist made used my clinical judgement to administer an Epipen dose to the patient. I asked my staff call emergency services. within moments their face came back to normal coloring and they were able to breath better. they did state their heartbeat was racing consistent with administration of the Epipen. I remained with the patient and counseled to focus on breathing. emergency services arrived several minutes later and took the patient in the ambulance with them. they then went to the hospital.


VAERS ID: 1670813 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a Moderna vaccine for his 2nd shot instead of a Pfizer. Patient had no type of adverse reaction and required no treatment of any kind.


VAERS ID: 1670818 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 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? 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: COVID Vaccine - Pfizer was given by mistake


VAERS ID: 1670833 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

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

Write-up: pt fainted after injection


VAERS ID: 1670837 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Cough, Lip swelling, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Pt stated she was a kidney donor. Pt has one kidney.
Allergies: Shellfish and Iodine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt received Moderna vaccine. Pt complained of chest tightness, throat itching , coughing and lip swelling. Pt was given Benadryl 50 mg and Ativan 0.5 mg. Symptoms improved. Pt was monitored for over 1 hour. pt was discharged home with family member.


VAERS ID: 1670843 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hyperhidrosis, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Profuse sweating, difficulty breathing, dizziness, tingling palms


VAERS ID: 1670845 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-16
Onset:2021-09-03
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWZ0181 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: allergic rhinitis, factor v deficiency
Allergies: strawberry- anaphylaxis
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pfizer COVID vaccine given 6/25/21 and 7/16/21. Patient presented with vertigo 9/3/21. No previous history of vertigo. Unknown if related. Meclizine, Zofran prescribed, patient will start modified epley maneuver.


VAERS ID: 1670861 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: The Patient stated they had an allergic reaction to the flu vaccine in 2014/2015
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the pharmacy to receive her COVID-19 Johnson and Johnson vaccine. After vaccination we asked the patient to remain in the pharmacy to monitor. Shortly after the patient experienced syncope and fell of the chair which they were sitting on for us to monitor them. I asked a fellow staff member to call 911. I and another staff member placed the patient back on the seat from which she fell to better assess the patient. she returned to consciousness. She still had her mask on and said for a second she was having difficulty breathing. I went to grab an Epipen to administer. when I came back the patient was coherent enough to ask that I do not administer the Epipen. I asked if she had difficulty breathing to which she responded "may I just take my mask off". I responded "of course do you need assistance?". she stated "no I got it". the patient then took off their mask and repeated, "Do not give me the Epipen I can breathe fine I just need a second". Upon further evaluation the patient did not exhibit swelling of the face, nor any redness. they also stated that they were able to breathe adequately so we refrained from administering the Epipen. I counseled the patient to focus on breathing techniques and closely monitored the patient. We remained with the patient until Emergency services arrived. The patient was then taken to the hospital.


VAERS ID: 1670884 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Immediate post-injection reaction, Loss of consciousness, Somnolence, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (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), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client passed out and began vomiting immediately after receiving vaccine. She was groggy and unresponsive for about 8 minutes, though she was breathing. 911 was called. Client revived and was talking and alert, refused transport to hospital by ambulance.


VAERS ID: 1670887 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Erythema, Eye swelling, Hypersensitivity, Oropharyngeal discomfort
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81 MG EC tablet 81 mg by mouth 2 (Two) Times Daily. atenoloL (TENORMIN) 25 MG tablet TAKE 1 TABLET BY MOUTH 2 (TWO) TIMES DAILY... B2/VIT A,C & E/LUT/ZEAXANTH/MN (ICAPS ORAL) 1 tablet by mouth 2 (Two) Times Daily . blood sugar di
Current Illness:
Preexisting Conditions: HTN, Dm
Allergies: Iodinated Contrast MediaShortness Of Breath Ace Inhibitors Nexium [Esomeprazole] PerfumeOther (See Comments)
Diagnostic Lab Data: Patient presents with allergic reaction COVID-19 vaccination. On exam no signs of anaphylaxis. Given IV Decadron Pepcid Benadryl fluids. EKG no ischemic changes. After period of observation patient had complete resolution of symptoms. Patient instructed she is allergic to COVID-19 vaccination not to receive it again. Plan discharge home with Benadryl Pepcid follow-up with PCP. Return and follow-up instructions provided. Diagnostic and treatment options were discussed with the patient. All questions were answered to their apparent satisfaction
CDC Split Type:

Write-up: This is a pleasant 70 y.o. female who presented with allergic reaction to COVID-19 shot. This was her first shot. She got the shot and within 10 to 15 minutes noticed that her face was red a little bit of swelling in her eyes her throat felt "funny" and she had some chest tightness. No difficulty swallowing no sensation of throat closing no wheezing or shortness of breath no abdominal pain nausea vomiting diarrhea or skin rashes. First responder was called and patient was taken to the ER.


VAERS ID: 1670892 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose decreased, Heart rate increased, Hyperhidrosis, Immediate post-injection reaction, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Hypoglycaemia (narrow), Dehydration (broad)

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

Write-up: Immediately after immunization of the vaccine, the patient started shaking and sweating, and laid on the floor. The pharmacist then picked up the patient and ask the technician to call 911. The patient continued to have shakes and sweats, and the patient vomited for 15 sec. Staff was instructed to not give the patient water or food, and to not have patient lay down. EMT arrived within 5-10 minutes and reported that the patient''s heart rate was high and blood glucose was low. EMT offered to take her to the hospital, but she signed waiver to not go to the hospital and she left with a friend.


VAERS ID: 1670896 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: Checked patient''s blood pressure and was normal 20 minutes after event
CDC Split Type:

Write-up: Patient lost consciousness about 2 minutes after administration of vaccine. Patient gained consciousness and was alert and feeling better after sitting down for 30 minutes.


VAERS ID: 1670897 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Headache, Injection site erythema, Injection site pruritus, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: she said her arm is red and itchy at the site, she had a fever, a headache, and diarrhea


VAERS ID: 1670911 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine 10 mg PO QD HCTZ-Lisinopril (12.5mg - 20mg) 1 PO BID Parazosin 4mg PO Q HS Simvastatin 40mg PO QHS
Current Illness: none
Preexisting Conditions: HTN Obeasity
Allergies: NKDA
Diagnostic Lab Data: a.fib while in hospital
CDC Split Type:

Write-up: got covid pneumonia 5 mnths later


VAERS ID: 1670912 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoaesthesia, Loss of consciousness, Muscle spasms, Nausea, Vaginal haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (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), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: N/A
Preexisting Conditions: Hidradenitis Suppurativa
Allergies: Sulfa antibiotics Food allergies: Eggs, Dairy, nightshades, citric acid, peanuts, tree nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loss of consciousness, muscle cramps, nausea, numbing of arms and legs, sweating, vaginal bleeding


VAERS ID: 1670914 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

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

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

Write-up: Patient alerted pharmacist that he had a history of fainting after getting blood drawn. Patient explained that it''s anxiety and combination of watching needle and blood. Pharmacist gave patient the shot without patient looking at the needle. Patient was seated and doing well for 5 minutes. Approximately 5 minutes after vaccination, he started to have loss of consciousness and had what looked like a seizure for about 15 seconds. Patient slowly recovered consciousness and was able to say his name and


VAERS ID: 1670917 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: after administration, patient left clinical services area under own power. Within a couple minutes, patient had syncope episode and fainted, partially caught by parents. patient was breathing and responsive. Offered ice pack and water and patient continued to rest. patient sat with assistance then returned to clinical services area to sit and rest approximately 3 minutes after fainting. patient left with parents at own discretion approximately 20 minutes later.


VAERS ID: 1670923 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Erythema
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Influenza vaccine
Other Medications: Atenolol 25 mg
Current Illness:
Preexisting Conditions: Hypertension, Mitral Valve Prolapse, Aortic Stenosis
Allergies: Eggs, Influenza Vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 47 year old female patient refers to the EMT feeling dizzy and began to present redness in the neck and chest 10 minutes after receiving her second dose of PFIZER. The EMT proceeded to take the patient to the observation area to take her vitals signs: BP 130/80, P, 99 saturation, respiration 19 and 74 DXT. Then, we performed IV access with normal saline 9% in the forearm and BENADRYL 50mg IV.


VAERS ID: 1670931 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pt stated she had gone to the cardiologist yesterday to follow-up on having a fast heartrate and palpitations and that they are going to put her on a monitor.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received vaccine at 11:39 am in RUA. After sitting in observation for about 10 minutes, pt c/o feeling dizzy and lightheaded. Pt put in w/c and taken to privacy area and placed in reclining chair. Skin cool and hand clammy. No pallor to skin. VS: B/P 130/88, P-96, R-18, T-36 C, O2 sat 99%. Pt also c/o a "fluttering" in the chest underneath the sternum area but denied having chest pain. Pt stated she also has had a fast heart rate and "palpitations" recently that has been waking her up at night. She saw a cardiologist yesterday for this issue and will be getting a monitor to wear for two weeks. Pt states the fluttering seems to come and go and has not had any of it before today. She also says she was a little worried about getting the vaccine. EMS was called at 1220 pm and arrived at 1227 pm. EMS personnel assessed pt and recommended her to go to ER. Pt complied and was taken by EMT''s to hospital.


VAERS ID: 1670933 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Paraesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: patient had dizziness and headache, lips were tingling


VAERS ID: 1670935 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Deafness, Dizziness, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies: nkda
Diagnostic Lab Data: EMT put her on a monitor and her BP, HR, and oxygen level were WNL. The let her leave under her own accord with her parent.
CDC Split Type:

Write-up: Patient became lightheaded and was not able to hear or see and was unable to respond appropriately to questions. Patient was laid on her back and began to recover. 911 was called and they responded. Her BP, HR and Oxygen levels were WNL when the EMT squad came.


VAERS ID: 1670939 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Road traffic accident
SMQs:, Accidents and injuries (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: Security notified us that a person had crashed their car into a building as she was leaving the campus. It was discovered she was a person who had received a vaccine here at the clinic. Emergency number was called by someone and paramedics showed up to the scene and patient was taken to the hospital.


VAERS ID: 1670945 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Pyrexia, Thirst, Tremor
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), 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? 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: Allergy to Sulfa
Diagnostic Lab Data: I might visit my doctor for long term suggestion, but everything seems fine to me by now
CDC Split Type:

Write-up: It started around 5am (almost 12 hrs after the injection), I got up for restroom, and I found out that I can''t control my jaw from shaking, when I came back to the bed from restroom, I can''t control my whole body from shaking (leg, and jaw mostly) and I can even easily hold a cup. I thought I mught get too dehydrated - cause I feel thirsty in the meantime - which might destroy the balance of ion of Na+ in my body. I drank nearly 1L of water and try to relax myself Fortunately the symptom went away after 1 hr, and I started a low fever(which is totally fine to me)


VAERS ID: 1670956 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: Menstrual bleeding


VAERS ID: 1670960 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Topamax, Wellbutrin, Zinc, Vitamin D, OCP,
Current Illness: None
Preexisting Conditions: None
Allergies: Keflex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting, diarrhea within 1 hour of vaccine.


VAERS ID: 1670978 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088021A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Headache, Injection site nodule, Injection site reaction, Pain in extremity, Pyrexia, Tension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C Vitamin D3 Zinc B12 Quercetin
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red, raised knot at injection site. Knot is feverish. Headache. Tension in shoulders. Pain/aches in bottoms of feet.


VAERS ID: 1670983 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-30
Onset:2021-09-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein, Electrocardiogram, Full blood count, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 100mg, Levothyroxine 50mcg
Current Illness:
Preexisting Conditions: Just anxiety
Allergies:
Diagnostic Lab Data: EKG shows ST elevation. Pending CBC and CRP. No friction rub heard. Otherwise classic presentation
CDC Split Type:

Write-up: New onset mild acute pericarditis


VAERS ID: 1671124 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / SYR

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

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

Write-up: PT WAS ASKED AND GIVE "1ST DOSE PFIZER SHOT" NAD IT WAS ASKED AND MARKED ON CONSENT FORM--UPON CHECKING ON THE WEBSITE AND BILLING INS-PT HAD RECEIVED A JOHNSON AND JOHNONS DOSE ALREADY!


VAERS ID: 1671125 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

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

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

Write-up: none


VAERS ID: 1671126 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 5 YEARS AGO FLU SHOT , DO NOT KNOW BRAND
Other Medications: NO
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: NO
CDC Split Type:

Write-up: RINGING EARS AND DIZZY FOR ABOUT 5 MINUTES .


VAERS ID: 1671128 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Needle malfunction resulted in most of the vaccine to be wasted; patient agreed to receive a full dose.


VAERS ID: 1671133 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 AR / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

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

Write-up: Complained of throat itchiness approximately 17 minutes after vaccination was administered. Seconds later, started having sensation of throat tightness and began coughing. Onsite clinician administered 0.3 mg epi pen to left outer thigh at 10:16 am. Patient refused 911 and Ambulance. She left vaccination site at 10:19 am and was transported to nearest Emergency Room by her friend who is an EMT. Patient left before vitals could be collected. She was discharged shortly after arrival to emergency department and was able to return to work on the same day.


VAERS ID: 1671134 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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: Moderna- 10 days later arm was red
Other Medications: unknow
Current Illness:
Preexisting Conditions: asthma
Allergies: papaya
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated her throat felt tight. Requested call to 911 and Epi pen was given. 911 arrived all vitals were normal. patient requested to go to the ER


VAERS ID: 1671136 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-06
Onset:2021-09-03
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

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

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

Write-up: none


VAERS ID: 1671139 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid dose 1 lymph node under arm swollen tender 1 week
Other Medications: Lisinopril, multivitamin
Current Illness: None
Preexisting Conditions: High blood pressure, obesity
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lymph node under left arm swollen slightly/tender


VAERS ID: 1671140 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-27
Onset:2021-09-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Fatigue, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Pt will have blood work done today. PTT CBC D-dimer Fibrinogen Prothrombin Time Panel
CDC Split Type:

Write-up: Brusing, fatigue and petechiae


VAERS ID: 1671145 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-31
Onset:2021-09-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site pruritus
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: herbphram liver tonic
Current Illness: none
Preexisting Conditions: back pain
Allergies: penicillin, erythromycin, sulfa, kflex
Diagnostic Lab Data: no tests/labs - visual inspection
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: When first noticed the morning of the 3rd day after the vaccine I had a red circle about the size of a silver dollar that was vey itchy. It is now early evening and the itchiness persists while the red circle is about twice in size.


VAERS ID: 1671151 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Impaired healing, Syncope, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: DIRECTLY AFTER RECEIVING VACCING PATIENT GOT DIZZY AND SAT DOWN - FAINTED WHILE IN THE CHAIR WHILE HER MOTHER HAD A HOLD OF HER - SHE CAME TO FAIRLY QUICKLY BUT COMPLAINED ABOUT BLURRY VISION AND TROUBLE HEARING. SHE REMAINED SITTING, DRINKING WATER - WE CALLED 911 WITH MOM''S PERMISSION - PARAMEDICS ARRIVED, CHECKED HER VITALS AND CLEARED HER TO GO WITH HER MOM - MOM SIGNED OFF WITH PARAMEDICS


VAERS ID: 1671157 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 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? 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 not approved to be given under the age of 18, patient is only 17 years old and was given this vaccine


VAERS ID: 1671158 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-23
Onset:2021-09-03
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ8982 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, COVID-19, Headache, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid-19 was detected on 9/3/212. 8/30 developed runny nose and headache. but resolved. 02/21 developed sore throat and lost of taste on 9/2/21


VAERS ID: 1671161 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pallor
SMQs:, Hypotonic-hyporesponsive episode (broad)

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

Write-up: Patient tolerated injection well, ambulated to waiting room, after approximately 5 min, customer came to clinic room 1, patient was laying on floor, assisted by mom, did not hit head, no injuries noted, pale, A/O x 4, patient stood up and tried to leave, layed down flat BP 92/60, patient ambulated to exam room 2, reclined back with feet elevated, drinking water, states had similar experience with last injection at health department, did not disclose, after about 10 min, states fells good, no concerns, refusing additional vitals, caregiver present for transport, no distress noted


VAERS ID: 1671362 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / SYR
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. 2021-22 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent HFA 44mcg Oral Inhaler, Azelastine 0.1%(137 mcg) Nasal Spray, Zyrtec 10mg, Fluticasone 50mcg Nasal Spray, Proair HFA 8.5g Oral Inhaler, Epinephrine 0.3mg Injector, Multi Vitamin and Probiotic
Current Illness: N/A
Preexisting Conditions: Asthma and Allergies, Innocent Heart Murmur
Allergies: Shellfish, Tree Nuts, Peanuts, Coconut, Dogs, Cats, Roaches,
Diagnostic Lab Data:
CDC Split Type:

Write-up: The intent of the vaccination visit was for me to receive the flu shot ONLY. That is what the appointment was for and that was what was on the paperwork that was filled out. The technician brought out 2 syringes; one for my family member and one for me. He went first and after he received his shot, the technician asked me for his COVID-19 Vaccination Record Card. She gave him a THIRD COVID-19 Shot and not the scheduled flu shot. He received his 1st COVID-19 shot on 30 June 2021 and his 2nd, I thought final, shot on 21 July 2021. Both were Pfizer. The paperwork clearly stated Afluria NOT Pfizer''s COVID-19 vaccination. The only mention of COVID-19


VAERS ID: 1671363 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mass, Neck mass
SMQs:

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

Write-up: Patient stated that he felt like a lump appeared near his collar bone/neck. He wasn''t sure if it was a swollen lymph node or something else.


VAERS ID: 1671366 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 10/21 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: oxybutynin er 10mg tab
Current Illness:
Preexisting Conditions: high blood pressure
Allergies: salt
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling in left arm, right arm, neck, and hands. Flush skin. Itching. Swollen lumps left arm.


VAERS ID: 1671375 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

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

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

Write-up: PATIENT PASSED OUT AFTER RECEIVING SHOT, BECAME LUCID AND THE PROCEEDED TO HAVE A SMALL SEIZURE


VAERS ID: 1671378 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known, not patient''s usual pharmacy
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received Moderna vaccine for 1st dose, accidentally given Pfizer for his second dose. Patient has reported no adverse events at this time.


VAERS ID: 1671380 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pulse abnormal, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt stated he felt dizzy after getting imz 10 yrs ago but wasnt sure of type of vaccine
Other Medications: none mentioned
Current Illness: none mentioned on consent form
Preexisting Conditions: none mentioned on consent form
Allergies: none mentioned on consent form
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt faint within minutes of getting immunization and was under constant supervision of pharmacist and tech. Thready pulse and started having mini convulsions. Pharmacy contacted 911 and paged code white. Pt stable after several minutes and started feeling normal. EMT came to monitor vitals and patient declined hospital visit to get checked out. We monitored patient for additional 30 min and then had him call someone to drive him home.


VAERS ID: 1671381 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Mobility decreased, Nausea, Retching, Somnolence, Visual impairment
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient reported a severe headache shortly after receiving vaccine. She also reported foggy vision. She began to get nauseated and was dry heaving. She could not sit up straight and became sleepy.


VAERS ID: 1671389 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: Not known
Preexisting Conditions: Not known
Allergies: azithromycin, shellfish, and penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient became faint a few minutes after his vaccine. I had him lie down on the floor and elevate his feet. When he started doing better he drank some water and ate a snack.


VAERS ID: 1671390 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: The patient received a concentrated dose of Pfizer. The vial was diluted by the tech with only 0.2 ml of NaCl instead of 1.8 ml. The patient was fine and did not suffer any side effects.


VAERS ID: 1671392 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Administration site pruritus
SMQs:

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

Write-up: A 33 Female patient present with itchy in the right arm after the administration of there first dose of Pfizer Lote#FF2588. Patient was in the observation area Paramedic noted that the patient have itchy in the administration site. Patient said to the paramedic that she take a Zyrtec 10mg before the administration. Vitals sing was HR:76, O2 96%, RR 19, BP 130/70, Glucose 101 and Temp: 97.7. We consult with Dr. and she give the order to administrated 6:45pm 4mg/ml dexthametasone on the left arm. At 7:15pm Paramedic do reevaluation BP; 130/70, HR; 71, O2 98% RR 19 and patient verbalize that she don''t have more itchy.


VAERS ID: 1671393 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

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

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

Write-up: He sat for maybe 5 minutes and then passed out. He woke up and didn''t know why he was on the floor. He again went in a daze with his eyes open and they had to rub his chest to get him to respond. Started throwing up, and not feeling g well.


VAERS ID: 1671394 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Rash, Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), 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: Zyrtec, clear lungs, oil of oregano, biotin, vitamin B12
Current Illness: None
Preexisting Conditions: Asthma and environmental allergies
Allergies: Relafen, Day-Pro, Percocet, Cayenne pepper, red and yellow peppers, cocoa and Shea butters, mold and cigarette smoke.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on both arms, neck, face and chest. Some blurriness in eyes, pain at injection site and a headache.


VAERS ID: 1671395 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: fainting, sweating, weakness was happening. treatment: laid down slowly and elevated legs, used cold compress. outcome: pt regained consciousness again after a few seconds and was ok.


VAERS ID: 1671397 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

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

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

Write-up: 09/03/21- Ct came into COVID-19 vaccine clinic to receive a 3rd dose of Moderna vaccine. PHN inadvertently gave client a Pfizer COVID-19 dose, not realizing it till after client had left the clinic/smg PHN attempted to call client later in day, no answer, voice mail message left to call PHN back. As of 18:35pm ct had not called back. PHN will attempt to contact client next week when back in the office.


VAERS ID: 1671582 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Cefuroxime, Hydromorphone, Levofloxacin, Nitrofurantoin, Penicillin G Benzathine
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Approximately 5 minutes post vaccine administration, patient developed shortness of breath and tightness in throat. She self administered her personal inhaler with no positive response. Epi was given in R thigh per vaccine OBS RN and ED was called. Patient was transported to ER by EMS


VAERS ID: 1671586 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: Patient received the first dose of Pfizer vaccine. A few minutes later the patient laid down on the floor telling staff he does not feel well. He complained that he felt like he was going to faint and black out. The patients complexion became yellow/pale. Seeing the patient we decided to call paramedics. Patient never fainted or blacked out, staff put feet up on a chair. Blood pressure was taken twice, each within normal limits. Pulse rate was low ~45bpm. Paramedics were called, after they checked on the patient he felt better and left half hour after paramedics arrived. Patient was with family members and felt comfortable leaving with them.


VAERS ID: 1671587 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

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

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

Write-up: Pt reported feeling nauseous and light-headed about 5 minutes after vaccination. We had her recline and gave her an ice pack which seemed to improve the symptoms. Pt reported feeling better about 10 minutes later.


VAERS ID: 1671591 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

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

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

Write-up: Pt had extreme dizziness. PT was laid down to floor with feet elevated. Ice pack was given. EM was called and pt was transported to nearby ER


VAERS ID: 1671601 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Cold sweat, Dizziness, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: one aspirin tablet the day prior
Current Illness: None
Preexisting Conditions: chronic abdominal pain of unknown origin. Heart murmur
Allergies: None
Diagnostic Lab Data: No test. Ambulatory wellness check
CDC Split Type:

Write-up: Dizziness, loss of balance, cold sweat, elevated heart rate


VAERS ID: 1671763 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM

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

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

Write-up: Patient got Moderna for her first dose and was supposed to get a second dose of Moderna. Patient received Pfizer rather than Moderna.


VAERS ID: 1671764 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient reported no otc , supplements, or remedies that were taken
Current Illness: none reported by by patient
Preexisting Conditions: none reported by patient
Allergies: no allergies to food.
Diagnostic Lab Data: Blood pressure checked 114/59 (5:10pm), 120/61 (5:25pm), 130/64 at 5:30, and 128/72 at 5:40pm.
CDC Split Type:

Write-up: Patient felt light headed and experienced numbness in his left arm. He reported that his left ear "felt clogged". He was sweating and appeared pale. He did not experience nausea. (observed by pharmacist at 5:10pm)


VAERS ID: 1671771 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: She was waiting in lobby after vaccine. After about 10 minutes her husband, who had been standing by her, called for help. She was pale, dizzy, and lightheaded. Husband and pharmacist worked to get her to the floor during which she passed out. 911 was called by pharmacy staff. She quickly came to and reported ringing in the ear and feeling warm. She had a sip of water She slowly got better and EMS arrived and took over. She left with EMS.


VAERS ID: 1671772 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

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

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

Write-up: Gave 0.5 ml of vaccine instead of 0.3ml.


VAERS ID: 1671776 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna
Other Medications: Vitamin C, women''s daily multi vitamin
Current Illness: Cold like symptoms
Preexisting Conditions:
Allergies: Keflex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 102.1, headache, chills


VAERS ID: 1671777 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 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: Obesity, Asthma, Immunocompromised
Preexisting Conditions:
Allergies: Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Gave 0.5 ml instead of 0.3ml


VAERS ID: 1671780 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

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

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

Write-up: Injected 0.5ml instead of 0.3ml


VAERS ID: 1671880 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamoxifen, oxybutynin, Claritin, gabapentin, losartan, venlafaxine, vitamin c, d e, calcium-magnesium-zinc, b-complex, biotin
Current Illness: None
Preexisting Conditions: Recovering from breast cancer, interstitial cystitis
Allergies: Paxil, sulfa, percodan, adhesive for medical dressings, avocados, sensitive to latex
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Rash on arm near the objection site


VAERS ID: 1671884 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Head injury, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: A few moments after the patient received his second dose of Pfizer vaccine, he collapsed onto the ground and hit his head on the right side. His mom immediately called for help. He was responsive shortly after while laying on the floor. I (pharmacist) brought him a bottle of water and he was able to sit up slowly to drink some water. He gradually felt better but appeared to be pale and veins on the sides of his head were apparent, more apparent than usual per his mom. The patient felt dizzy and lightheaded throughout. He rested on the ground for a few minutes and then we moved him to the open waiting room area by the pharmacy to sit down. After talking to the patient, he mentioned that he only had a snack to eat all day. The store called EMS on the mom''s behalf, the fire rescue team and EMS arrived shortly. His blood pressure was low per the EMS''s observation. They took him to the hospital for further analysis.


VAERS ID: 1671885 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Headache, Pain, Pruritus, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Covid arm- 2x3 inch raised red painful bump. Swelling itching sore no rash anywhere else. Other side effects were fever & headache.


VAERS ID: 1671899 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Limb mass, Peripheral swelling, Rash, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), 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? 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: Large red lump. Swollen, hot to touch. Rash. Increasing in size. Nurse called it covid arm. Take antihistamines and ice pack


VAERS ID: 1671905 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PC3183 / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Body temperature increased, Chills, Fatigue, Joint range of motion decreased, Pain, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 09/03/21; extremely sore arm; limited rom due to pain; extreme fatigue and weakness; extreme body aches and joint pain; 99.8F temp; chills. This vaccine was mandated after testing positive for high antibodies on 8/23/21 after previous Covid infection in July 2020. I fear second dose will be even worse.


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