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From the 9/17/2021 release of VAERS data:

Found 711,579 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 281 out of 7,116

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VAERS ID: 1676581 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-04
Onset:2021-08-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF0884 / 1 - / -

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: IEPFIZER INC202101095154

Write-up: Mini Seizure; Black Out; This is a spontaneous report from a contactable consumer downloaded from the regulatory authority-WEB. Regulatory authority number is IE-HPRA-2021-082129, Safety Report Unique Identifier is IE-HPRA-2021-082129. A 17-year-old female patient received BNT162B2 (COMIRNATY, Lot Number: FF0884, Expiry date not reported), via an unspecified route of administration on 04Aug2021 (at the age of 17 years), as dose 1, single for COVID-19 immunisation. Medical history and concomitant medications were not reported. The patient experienced mini seizure on 04Aug2021 with outcome of recovered on unspecified date, and black out on 04Aug2021 with outcome of recovered on unspecified date. Therapeutic measures were taken as a result of the events that included water, sugar and rest. The events were reported as serious, medically significant by the health authority. Case narrative: Initial report received by the HPRA on 09Aug2021 from a member of the public. This report concerned a 17 year old female who experienced a seizure and loss of consciousness following vaccination with Comirnaty for Covid-19 immunisation. The patient was not taking any concomitant medication. Information regarding the patient''s medical history/concurrent conditions was not included in the report. On 04Aug2021 the patient was vaccinated with her first dose of Comirnaty (batch details: FF0884). 25 minutes later on 04Aug2021 the patient experienced a mini seizure and blacked out. The duration of the reaction was reported as 10 minutes. The patient was treated with water, sugar and rest. At the time of reporting the patient had recovered. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1681191 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-04
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Headache, Hyperhidrosis, Hypotension, Nausea, Pain, Presyncope, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dust allergy; Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210805; Test Name: Blood pressure; Result Unstructured Data: 103/59 mmHg
CDC Split Type: PTJNJFOC20210901346

Write-up: GENERAL BODY PAIN; BLOOD PRESSURE LOW; PERSPIRATION EXCESSIVE; NEAR FAINTING; FEVER; HEADACHE; NAUSEA; This spontaneous report received from a consumer via Regulatory Authority (EVHUMAN Vaccines, PT-INFARMED-T202108-908) on 31-AUG-2021 and concerned a 21 year old male of unknown race and ethnicity. The patient''s weight was 69 kilograms, and height was 176 centimeters. The patient''s concurrent conditions included dust allergy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 21C14-01 expiry: UNKNOWN) 0.5 ml, 1 total administered on 04-AUG-2021 for covid-19 vaccination. No concomitant medications were reported. On 04-AUG-2021, the patient experienced general body pain, blood pressure low, perspiration excessive, near fainting, fever, headache, nausea. On 05-AUG-2021, Laboratory data included: Blood pressure (NR: not provided) 103/59 mmHg Iu international unit (s). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from general body pain, blood pressure low, perspiration excessive, near fainting, fever, headache, and nausea on 05-AUG-2021. This report was serious (Disability Or Permanent Damage).


VAERS ID: 1695104 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003605 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Hyperpyrexia
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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20213

Write-up: .; This case was received via the regulatory authority (Reference number: IT-MINISAL02-771576) on 04-Sep-2021 and was forwarded to Moderna on 04-Sep-2021. This regulatory authority case was reported by a physician and describes the occurrence of HYPERPYREXIA in a 14-year-old female patient who received mRNA-1273 (Spikevax) (batch no. 3003605) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 03-Aug-2021, the patient received dose of mRNA-1273 (Spikevax) (Intramuscular) .5 milliliter. On 04-Aug-2021, the patient experienced HYPERPYREXIA (seriousness criterion medically significant) and HEADACHE . At the time of the report, HYPERPYREXIA and HEADACHE was resolving. mRNA-1273 (Spikevax) (Intramuscular) was withdrawn on 03-Aug-2021. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication information was mentioned by reporter No treatment medication information was mentioned by reporter Company comment:Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Translation has been requested.; Reporter''s Comments: 09/08/2021 Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Translation has been requested.


VAERS ID: 1697637 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-04
Onset:2021-08-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF0900 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Epilepsy
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Generalised convulsive seizures following immunisation (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC202101131126

Write-up: about 2 minutes after the injection, the patient collapsed and cramped; This is a spontaneous report from a non-contactable consumer downloaded from the Medicines Agency (MA) EudraVigilance-WEB, regulatory authority number DE-PEI-202100175891. A 16-year-old female patient received BNT162b2 (COMIRNATY, Lot Number: FF 0900), via intramuscular on 04Aug2021 (16-year-old at time of vaccination) as single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced "about 2 minutes after the injection, the patient collapsed and cramped" (hospitalization) on 04Aug2021. The outcome of the event was unknown. Relatedness of the drug to the event "Epileptic fit" was reported by the regulatory authority (PEI) as "D: unclassifiable". No follow-up attempts are possible. No further information is expected.


VAERS ID: 1697638 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-16
Onset:2021-08-04
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 1F0301 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Facial paresis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Infection upper respiratory
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC202101125009

Write-up: Facial nerve paresis; This is a spontaneous report from a non-contactable physician downloaded from the regulatory authority-WEB [DE-PEI-202100176463]. A 13-year-old female patient received bnt162b2 (COMIRNATY, Strength 0.3ml), dose 1 via an unspecified route of administration on 16Jul2021 (Lot Number: 1F0301) (at age of 13-year-old) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included upper respiratory tract infection from Jul2021 and ongoing. The patient''s concomitant medications were not reported. The patient experienced facial nerve paresis (hospitalization) on 04Aug2021 with outcome of unknown. Result of assessment for Facial nerve paresis/regulatory authority /C. Inconsistent causal association to immunization. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1522770 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-31
Onset:2021-08-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Asthenia, Chest pain, Erythema, Headache, Malaise, Nausea, Pain in extremity, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I received my shot on 7/31/2021. On 08/01/2021 around 2:30pm I started feeling nauseated and weak. I began to feel a little better around 7:30pm. On 08/02/2021 I woke up around 6:30am with a headache and feeling sick to my stomach. I went to work thinking it would get better but it didn''t. Around 2:00pm my headache was gone. Then around 5:30pm my headache came back and wouldn''t go away even after I took some ibuprofen. I woke upon 08/03/2021 around 6:00am and still wasn''t feeling my best but it wasn''t as bad as the other days. I still had a slight headache and my arm was still sore including across my chest and shoulders, so I took some ibuprofen. I arrived at work around 8:55am and before I got out of my car I noticed my arm was red, swollen and hot to the touch. I still currently have a headache and my arm is still red and hot to the touch and I still have soreness across my chest and arms.


VAERS ID: 1522782 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Cough, Throat tightness, Tremor
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Diazepam 2mg three times a day, Fluvoxamine 50mg at bedtime,
Current Illness: None
Preexisting Conditions: Recurrent Major Depression, PTSD, Hypomania, Generalized Anxiety, Anorexia, Bipolar 1
Allergies: Lidocaine: Rash and anaphylaxis, Seroquel-hives, Gabapentin: unknown, Penicillin: hives, Latex: hives, Banana Flavor: unknown.
Diagnostic Lab Data: Transported to closest hospital for further care.
CDC Split Type:

Write-up: Patient received first Pfizer covid vaccine, has multiple allergies and was being kept for 30mins post to monitor for reactions. About 10 minutes after receiving vaccine patient complained of feeling of throat closing and coughing. At 9:24am epi pen was administered due to anaphylactic reaction.. Patient was put on a nonrebreather mask and then transitioned to 2L NC. Heart rate was 163 and SpO2 was 97%. Unable to get blood pressure as patient was shaking. Patient was transported by EMS to closest hospital.


VAERS ID: 1522811 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-25
Onset:2021-08-03
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Blood lactic acid decreased, COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Fatigue, Hypoxia, Lung infiltration, Lung opacity, Pneumonia, Pulmonary oedema, Pyrexia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown at time of vaccination. Home Medications on hospitalization: Zovirax ; Lipitor; Vit D3, Decadron; Cymbalta; Neurontin; Revlimid,; Toprol; Nitrostat; Roxicodone; MIralax; Lyrica; Xarelto; Bactim; Vit B complex; Darzalex
Current Illness: Unknown
Preexisting Conditions: History of Multiple Myeloma; CAD; HTN, Hyperlipidemia; Chronic Kidney Disease (stage 3); Neuropathy
Allergies: NKDA
Diagnostic Lab Data: 8/3/21 lactic acid 2.1; positive COVID test 8/3/21; hypoxia 8/3/21 87% on room air; Chest x ray 8/3: patchy opacities right perihilar lung and possibly left peripheral lower lung field may represent multifocal pneumonia and/or pulmonary edema
CDC Split Type:

Write-up: Ongoing hospitalization began 8/3/21 with bilateral interstitial infiltrates, mild hypoxia, temperature 101.2, fever, weak, short of breath, increased fatigue, cough. Treatment: dexathasone 6 mg IV daily, supplemental oxygen. Treating empirically for superimposed pneumonia with Zosyn. Treatment began 8/3/2021.


VAERS ID: 1522818 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-01
Onset:2021-08-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Echocardiogram, Electrocardiogram, 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: na
Current Illness: na
Preexisting Conditions: na
Allergies: nkda
Diagnostic Lab Data: ekg, echocardiorgram, admission to hosp for observation 8/3/21
CDC Split Type:

Write-up: pericarditis


VAERS ID: 1522839 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

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

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

Write-up: Pt. states that after receiving the 2nd dose of Phizer 08/03/2021, started to experience body aches and developing a rash throughout the chest. Rash is noticeably hot to the touch with welps forming. Primary notified but has yet to reach out to Pt. Still continuing to experience the fatigue with body aches.


VAERS ID: 1522858 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, 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: patient does not take medications
Current Illness: Patient does not suffer from diseases
Preexisting Conditions: Patient suffers from asthma but keeps it under control
Allergies: Patient is not allergic to anything
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 16 year old male patient oriented time, place, space reports feeling dizzy in the observation area after 12 minutes after administration of the first PFIZER vaccine, he presented with paleness of the face and upper extremities. Paramedic proceeds to take him to a stretcher to take vital signs with Dx: 101, BP 80/60, P: 88, Sat: 99%. Doctor is called and proceeds to indicate that the patient should drink juice since he did not have breakfast. Mom arrives with juice at 9:59am, Patient looks better. 10:16am patient reports feeling better. Retake vitals 15 minutes later. BP: 80/60, educates mother about the importance of breakfast before receiving second dose of PFIZER and discusses with the nursing staff about the symptoms he presented in his first dose.


VAERS ID: 1522862 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-28
Onset:2021-08-03
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dysmenorrhoea, Muscle spasms, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad)

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

Write-up: July 1st had a week of spotting. Then had a really heavy painful menstrual cycle at the end of July. Typically, my cycles are predictable and it rack them via an app. Now, 8/1 same pattern. Spotting and cramping. This is completely unusual and there have been no other major changes aside from the vaccine.


VAERS ID: 1522863 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

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

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

Write-up: Dizziness after administration, patient stayed seated until feeling passed


VAERS ID: 1522866 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 felt dizzy, fainted, then came to and felt dizzy and nausea


VAERS ID: 1522867 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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 felt like he was going to pass out approximately 1 minute after the vaccine was given. He experienced a brief period of vasovagal syncope. After about a minute he was aware and feeling better. A physician examined him and took his vital signs. After about 5 minutes he was feeling normal.


VAERS ID: 1522878 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / N/A LA / IM

Administered by: Other       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: Patient did not disclose.
Current Illness: Patient did not disclose.
Preexisting Conditions: Patient did not disclose.
Allergies: Patient did not disclose.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient checked No to "Has the person to be vaccinated ever received a COVID-19 vaccine?", so patient was given the Janssen Vaccine he requested. When Patients data was entered into LINKS, it was found that he had received a first dose of Moderna on January 12th, 2021.


VAERS ID: 1522887 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: Approximately 12 minutes after receiving the injection, the patient complained of itching on the left arm and head. Patient stated no issue with mouth or lips. With the parents approval, I administer one 25mg diphenhydramine tablet. Mom and patient was counseled to observe for other signs of an allergic reaction, such as hives and swelling of the lips, tongue, and face. If allergic reaction continues to develop, they were counseled to contact their physician on call 911.


VAERS ID: 1522906 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Haemorrhage, Head injury
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: Patient received Moderna dose #2 and was instructed to wait 15 minutes in waiting area. Patient felt light headed and was on his way to tell pharmacist when he fell and hit his head to the ground. He had a bleed on his right eyebrow area. Called 911 and paramedics came and took patient to the hospital.


VAERS ID: 1522921 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Throat tightness, Tremor
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Approximately 10 minutes after injection, patient started feeling "not right" and lightheaded. Patient was placed in a supine position and was given water. Patient''s arms and legs began shaking. After approximately 10 minutes, patient was feeling better and was placed in a sitting position. After sitting for a few minutes, patient began feeling "not right" and began shaking. Patient stated that her throat felt tight but was able to swallow, speak and breath without any problem. After discussion, patient decided to go to ER for evaluation.


VAERS ID: 1522934 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: There are no adverse events, vaccine administration error.


VAERS ID: 1522939 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-31
Onset:2021-08-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: 3 days after vaccine with axillary swelling, skin erythema distal to injection site


VAERS ID: 1522942 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (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: Viibryd, Buproprion XL, Buspirone, Allegra, PhenQ
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath, chest pain, heart fluttering


VAERS ID: 1522954 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-01
Onset:2021-08-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Swollen and Tender lymph nodes in arm pit of the injected arm. Sore to the touch


VAERS ID: 1522969 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088021A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Muscle spasms, Neck pain, Pain in extremity, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estroven Complete Multi-Symptom (Rhapontic Rhubarb root extract-4mg )1xd RenewLife Ultimate Flora Extra Care Probiotic (30 billion cultures, 12 strains) 1xd NatureMade Vitamin E 400 IU (180mg) 2xd NatureMade Vitamin B12 (1000mcg) 3xd Sprin
Current Illness: None
Preexisting Conditions: Autosomal Dominant Polycystic Kidney Disease, Polycystic Liver Disease, Fatty Liver Disease
Allergies: Eggs-moderate Bee Venom-mild/moderate
Diagnostic Lab Data: None so far. Am monitoring and will see a healthcare provider if it continues.
CDC Split Type:

Write-up: I waited 15 minutes after getting the shot and my arm was sore but I assumed that was to be expected. I left the store at 1137 because everything seemed okay. I headed to the grocery store. I left the grocery store at 1152 and I was concerned because the left side of my face felt like I''d taken a light hit of Novocaine (no droopy eyelids or mouth though) and the left side of the back of my neck felt like it was trying to spasm. My left arm felt strange and I began having sharp pain in my left outer thigh, which also felt strange. It is now 1300 and I feel a little better although the left side of my face still doesn''t feel right and left back of my neck is feeling sore.


VAERS ID: 1522978 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood pressure increased, Chest pain, Hyperhidrosis, Hypersensitivity
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Was seen at
CDC Split Type:

Write-up: staff member became diaphoretic, complains of chest pain, increased blood pressure. Sent to and diagnosed with an allergic reaction to Moderna vaccine.


VAERS ID: 1523009 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: The patient fainted for a few seconds roughly 8 minuets after administration. The patient got up off the floor and waited for the ambulance. He told us he did want any treatment or care; he said he was fine. We call 911 and had the ambulance come to the pharmacy. The patient refused any treatment multiple times. Patient got up from their chair and left.


VAERS ID: 1523019 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Presyncope
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: none known
Current Illness: none known
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lightheaded, sweating, feeling faint, almost fainted


VAERS ID: 1523031 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Numbness/tingling in arm where vaccine was given


VAERS ID: 1523036 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Pharyngeal paraesthesia
SMQs:, Anticholinergic syndrome (broad), Dementia (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: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fifteen minutes after injection patient started to complain of lightheadedness and tingling in the throat area. Vital signs taken: 1150 - BP 87/75, P 90, O2 sat 98% respiration regular. 1155 - repositioned BP cuff - BP 126/94, P98, O2 98% respiration regular. Continued tingling in throat. Associate given water to drink. 1205 - BP 125/94, P 79, O2 97%, respirations 20. Continues to feel lightheaded and now states stomach feels weird 1215 - 50mg Benadryl given by mouth 1222 - Associate still feeling lightheaded. Offered to be evaluated in emergency department, associate refused. Vital signs BP 125/89, O2 97%, P 82, R 20. Associate taken by w/c to be taken home by brother. Alert and oriented to self, place and time. Provided instructions to return to the emergency department if worsen or change. Associate verbalized understanding.


VAERS ID: 1523039 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 3 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. T024669 / N/A RA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS AP545 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: At present time there is NO adverse reaction. Third Moderna vaccine was given in error.-----Patient had received both Moderna vaccines on 2/10/2021 (lot 031120A) and 3/12/2021 (Lot 027l20A). On August 3, 2021 patient was here for Pneumovax 23 and Shingrix. Pneumovax 23 had been given in right arm then Shingrix in left arm but Moderna was given in error in the left arm( Lot 042B21A). Went ahead and gave the first Shingrix in the left arm after error was discovered. patient has now received 3 Moderna vaccines.


VAERS ID: 1523041 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 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: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: fainted about 1-2 minutes after getting her injection. She was standing by her mother while her sister got her shot.


VAERS ID: 1523059 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-01
Onset:2021-08-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Hyperhidrosis, Musculoskeletal chest pain, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Rib cage pain, profuse sweating, nausea and headache.


VAERS ID: 1523063 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Nausea-Medium


VAERS ID: 1523082 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 OT / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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: Unknown
Current Illness: No known illnesses
Preexisting Conditions: No known illnesses
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose administered was less than recommended volume. Patient received less than half of dose in left deltoid. Dose was repeated in right deltoid arm immediately. Patient was monitored and displayed no immediate adverse effects.


VAERS ID: 1523087 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Pain, 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:
Other Medications: Telemisartan hydrochloride, bisopril, effector er
Current Illness: None
Preexisting Conditions: High bp
Allergies: Laytex, nystatin, coedine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, body chills, achiness


VAERS ID: 1523092 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2020-12-22
Onset:2021-08-03
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 UN / IM

Administered by: Work       Purchased by: ?
Symptoms: Ageusia, COVID-19, Fatigue, Headache, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: Covid test 8/3/21 - positive
CDC Split Type:

Write-up: 8/2/21 loss of taste, fatigue , headache - tested positive 8/3/21


VAERS ID: 1523098 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-11
Onset:2021-08-03
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Abdominal X-ray, COVID-19, Chest X-ray, Chills, Cough, Diarrhoea, Fatigue, Influenza virus test, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zofran Bentyl
Current Illness: No known.
Preexisting Conditions: Asthma
Allergies: Penicillin
Diagnostic Lab Data: Chest X-Ray Abdominal X-Ray SARS-CoV-2 (COVID-19) PCR with POSITIVE RESULTS
CDC Split Type:

Write-up: Chills; fever; cough; fatigue; nausea; diarrhea = 2 days


VAERS ID: 1523099 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Crying, Lip disorder, Loss of consciousness, Panic attack, Paraesthesia oral, Throat tightness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: dm2
Preexisting Conditions: DM2
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given vaccine @ 917am, during observation Nurse began to notice patient was crying. At 932am patient stated needed water and stated having a panic attack. Observing nurse flagged down 2 other nurses to assist with monitoring of patient. Vitals checked BP 231/145, pulse 131 and O2 96%, patient moved to separate observation area onto gurney. Patient stated feeling of tingling in mouth, soon stated cant move lips and throat felt like it was closing. Nurse proceeded to get emergency Epi-pen. At 9:45am nurse state patient became unresponsive and administered Epi-pen, patient immediately responded to medication administration. Patient soon after transferred to ER.


VAERS ID: 1523104 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Salivary hypersecretion
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prolia injection 5/24/21 Warfarin daily 5.5-6mg depending on meeting INR of 2-3. DHA, Flax Oil, D3, Olive and Coconut Oil, Fiber Gummies and Elderberry Gummies
Current Illness: Lupus APS-SLE (Diagnosed 2013 when I had a DVT.) Osteoporosis diagnosis this year.
Preexisting Conditions: Obese.
Allergies: Sensitivity to Sulfa based medications. They make me feel achy and flu-ish so the doctor prescribes other Rx when antibiotics are needed.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Within the first ten minutes, I felt an increase in salivation and metallic taste.


VAERS ID: 1523113 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose normal, Somnolence, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: Blood Glucose: 100 (performed by EMT)
CDC Split Type:

Write-up: Client found on the ground, lying to left side, unresponsive x 30-60 sec. BP: 130/80, Pulse: 71, 02 sat on RA: 98, EMS initiated. Client finally became responsive, denies pain. Asked what happened, stated he felt very sleepy after receiving the vaccination and felt that he fell asleep. Client stated that he has not eaten and only had juice. EMS on site, BP:126/71, 74, 99 02 sat on RA. Blood glucose obtained by EMS: 100. Client refused to be transported to ED, signed declination. Client''s cousin present.


VAERS ID: 1523119 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Pain, Poor quality sleep, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (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: Allegra
Current Illness: None. However, slight seasonal allergies.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Did not sleep well. Woke up at 5:30am. He is achy and has the chills, fever of 102.7, and a bad headache. I?ve given Motrin and he still has the symptoms.


VAERS ID: 1523132 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypophagia, 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: na
CDC Split Type:

Write-up: Patient received her vaccine and passed out in the waiting area. She came around after less than 1 minute. She stated that she had not eaten and passes out at seeing the needle. She is currently doing well. Just a patient specific reaction to seeing a needle and not the vaccine


VAERS ID: 1523148 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: N/A
CDC Split Type:

Write-up: Client was inadvertently administered Pfizer COVID 19 vaccine , instead of Moderna COVID 19 vaccine for his second dose. Client initially received Moderna vaccine for his first dose. Client completed the Pfizer consent form today and initially check he had received a dose of Pfizer before he scratched it out on the form. His mother was present with him.


VAERS ID: 1523153 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

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

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

Write-up: Vaccine was given 1 week early. First dose was given on 7/20/21 and second dose was given on 8/3/21


VAERS ID: 1523166 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-08-03
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Pt tested positive for COVID after being fully vaccinated


VAERS ID: 1523171 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-01-28
Onset:2021-08-03
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 - / IM

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

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

Write-up: PATIENT CHOSE TO BE REVACCINATED WITH PFIZER AFER RECEIVING 1 DOSE OF MODERNA. PATIENT DID NOT DISCLOSE THIS INFORMATION TO THE PROVIDER WHICH WOULD HAVE PROMPTED EDUCATION ON RECEIVING 1 DOSE OF PFIZER.


VAERS ID: 1523173 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Hot flush, Myalgia, Night sweats
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: 8 hrs after vaccination - chills, shivering, headache, followed by hot flashes, night sweats, and myalgias


VAERS ID: 1523183 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Pruritus, Vaccination complication
SMQs:, Anaphylactic reaction (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: Surtaline, birth control, sleep med
Current Illness: Mental health issues
Preexisting Conditions: Mental health issues and stomach ulcers
Allergies: Latex, pumkin, rabbit dander, lactose intolerant
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid arm with high amount of pain and itching


VAERS ID: 1523188 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-26
Onset:2021-08-03
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, 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: Liothyronine, Levothyroxine, Sertraline
Current Illness: None
Preexisting Conditions: Hashimoto''s Disease
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme fatigue for 48 hours starting the morning after the vaccine Heart palpitations for 24 hours starting the morning after the vaccine


VAERS ID: 1523193 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: patient stated while recovering that she has had prior adverse events when being administered injectable medications.
Other Medications: Unknown as patient does not fill medications at our pharmacy.
Current Illness: No known illnessess
Preexisting Conditions: No known chronic conditions.
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 5 minutes of receiving Pfizer vaccine, patient displayed symptoms of nausea and vomiting. Patient looked pale and slightly disoriented. She was provided a chair to sit, water to drink, and a waste basket with plastic bag to vomit, if needed. She decided to remain seated on the floor and waited to improve. After a short time, color in her face returned and it she or an employee called a paramedic for first aid assistance. Paramedics arrived in about 15 minutes, took vitals, and determined it was be best to take her for further evaluation at hospital.


VAERS ID: 1523200 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2020-12-30
Onset:2021-08-03
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 4 - / 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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PATIENT IS A NURSE AND ADMITS TO RECEIVING 2 DOSES OF MODERNA AT ANOTHER PROVIDER THEN RECEIVING 2 DOSES OF PFIZER. PATIENT DID NOT DISCLOSE THE FACT RECEIVED 2 DOSES PRIOR. AND PATIENT IS VERY HAPPY RECEIVING 4 DOSES AND WANTED TO KNOW WHY THEIR 4 DOSES ARE NOT SHOWING UP ON SCHEDULER DETAILS OR THE APP.


VAERS ID: 1523206 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Dizziness, Fall, Immediate post-injection reaction, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Pt. reports same reactions to all vaccinations/needle procedures
Other Medications: none reported
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. received vaccination & immediately after reported increased anxiety. dizziness, nausea. Patient reports this is his "normal" and occurs with "shots". Patient attempted to stand , and fell to buttocks. Patient did not head head, no LOC, remained A&Ox4. V/S - 140/85. HR 60. O2 100% Patient reports symptoms subsided, patient left clinic.


VAERS ID: 1523207 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine , paroxetine
Current Illness: no
Preexisting Conditions: hypothyroidism
Allergies: penicillin
Diagnostic Lab Data: Pt had a mole reoved at dermatologist office on 7-28-21.
CDC Split Type:

Write-up: bumpy, itchy haves/rash on left side of face


VAERS ID: 1523210 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: sulfa
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient became light headed & woozy. She felt better after drinking water, her blood pressure was 118/72 HR 60. She left after she felt better about 15 minutes.


VAERS ID: 1523211 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-01
Onset:2021-08-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Went to hospital after and my EKG/labs were normal.
CDC Split Type:

Write-up: Passed out for approximately five minutes thirty seconds after receiving the injection. Felt lightheaded and weak for thirty minutes after the injection. I?ve never passed out from a shot or vaccine before.


VAERS ID: 1523217 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-05-20
Onset:2021-08-03
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole 20mg PO daily
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: He currently has no adverse signs or symptoms. States "he feels great." No pending tests or labs at this time.
CDC Split Type:

Write-up: Patient received J&J COVID vaccine on 03/26/2021. He received a second J&J COVID vaccine on 05/20/2021. He stated he wanted an "extra dose" to continue to "build his antibodies."


VAERS ID: 1523219 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT DISCLOSED
Current Illness: NONE
Preexisting Conditions: HTN,H/O CARDIAC ABLATION, DM
Allergies: NONE REPORTED
Diagnostic Lab Data: LS CLEAR. HRR. VITALS @ 1517: HR 98, BP 158/90, RR 20 VITALS @ 1532: HR 88, BP 138/81, RR 18
CDC Split Type:

Write-up: PT REPORTED FEELING FLUSHED AND DIAPHORETIC. NO DIZZINESS, CHEST PAIN, NUMBNESS OF EXTREMITIES, CHEST PAIN, PRURITIS OR DYSPNEA REPORTED.


VAERS ID: 1523220 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-26
Onset:2021-08-03
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: SULFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT CALLED REPORTING PAIN AND SWELLING AT INJECTION SITE AND NAUSEA A WEEK AFTER RECEIVING VACCINE. HAS HAD SOME RELIEF WITH OTC REMEDIES(TYLENOL, ETC). CALL DISCONNECTED WHILE PLACED ON HOLD TO INVESTIGATE. CALLED NUMBER ON FILE, LEFT VM.


VAERS ID: 1523232 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088021A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Headache, Oxygen saturation decreased, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Yes, 7/5/2021; Moderna 1st dose; body aches, chills, fever
Other Medications: Tylenol Arthritis Pain Formula Metformin Amlodipine/Valsartan 5/320 Gabapentin Dexilant Simvastatin Chlorthalidone Klorcon
Current Illness: None
Preexisting Conditions: High Blood Pressure Type 2 Diabetes Gerds
Allergies: None
Diagnostic Lab Data: None at this time; I am headed to the ER
CDC Split Type:

Write-up: Fever, Chills, Body Aches, Low Oxygen Level, Headache, Cough


VAERS ID: 1523237 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Pruritus, Throat irritation, Throat tightness, Urticaria
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Diflucan and Tetanus Vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came in for a 1st dose Moderna vaccine today 08/03/21 @ 9:30am. She was given vaccine around 9:40am and stated, she started experiencing chest heaviness/tightness and sensation of having something in her throat, but not being able to cough it up within 15 minutes of getting vaccine. She was offered some water and stayed seated for an additional 10 minutes or so and decided she was going to leave even though she was not feeling symptoms improve. She was offered to speak to site''s nurse hotline and she refused. She stated she is a nurse herself and will seek further treatment if necessary. She called Pharmacy back at 1pm notifying us of symptoms getting worse started feeling itching and broke out in hives. She took a Claritin and Benadryl and stated the hives were relived after about one hour, but still has itchiness in her throat. She is concerned about completing dose serious and having a more severe allergic reaction.


VAERS ID: 1523240 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Patient received Moderna Covid-19 Vaccine on 7-6-21 Patient received Pfizer Covid-19 Vaccine on 8-03-21


VAERS ID: 1523242 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

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

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

Write-up: The second dose was given early on 8/3/2021. It should have been given 08/12/2021. No complications.


VAERS ID: 1523244 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Malaise, Retching, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NO
Preexisting Conditions: EPILEPSY
Allergies: TRAMEDOL, NAPROXEN, DAROCET
Diagnostic Lab Data:
CDC Split Type:

Write-up: EMPLOYEE OBSERVATION TIME WAS UP AND EMPLOYEE STOOD UP AND STATED SHE DID NOT FEEL WELL AND SHE FELT LIKE SHE WAS ABOUT TO BE SICK AND ASKED INFECTION CONTROL STAFF WHERE THE NEAREST BATHROOM WAS EMPLOYEE STARTED TO RUN TO RESTROOM AND INFECTION CONTROL STAFF HEARD NOISES THAT SOUNDED LIKE EMPLOYEE WAS THROWING UP. WHILE NURSING STAFF WERE WAITING OUTSIDE OF RESTROOM, OUR MEDICAL DIRECTOR DR CAME TO ASSESS EMPLOYEE V/S WERE TAKEN AND WNL. DR UPON HIS ASSESSMENT DETERMINED THAT EMS NEEDED TO BE SUMMONED WHILE WAITING FOR EMS EMPLOYEE COMPLAINED SHE HAD TO DIARRHEA AND STARTED TO HAVE UNCONTROLLED DIARRHEA, AFTER EMPLOYEE WAS DONE WITH USING RESTROOM SHE BEGAN TO GAG AND THROW UP CLEAR FLUID SHORTLY AFTER EMS ARRIVED AND TOOK OVER EMPLOYEE.


VAERS ID: 1523245 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sprintec 28, sertraline 100mg, Vyvanse 50mg
Current Illness: none known
Preexisting Conditions: none known
Allergies: penicillin, amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient experienced syncope shortly after receiving the vaccine. According to her mother who directly witnessed the event she got dizzy/queasy and passed out, slumping off the bench and onto the floor. When I got out to her she was conscious and sitting on the floor. She then vomited a little. She was pale and sweaty. With the mothers help i got her up on the bench seat to lie down. After about 15 minutes she said she was feeling fine.


VAERS ID: 1523247 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Laboratory test normal, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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: nk
Diagnostic Lab Data: pt was transported by ambulance. she later came in and informed us that her labs were normal. She appeared well and content.
CDC Split Type:

Write-up: patient fainted. was unconscious for 10-20 seconds. We positioned her on the floor and supported her. She regained consciousness, but was very hot and sweaty. we gave her some wate


VAERS ID: 1523249 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: recommended visit to physician for evaluation
CDC Split Type:

Write-up: one leg has swollen, red, tender, warm to the touch


VAERS ID: 1523252 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Flushing, Pharyngeal swelling
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: multiple
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt with history of multiple drug allergies including anaphylaxis to IV antibiotic of some kind. Rec''d first dose of Pfizer vaccine at 1419. At 1425, C/O "throat feeling swollen" and noticeable generalized flush. No SOB or wheezing, able to maintain conversation with nurse. VS stable. Notified EMS per adverse drug reaction chart. EMS arrived and transported patient to Hospital.


VAERS ID: 1523255 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-08-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Heavier periods than normal


VAERS ID: 1523256 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site induration, Injection site nodule, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: very sore/painful arm at the injection site, hard bump/knot - advised patient on icing the area and taking ibuprofen as needed


VAERS ID: 1523259 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Loss of consciousness, 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), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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:
Current Illness: asthma
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 minutes after vaccination given patient lost consciousness and then vomited. She came to and then again lost consciousness. Epi-pen was administered and patient regained consciousness but was not able to talk. EMS was called and took her to hospital.


VAERS ID: 1523260 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Malaise
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? 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: PENICILLIN AND SULFA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 5 Minutes after receiving his 1st dose of the Pfizer vaccine, pt told his wife he was not feeling well and slumped over. He was trying to cough and was having a difficult time breathing. He was not able to answer any questions. We contacted 911 and quickly administered an EPIPEN 0.3mg. Patient was responsive after that.


VAERS ID: 1523271 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient reports experiencing these symptoms with past vaccinations, but provided no specifics.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 2-3 minutes after administering vaccination, patient became dizzy, lightheaded, and nausea. Patient then proceeded to vomit into a trashcan. Water was given to the patient and the patient was laid back into a reclining chair. Patient reported that he experiences these symptoms with previous injections. Additionally, patient reported that he did not eat anything during the day. After 10 minutes of sipping water and laying back in the chair. The patient''s symptoms had subsided and felt alright to leave the store. Patient was instructed to return to the pharmacy or hospital if his symptoms returned.


VAERS ID: 1523277 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: WITHING 5 MINUTES FOLLOWING VACCCINATION PATIENT SLUMPED IN HER CHAIR AND FATHER REPORTED A MILD SEIZURE. PATIENT WAS CONCIOUS AND RESPONSIVE TO QUESTIONS UNTIL PARAMEDICS ARRIVED.


VAERS ID: 1523279 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 989893 / 1 LA / IM

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

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

Write-up: PATIENT HAD SWELLING IN LIPS, TROUBLE BREATHING, PATIENT WAS GIVEN EPIPEN AND 911 WAS CALLED


VAERS ID: 1523281 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 RA / IM

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

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

Write-up: Patient came to pharmacy to receive the second Moderna vaccine. She received the incorrect dose in April. Our pharmacy was just completing the Moderna series based on the guidance of the manufacture and guidelines. Again, we completed the series and did not give the initial incorrect dose.


VAERS ID: 1523297 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dry mouth, Oropharyngeal discomfort, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Presented for 1st dose Moderna COVID vaccine at 1350. Approximately 20 minutes following administration of vaccine, complained of dry mouth, feeling of thickness in tongue, and fullness in throat. Able to drink water, speak clearly, and no signs of respiratory distress. 1402 BP 148/96 HR 102 Pulse oximetry 99 1405 Administered 50 mg Diphenhydramine IM RD 1410 States right side of throat less thick and tongue and left throat unchanged. Speech clear and not in respiratory distress 1411 BP 150/88 HR 88 Pulse oximetry 98 1440 States throat and tongue unchanged 1440 Patient phoned family to accompany home 1442 Paged Emergency for consultation 1445 Team arrived 1445 BP 144/88 HR 77 Pulse oximeter 88 1446 Response team administered Epinepherine pen 0.3 mg/ml Lot 0FM501 1447 Patient conversing with team 1450 Reports throat and tongue improved 1500 Ambulated to bathroom 1515 States no symptoms of fullness in mouth or throat 1515 BP 154/88 HR 100 Pulse oximetry 98 Instructed to follow up with her provider for follow up 1516 Daughter accompanied patient upon discharge home


VAERS ID: 1523298 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / ID

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient told EMS, he has been on Metoprolol for years
Current Illness: unknown
Preexisting Conditions:
Allergies: per patient, none that he was aware of
Diagnostic Lab Data:
CDC Split Type:

Write-up: The Shift Lead heard items fall on floor on the hardware aisle.. she went over and found the patient passed out and she approached him and had him walk over to the pharmacy area and sit in a chair and then she came and got a Pharmacist (myself). I ran out to the waiting area and found the patient having a seizure in the chair..I immediately told pharmacy staff to call 911 and then our soon to be Pharmacist, pending passage of boards in August, grab an Epi-Pen out of the immunization room and immediately told patient we are going to give you an Epi-pen..patient then stopped seizing.. at this point we talked to him to find out his health history and how he was currently feeling and was waiting on EMS to arrive. we wanted to place him on the floor with legs elevated but then EMS arrived and took over. Per EMS his blood pressure and heart rate were very low and they wanted to take him to Hospital. Patient is on the way to Hospital


VAERS ID: 1523300 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-08
Onset:2021-08-03
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Lung opacity, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: levothyroxine
Current Illness: NA
Preexisting Conditions: obesity, thyroid CA s/p thyroidectomy, hypothyroidism, depression, OSA, anxiety
Allergies: NKDA
Diagnostic Lab Data: COVID ag+ 7/29, covid PCR+ 8/3. CXR 8/3 bilateral pulmonary opacities.
CDC Split Type:

Write-up: Hospitalized today for COVID PNA


VAERS ID: 1523301 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood urine present, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore arm, Blood in Urine, Loss of senseation of touch Pharmacy provided the vaccine, patient called me the pharmacist to report adverse reactions. We referred her to the hosptial or her PCP. She said she would go to see them.


VAERS ID: 1523302 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Pt states a blood clot came out of the injection site after receiving the vaccination


VAERS ID: 1523305 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Diplopia, Dizziness, Nausea, Pallor, Visual impairment
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Ocular motility 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: Patient reported history of similar reactions during previous, unspecified vaccinations.
Other Medications: None reported
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Dust/environmental allergies; has hives and watery eyes
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At 12:52, patient reported feeling lightheadedness, "double vision," "slight nausea" and "saw white." Patient reported his symptoms began "about 5 minutes ago". RN assessed patient. Patient appeared pale. Patient assisted into anti-gravity chair. Patient reported history of similar episodes with previous vaccinations and blood draws. Patient denied itchiness, rashes, hives, difficulty swallowing and difficulty breathing. Patient reported history of asthma, environmental allergies, and no current medications. At 12:54, EMT assessed patient vital signs: blood pressure 112/68 mmHg and pulse 63 beats/minute. Patient given juice and advised to drink juice. Patient able to drink juice. At 13:00, EMT reassessed patient vital signs: blood pressure 110/72 mmHg and pulse 71 beats/minute. At 13:06, patient reported feeling "a lot better." Patient denied dizziness and nausea. At 13:10, EMT reassessed patient vital signs: 116/70 mmHg and pulse 70 beats/minute. At 13:20, EMT reassessed patient vital signs: blood pressure 116/78 mmHg and pulse 70 beats/minute. Patient reported "feeling better." Patient denied dizziness, lightheadedness, nausea, and double vision. Patient stated he was "okay" with driving home. RN educated patient on signs/symptoms of when to seek emergency care; to follow-up with primary care provider; and to sign-up on v-safe. At 13:23, patient left facility with unlabored respirations and steady gait.


VAERS ID: 1523314 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

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

Write-up: After receiving Pfizer vaccination, pt had a seizure 8 minutes later. Seizure, Grand Mal, lasting 10-15 seconds. Pt was triaged and stabilized. An ambulance transported pt to local hospital.


VAERS ID: 1523321 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Patient received the Pfizer vaccine at age 11. No adverse events noted.


VAERS ID: 1523330 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Injection site haemorrhage, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood pressure was taken which was normal 111/80 and pulse of 75. EMT was called to do a final check-everything appeared normal
CDC Split Type:

Write-up: pt. receive 2 dose of Pfizer vaccine and started bleeding from injection site. Pt. appeared to be anxious /scared from the site of blood. She stood up and fainted.


VAERS ID: 1523334 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Discomfort, 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: Metformin; Metoprolol; Citalopram; Prevacid
Current Illness: DM 2; HTN; MRSA
Preexisting Conditions: DM; HTN; MRSA; Depression and Anxiety; GERD
Allergies: PCN; Sulfur; Iodine; Lisinopril
Diagnostic Lab Data: No labs done. Pt was provided both Oral and IM Benadryl.
CDC Split Type:

Write-up: Pt called PCHC as this was given in her home as she was homebound. A couple hours after COVID vaccine she began having severe itching and feeling uncomfortable. Did not have any type of respiratory distress.


VAERS ID: 1523345 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-25
Onset:2021-08-03
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Joint swelling, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Swelling in right elbow. Swelling in both knees. Weakness of muscles in right leg.


VAERS ID: 1523353 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: faints during most vaccines (his words)
Other Medications: no available info
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKA
Diagnostic Lab Data: none available
CDC Split Type:

Write-up: Patient received vaccine, was ok for a few minutes and then fainted. Patient urinated, and then regained consciousness a few minutes later. He was groggy, and refused medical attention from paramedics when they arrived. He eventually left with a family member.


VAERS ID: 1523382 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blindness, Chills, Dizziness, Feeling hot, Migraine, Muscular weakness, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)

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

Write-up: Sudden and gradual loss of vision, overheating, chills, migrane-like headache, nausea, muscle weakness, lightheaded


VAERS ID: 1523396 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

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

Write-up: Client received 1st covid vaccine dose of Moderna (037B21A) on 04/16/21 and received 2nd covid vaccine dose of Pfizer (EW0198) on 08/03/21. Client received two different mRNA vaccines, monitored for 15 minutes and no signs of adverse reaction noted.


VAERS ID: 1523398 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Malaise, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 13:50 The mother complained of patient being nauseated. Approached patient, noticed she was really pale. C/O dizziness and not feeling well. Placed feet up in a chair and assisted patient while other nurse grabbed the gurney. Patient started to gain some color. Transferred to gurney by one-person assist. Placed on supine position. Mother and brother at bedside. 13:55 Slowly lifted up as tolerated. Patient''s color close to normal. Instructed to start drinking fluids. Denied any nausea. Patient felt better. Denied any dizziness. 14:10 Placed in sitting position. Patient felt back to baseline. Per mother, color is back to normal. Encouraged to drink at least half of the water in the bottle. 14:15 Sat patient on the side of the bed. Asymptomatic. 14:20 Ambulated. Denied dizziness or lightheadedness. Patient and mother comfortable going home. ED precautions provided and instructed to follow up with PMD. Mother verbalized understanding.


VAERS ID: 1523407 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

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

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: Cyclobenzaprine (FLEXERIL) 5 mg Oral Tab Junel FE 1.5/30 (28) Ibuprofen (MOTRIN) 800 mg Oral Tab Ergocalciferol, Vit D2, (DRISDOL) 1,250 mcg (50,000 unit) Oral Cap
Current Illness: n/a
Preexisting Conditions: ANXIETY SEBORRHEIC DERMATITIS NECK PAIN FEMALE PELVIC PAIN TELOGEN EFFLUVIUM
Allergies: nkda
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt c/o feeling dizzy, nauseous, lightheaded about 10 mins after receiving first dose of Pfizer vaccine. RN came to assess patient, patient looked pale and diaphoretic. Ice pack applied to back of neck, ice water given, feet propped on second second and fan faced toward patient. Pt states she did have a light breakfast in the morning was anxious about the vaccine prior to receiving it. VS were taken immediately at 1152: 76/46 (54), HR 62, 98% SpO2 on RA. Pt A&O x4. RN STAT was called at 1155. Pt''s VS were taken a second time at 1155: 112/56 (72), HR 65. Pt stated she was feeling better but pt was still pale and diaphoretic. Pt refused to transfer via gurney and felt safe to transfer via wheelchair to treatment room.


VAERS ID: 1523409 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None, had terbinate resection surgery 7/20/21
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received vaccine at 2:30pm, started to feel lightheaded approximately 5 minutes after vaccine was administered. She was given water, and measured BP every 2 minutes. Patient states her blood pressure is normally very low, her mom agreed. First reading 80/52mmHg, second 87/58mmHg. Patient''s mother called her PCP and patient started to feel better. Patient was completely coherent the entire time-answering questions and able to describe her symptoms with great detail, but closed her eyes a few times and said she felt dizzy. Dr stated she would call her back shortly. Patient left pharmacy and asked us not to call 911 or first responders. She will follow up with her doctor via phone and decide at that time if she will get her second vaccination.


VAERS ID: 1523418 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Loss of consciousness, Muscle tightness
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), Dystonia (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data: Transported to local ER. Care after arrival to the hospital is unknown to this reporting pharmacy
CDC Split Type:

Write-up: Patient stated he felt light-headed about 5 min after the vaccine. He sat down and leaned forward with his head in his hand. Witness states he then appeared to tense up and fall forward. He regained consciousness quickly and was able to talk and understand. EMS arrived. He got back into the chair and a few moments later he had another episode. Parents agreed to let EMS transport to the nearest ER as a precaution. Duration from onset of symptoms until transportation by EMS was about 20minutes.


VAERS ID: 1523419 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fall, Skin abrasion, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (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: syncope
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: 12:54 pm 8/3/21 BP: 100/70 HR: 62 Resp: 16 Temp: 98 O2 Sat: 96%
CDC Split Type:

Write-up: Client vaccinated in private area due to history of syncope with needles. After vaccination, patient lied down for ~30 seconds. Client proceeded to stand up and walk 2 steps towards post observation area before falling down. Client reported no loss of consciousness, but did report dizziness and blurry vision immediately prior to falling down. Patient continue to lie down while medical staff adjusted posture. Patients legs were propped up on chair where an abrasion on her right knee was noted. EMS was called and was assessed. Patient denied any need to go to the hospital for further evaluation.


VAERS ID: 1523424 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Vomitting after few minutes and feeling dizzy.


VAERS ID: 1523426 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Client light headed and sweaty within a couple minutes of receiving vaccination. Symptoms resolved after reclining back in his seat. No LOC. Initial vitals: bp 97/72, hr 58. Observed for additional 15 minutes. No further symptoms and client declined further evaluation. Bp 134/94, hr 66 prior to leaving. Client reported similar reaction in the past to vaccination and giving blood. Advised client to let medical staff know in the future prior to intervention.


VAERS ID: 1523438 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Lip pruritus, 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: Ibuprofen 600 mg as needed for pain form fractured wrist
Current Illness: None
Preexisting Conditions: None
Allergies: Eggs, flaxseed, nitrofurantoin, peanut oil, walnuts
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Itchy face and lip


VAERS ID: 1523439 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 STATED THAT SHE HAD SHAKING MOVEMENT; VITALS WERE TAKEN AND STABLE.


VAERS ID: 1523444 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Blood pressure decreased, Dyspnoea, Hyperventilation, Injection site urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Dehydration (broad)

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

Write-up: Approximately 10 minutes after vaccination, patient has difficulty breathing and begins to hyperventilate. She complains that she cannot breathe and hives erupt around the injection site on the left arm. 911 is called. Blood pressure is normal at 135/85. Subsequent pressure drops to 118/77. Pharmacist administers 0.3mg epinephrine IM to left thigh followed by diphenhydramine 50mg IM to left arm. Patient is moved to supine position and continues to have difficulty breathing. She is wheezing, squeak noises indicated possible narrowing of airways and she cannot talk. A second dose of epinephrine is administered approximately 2:35PM. Paramedics arrive and patient is transported to hospital.


VAERS ID: 1523454 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Heart rate irregular, Respiratory rate decreased
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu shot 6 years ago
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administered intramuscularly into left deltoid at 1620. By 1621 patient c/o difficulty breathing and showed s/s of loss of airway. EMS called while vital signs were being monitored. All vital signs were WNL save for irregular heart rate and irregular rate of respiration. EMS on site at 1629 and transported stable patient to ER.


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