National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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 291 out of 7,116

Result pages: prev   192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390   next


VAERS ID: 1669675 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-03
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATJNJFOC20210902236

Write-up: SARS-COV-2 INFECTION; VACCINATION FAILURE; This spontaneous report received from a physician by a Regulatory Authority (EVHUMAN Vaccines, AT-BASGAGES-2021-042484) on 31-AUG-2021 concerned a 38 year old male of unspecified race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: XD975 expiry: Unknown) dose was not reported, 1 total, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-AUG-2021, the patient experienced severe acute respiratory syndrome (SARS-CoV-2) infection and vaccination failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the severe acute respiratory syndrome (SARS-CoV-2) infection and vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint.


VAERS ID: 1669676 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-03
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATJNJFOC20210902466

Write-up: VACCINATION FAILURE; SARS-COV-2 INFECTION; This spontaneous report received from a physician by a Regulatory Authority (EVHUMAN Vaccines, AT-BASGAGES-2021-042485) on 31-AUG-2021 concerned a 20 year old male of unspecified race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 21C11-01 expiry: Unknown) dose was not reported, 1 total, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-AUG-2021, the patient experienced vaccination failure and severe acute respiratory syndrome (SARS-CoV-2) infection. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccination failure and severe acute respiratory syndrome (SARS-CoV-2) infection was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint.


VAERS ID: 1671532 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-29
Onset:2021-08-03
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Abortion spontaneous
SMQs:, Termination of pregnancy and risk of abortion (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: FRPFIZER INC202101086838

Write-up: Early miscarriage; This is a spontaneous report from a contactable consumer downloaded from the regulatory authority-WEB FR-AFSSAPS-TO20216806. A 34-year-old female patient received bnt162b2 (COMIRNATY), intramuscular, administered in Arm Left on 29Jul2021 (Batch/Lot Number: unknown) as dose number unknown, single for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 03Aug2021, the patient experienced early miscarriage. The spontaneous miscarriage was in early pregnancy (1st trimester, without further details). The outcome of the event was unknown. No follow-up attempts are possible. Information on batch/lot number cannot be obtained.


VAERS ID: 1678476 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-28
Onset:2021-08-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Eczema
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CAPFIZER INC202101023392

Write-up: Patient has severe Eczema; Difficulty to breathe out; This is a spontaneous report from a contactable consumer (Pfizer Colleague). A 13-year-old female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on 28Jul2021 (at age of 13 years old) as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously took first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot number was not reported), as single dose for COVID-19 Immunization. Had 2nd shot on 28Jul and on 03Aug, difficulty to breathe out. Patient has severe Eczema. The outcome of the events was unknown. The lot number for [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1679491 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-30
Onset:2021-08-03
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE6975 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Extrasystoles
SMQs:, Tachyarrhythmia terms, nonspecific (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC202101088850

Write-up: Extrasystoles; This is a spontaneous report from a non-contactable physician downloaded from the Medicines Agency (MA) EudraVigilance-WEB, company number DE-PEI-202100170017. A 16-year-old male patient received bnt162b2 (COMIRNATY; Batch/Lot Number: FE6975), via an unspecified route of administration on 30Jun2021 (at the age of 16-year-old) as dose number unknown, 0.3 ml single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced extrasystoles on 03Aug2021. The event was reported as serious since it caused hospitalization on an unspecified date. Outcome of event was unknown. No follow-up attempts are possible, No further information is expected.


VAERS ID: 1687876 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE9174 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Fatigue, Pain, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none, Comment: The patient did not have any relevant medical history or concurrent conditions
Allergies:
Diagnostic Lab Data:
CDC Split Type: IEPFIZER INC202101125191

Write-up: Ache; General tiredness; Heavy chest / Heavy chest- Feeling like something was leaning on chest squashing it; Heart racing; This is a spontaneous report from a contactable consumer or other non hcp downloaded from the regulatory authority-WEB, regulatory authority number IE-HPRA-2021-082506, Safety Report Unique Identifier [IE-HPRA-CVARR2021081316918]. A 17-years-old female patient received first dose of bnt162b2 (COMIRNATY, formulation: Solution for injection, Lot number: FE9174), via an unspecified route of administration on 03Aug2021 (at the age of 17 years) as dose 1, single for covid-19 immunization. The patient did not have any relevant medical history or concurrent conditions. The patient was not taking any concomitant medication. It was stated that, on the same day of administration, i.e., on 03Aug2021, the patient experienced heart racing. Then 20 hours later, on 04Aug2021, the patient experienced heavy chest. It was reported that the patient did not experience heavy chest on 05Aug2021, but the symptom resumed on 06Aug2021 and it was further described as something leaning on chest, squashing it. Then 06 days later, on 09Aug2021, the patient experienced general tiredness and aches. It was reported that the patient had not returned to pre-vaccine health. All the events were reported as serious with seriousness criteria as Disabling/Incapacitating (disability). The patient was treated with Panadol (paracetamol) over the course of a few days (corrective). On 08Aug2021, the patient attended out of hours GP service, was advised it was a side effect of vaccine and was advised to continue the use of Panadol (paracetamol). The outcome for all the events was reported as not recovered, at the time of report (at the time of reporting, the symptoms had persisted for 9 days and symptoms were continuing). No follow-up attempts are possible. No further information is expected.


VAERS ID: 1688164 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF4204 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure decreased, Blood pressure measurement, Body temperature, Feeling abnormal, Hyperhidrosis, Oxygen saturation, Presyncope
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Mitral valve incompetence (only regular follow-up visits.)
Allergies:
Diagnostic Lab Data: Test Date: 20210803; Test Name: Blood pressure; Result Unstructured Data: Test Result:100/56 mmHg; Test Date: 20210803; Test Name: Blood pressure; Result Unstructured Data: Test Result:119/90 mmHg; Comments: After observation; Test Date: 20210803; Test Name: Blood pressure; Result Unstructured Data: Test Result:114/68 mmHg; Comments: last Blood pressure (after 30 minutes); Test Date: 20210803; Test Name: Body temperature; Result Unstructured Data: Test Result:36.4 Centigrade; Comments: before the vaccination.; Test Date: 20210803; Test Name: SpO2; Test Result: 98 %
CDC Split Type: JPPFIZER INC202101119736

Write-up: anaphylaxis; 100/56 mmHg / Blood pressure decreased; Feels poorly; Sweaty; Vasovagal reflex; This is a spontaneous report from a contactable physician received from the regulatory authority. Regulatory authority report number is v21125018. A 17-year and-old female patient received the first dose of bnt162b2 (COMIRNATY, Solution for injection, Lot number FF4204, Expiration date 31Oct2021) via an unspecified route of administration on 03Aug2021 17:51 (at the age of 17 years old) as a dose 1, single for COVID-19 immunization. Body temperature before vaccination was 36.4 Centigrade. Patient''s history according to the Vaccine Screening Questionnaire (including underlying diseases, allergies, vaccinations received or diseases developed within the last month, medications used, past adverse drug reaction history, and growth status) included that Mitral valve incompetence (only regular follow-up visits). The patient''s concomitant medications were not reported. On 03Aug2021 around 18:06 (same day of the vaccination), the patient experienced Feels poorly, Sweaty, and Blood pressure decreased. On 03Aug2021, (same day of the vaccination), the outcome of the event was recovered. The course of the event was as follows: After the patient received the COMIRNATY, during observation (after around 15 minutes at 18:06), the patient felt poorly, sweaty occurred when the patient was 100/56 mmHg, SpO2 98%. The patient received observation at supine, lower limb lifted. After observation became 119/90 mmHg, last Blood pressure (after 30 minutes), 114/ 68 mmHg. The reporting physician classified the event as non-serious. There was no other possible cause of the event such as any other diseases. The causality between the event and bnt162b2 as unassessable. Reporter''s comment: Suspected intramuscular injection of vasovagal reflex (determined to be probably anaphylaxis).; Reporter''s Comments: Suspected intramuscular injection of vasovagal reflex (determined to be probably anaphylaxis).


VAERS ID: 1688177 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY3860 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure decreased, Blood pressure measurement, Body temperature, Bradycardia, Feeling cold, Heart rate, Heart rate decreased, Loss of consciousness, Oxygen saturation, Pallor, Peripheral coldness, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Orthostatic dysregulation (Orthostatic dysregulation was suspected.)
Allergies:
Diagnostic Lab Data: Test Date: 20210803; Test Name: Blood pressure; Result Unstructured Data: Test Result:88/47; Test Date: 20210803; Test Name: Body temperature; Result Unstructured Data: Test Result:36.5 Centigrade; Comments: before vaccination; Test Date: 20210803; Test Name: heart rate; Result Unstructured Data: Test Result:45; Test Date: 20210803; Test Name: SPO2; Test Result: 97 %
CDC Split Type: JPPFIZER INC202101120164

Write-up: no Consciousness for a moment; Bradycardia; Vasovagal reflex; Complexion ill; Feeling cold; Cold extremities (+); BP 88/47; HR 45; This is a spontaneous report from a contactable physician received from the Regulatory authority report number is v21124972. A 12-year-old male patient received bnt162b2 (COMIRNATY), dose 1 via an unspecified route of administration on 03Aug2021 11:50 (Batch/Lot Number: EY3860; Expiration Date: 31Aug2021) (at the age of 12 years) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included orthostatic intolerance (Previously, the patient presented a symptom by which Orthostatic dysregulation was suspected). The patient''s concomitant medications were not reported. The patient experienced no consciousness for a moment, bradycardia, vasovagal reflex, complexion ill, feeling cold, cold extremities (+), bp 88/47, hr 45, all on 03Aug2021 11:55 (assessed as medically significant) with outcome of recovered on 03Aug2021. Therapeutic measures were taken as a result of events. On 03Aug2021 at 11:55 (the day of the vaccination), the patient experienced Vasovagal reflex. On 03Aug2021 (the day of the vaccination), the outcome of the event was recovered. The course of the event was as follows: After receiving COMIRNATY intramuscularly, the patient was in a chair. Within about 5 minutes, the patient developed Complexion ill, no Consciousness for a moment, and the patient laid. Then experienced Feeling cold, Bradycardia, and was moved from the waiting room to the treatment room. The patient was conscious but had Complexion ill, Cold extremities (+). BP 88/47, HR 45, SpO2 97%. Considering the symptoms would be Vasovagal reflex, IV fluids was performed, and METLIGINE (2 mg) was orally taken. As the symptoms were abated in about 1 hour, the patient walked back to home on his own. The reporting physician classified the event as non-serious and assessed that the event was related to bnt162b2. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: Previously, the patient presented a symptom by which Orthostatic dysregulation was suspected; it was considered that there was a factor that could easily cause Vasovagal reflex. No follow-up attempts are possible. No further information expected.


VAERS ID: 1688722 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042D21A / 1 LA / OT

Administered by: Unknown       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TEGRETOL
Current Illness: Brain tumor (Cavernous Angioma)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CAMODERNATX, INC.MOD20213

Write-up: I had 2 seizure with vaccine within 4hr (4PM) & 7hrs (7PM) after the shot was given 03Aug2021); This spontaneous case was reported by a consumer and describes the occurrence of SEIZURE (I had 2 seizure with vaccine within 4hr (4PM) & 7hrs (7PM) after the shot was given 03Aug2021)) in a 49-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 042D21A) for COVID-19 vaccination. Concurrent medical conditions included Brain tumor (Cavernous Angioma). Concomitant products included CARBAMAZEPINE (TEGRETOL) for Seizures. On 03-Aug-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 03-Aug-2021, the patient experienced SEIZURE (I had 2 seizure with vaccine within 4hr (4PM) & 7hrs (7PM) after the shot was given 03Aug2021)). At the time of the report, SEIZURE (I had 2 seizure with vaccine within 4hr (4PM) & 7hrs (7PM) after the shot was given 03Aug2021)) outcome was unknown. For mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular), the reporter considered SEIZURE (I had 2 seizure with vaccine within 4hr (4PM) & 7hrs (7PM) after the shot was given 03Aug2021)) to be possibly related. No treatment information was reported. Consumer was not able to share 1st dose information for COVID-19 vaccine.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested. Of note, the event was assessed as non-serious. Based on medical judgement and the lack of evidence of seriousness from a clinical or regulatory standpoint, the event is not considered serious. Moreover, the patient''s medical history of Cavernous Angioma is a confounding factor that may play a possible contributory role.


VAERS ID: 1701251 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2752 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abortion induced, Blood pressure measurement, Body temperature, Exposure during pregnancy, Oligohydramnios, Premature rupture of membranes, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? Yes
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: Test Name: blood pressure; Result Unstructured Data: Test Result:normal; Test Name: body temperature; Result Unstructured Data: Test Result:apyretic
CDC Split Type: ESPFIZER INC202101174679

Write-up: Premature rupture of membranes; severe oligoamnion/This situation supposes a pregnancy classified as "unviable" by not having amniotic fluid; Drug exposure during pregnancy, second trimester/in the 20th week of gestation; Abortion/A legal pregnancy interruption was carried out 16Aug2021 without incident; Bleeding vaginal/Slight bleeding; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB ES-AEMPS-986657. A 35-year-old female patient received BNT162B2 (COMIRNATY), via an unspecified route of administration on 03Aug2021 (Lot Number: FF2752, at the age of 35-year-old) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced drug exposure during pregnancy, second trimester on 03Aug2021, premature rupture of membranes on 04Aug2021, abortion on 16Aug2021, and bleeding vaginal on 16Aug2021. The clinical course was as follows: A 20 weeks pregnant woman who was admitted on 04Aug2021 due to premature rupture of membranes. Echo single fetus in breech position, positive fetal beat, normoinserted placenta, severe oligoamnion. Patient with the aforementioned history who was admitted after premature rupture of the membranes a week ago. She was in the 20th week of gestation. This situation supposes a pregnancy classified as "unviable" by not having amniotic fluid and not presenting the ideal conditions for the correct development of the fetus. The fetus was still alive but pregnancy and healthy development was unfeasible. A legal pregnancy interruption was carried out 16Aug2021 without incident. She was fine. Apyretic, Slight bleeding. No pain. On 16Aug2021, patient was put on anti-D immunoglobulin. Apyretic and normotensive. The patient underwent lab tests and procedures which included blood pressure: normal, body temperature: apyretic. All events was considered as life-threatening. The outcome of the events "Abortion/A legal pregnancy interruption was carried out 16Aug2021 without incident" and "Bleeding vaginal/Slight bleeding" was recovered on unspecified date in 2021, for other events was recovering.


VAERS ID: 1701359 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE2296 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Bronchitis, Dyspnoea, Pyrexia, Superinfection bacterial, Vaccination site pain, Viral tonsillitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210806; Test Name: Body temperature; Result Unstructured Data: Test Result: 39.5 Centigrade
CDC Split Type: FRPFIZER INC202101142876

Write-up: Bronchitis; tonsilitis/viral angina; bacterial superinfection; fever of 39.5 C; breathing difficulties; Vaccination site pain/intense pain for 48 hours at the vaccination site; This is a spontaneous report from a contactable consumer (patient) downloaded from the Medicines Agency (MA) EudraVigilance-WEB. The regulatory authority number is FR-AFSSAPS-NC20213779. A 17-year-old female patient received BNT162B2 (COMIRNATY Solution for injection), intramuscular in the left arm, on 03Aug2021 (Batch/lot number: FE2296), at age 17 years old, as dose 1, single, for COVID-19 immunisation. Relevant medical history and concomitant medications were not reported. On 03Aug2021, the patient experienced vaccination site pain/intense pain for 48 hours at the vaccination site. On 06Aug2021, the patient experienced tonsilitis/viral angina, bronchitis with fever of 39.5 C and breathing difficulties, requiring medical attention. The events resulted to physician''s office visit. Upon consultation, the patient was prescribed with paracetamol for fever and pain, and antibiotic therapy with azithromycin for tonsilitis/viral angina and bronchitis and in case of bacterial superinfection. The patient recovered from vaccination site pain/intense pain for 48 hours at the vaccination site on an unspecified date. The outcome of the remaining events was not recovered. The health authority assessed this report as serious (medically significant). Note from pharmacovigilance: Accountability score(s) established without prejudice to the elements of investigation which could be carried out within the framework of legal or amicable compensation procedures. Nutrition Health No. 84/50, 24Jan1985. Published in Therapies 2011; 66(6): 517-525) No follow-up attempts are possible. No further information is expected.


VAERS ID: 1705439 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE7051 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Type I hypersensitivity
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Hypersensitivity (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to animal (Rabbit hair allergy); Allergy to chemicals
Allergies:
Diagnostic Lab Data: Test Name: SARS-CoV-2 test; Test Result: Negative
CDC Split Type: FRPFIZER INC202101148815

Write-up: Hypersensitivity type I/redness in the thighs,face,neck /burning sensation and pruritus/swelling of the lower lips,cheeks, face/itching; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority Report Number: FR-AFSSAPS-LL20215372. A 15-year-old female patient who received a first dose of BNT162B2 (COMIRNATY) Pfizer vaccine (lot#FE7051), at the age of 15 years old, Intramuscular on 03Aug2021 in the left arm for covid-19 immunization. Medical history included Rabbit hair allergy, Reaction to using shampoo. Concomitant drug was not reported. Patient experienced Hypersensitivity type I with vaccine: 6 hours later she presented linear redness in the thighs with a burning sensation and pruritus, taking Aerius didn''t change anything. The redness spread to the back and arms prompted a consultation around 6:00 p.m. in the hospital emergency room. During the transfer the redness spread to the face and the family noticed swelling of the lower lips and cheeks. Passage to the emergency room at 6:41 pm: treatment with Polaramine then exit. Return to the emergency room 1 hour after discharge (11:41 p.m.) for redness of the neck and face, recurrence of itching and swelling of the face. Treatment prescribed for the next 15 days with Polaramine 2mgx4. Today 04Aug2021 at 12:37 pm persistence of pruritus which affects more particularly the face and neck despite taking the treatment. Outcome of the event was not recovered. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1519310 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Laboratory test, Pericarditis, Pleural effusion
SMQs:, Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: pepcid,quercetin, vitamin C, chelated zinc, biotin, vitamin D-3, co-q-10, melatonin, simvastatin, probiotic, preservision, mucas relief, one a day vitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Medical Center has results of all tests Dr at Hospital have exam results
CDC Split Type:

Write-up: June 19 2021 diagnosed with Perycarditis, treatment antiinflammatory medicines and pain killers, lasted until week of July 2 when diagnosed with puerleffussion As of this date still experienceing weak condition


VAERS ID: 1519501 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-30
Onset:2021-08-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye irritation, Fatigue, Somnolence, Yawning
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Hypoglycaemia (broad)

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

Write-up: 07/30/21 @20:00hrs = 1st dose/ 0 complications. 07/31/21 (2nd day/night) = 0 complications. 08/01/21 (3rd day/night) = 0 complications. 08/02/21 (4th day, @0500hrs) = Extreme Exhaustion, even with 7 hrs of sleep prior to waking up. The feeling is very similar to taking too much Melatonin or Benadryl. Sleepiness, exhaustion, eyes burning, yawning, etc.


VAERS ID: 1519522 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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: n/a
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: About 20 minutes after the vaccine, she came up to the pharmacy and said she had numbness/tingling in her left arm and face. We observed her for about 25 more minutes and symptoms didn''t seem to change. The injection site looked normal. She wasn''t having any trouble breathing and was very talkative and active. Told her if things progressed throughout the day to go see the doctor.


VAERS ID: 1519545 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-31
Onset:2021-08-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Breast swelling, Hypoaesthesia, Lymphadenopathy, Pharyngeal swelling, Swelling of eyelid
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Olmsartin HCTZ40-25mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Softball sized enlarged right lymph node under right arm, right breast double in size, right eye swollen shut, no feeling in right fingers, right side swollen gland in throat.


VAERS ID: 1519563 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-08-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0719 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 20mg
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes


VAERS ID: 1519575 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 4 RA / IM

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

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

Write-up: Pt received 2 Pfizer covid 19 vaccines in March and April of 2021. Pt returned for another vaccine, claiming it was his first vaccine, on 12 July 2021. Pt was given the pfizer vaccine and a vaccine card. Today, pt returned for his "second" shot, which was really his 4th shot. Pt presented the card he received on 12 July and was given a 4th dose of pfizer covid 19 vaccine.


VAERS ID: 1519587 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Allergy: Tree nuts, no all to medicaions. No hx anaphylaxis
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received second dose of Pfizer 7 days prior to scheduled second dose. NO symptoms or adverse reactions noted. observed for 15 minutes with EMS. Medical Consult on site counseled patient on signs and symptoms of when to call PCP. Observed leaving with parent with no signs of distress. No treatment given by EMS, no transport to hospital needed.


VAERS ID: 1519618 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-25
Onset:2021-08-02
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, COVID-19, Condition aggravated, Fibrin D dimer increased, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clonidine, Demeclocycline, Toradol, Chloricon, Lipitor,
Current Illness: unknown
Preexisting Conditions: Cardiac, back pain
Allergies: KNA
Diagnostic Lab Data: Covid swab in ED only testing
CDC Split Type:

Write-up: January 28, 2021 Covid vaccine #1 February 25, 2021 Covid vaccine #2 8/2/2021- Patient Came into ED for back pain, came in with pain and said she had a fever 2 weeks ago of 103. Rule out ediology with Covid screen, high D-Dimer. Covid positive and patient admitted.


VAERS ID: 1519631 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Malaise, Pallor, Retching
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Intuniv
Current Illness: n/a
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 2min after administration, patient said he does not feel well. He said he felt light-headed and was looking pale. We sat him down again and gave him cold water to sip. He looked like he was going to pass out. Pulse was normal. He started to gag like he was about to vomit but did not vomit. We called the ambulance and they arrived to check on him. He was feeling much better and stats within normal limits. His mom came to drive him home.


VAERS ID: 1519673 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-01
Onset:2021-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Woke up the morning after with a racing heart at 100+ BPM and shortness of breath


VAERS ID: 1519677 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-28
Onset:2021-08-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Respiratory tract congestion
SMQs:

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

Write-up: Employee calling to report a reaction after receiving a COVID-19 vaccine. Vaccine Name - Pfizer Vaccine Date - 7/28/2021? Is this your first or second dose- First Date of symptom onset - ? 8/2/2021 Symptoms - ? Headache, congestion, and fatigue Last day of work and shift - ? Unknown Home remedies- Tylenol Extra strength 500 mg X 2 Any improvement- Employee just took it so not as of yet. Recommendation- Advised employee to take Tylenol Extra Strength 500 mg per package instructions and if symptoms not resolving or get worse to call us back. Employee voiced understanding Employee of information ? Yes Employee voiced any concerns ? No Employee?s questions answered to employee?s satisfaction -Yes


VAERS ID: 1519681 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-30
Onset:2021-08-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (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: N/A
Current Illness: Sinus Infection
Preexisting Conditions: Asthma
Allergies: Penicillian/ Amoxicillian
Diagnostic Lab Data: None
CDC Split Type: unknown

Write-up: Vertigo,


VAERS ID: 1519690 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-31
Onset:2021-08-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine and birth control Blisovi 24 fe
Current Illness: None
Preexisting Conditions: None
Allergies: Codeine, penicillin, and tree nuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever, headache, cough, nausea, body aches, cold chills, runny nose


VAERS ID: 1519713 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-23
Onset:2021-08-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Vertigo
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (narrow), 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: Errin birth control Levothyroxine Naproxen
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Experiencing vertigo mainly when laying down and turning over to my side. I get dizzy when leaning my head to the side while looking at something, pickup something. Also experience numbness in the left side of my jaw and below my nose. No treatment. It happens for a few seconds at a time.


VAERS ID: 1519715 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Oral pruritus, Pruritus, Skin burning sensation, Throat irritation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt reported "slight burning and itching" on skin; described it as "all over, on my arms, my back, and my face". Upon inquiry, denied any respiratory distress or swelling / itching in throat or mouth. Stated the itching sensation started approx 5 minutes s/p injection. No hives or erythema or swelling upon observation. Per standing order, this RN administered 1 tab Cetirizine Hcl, PO x1 @ 12:30PM. Supervisor aware. Pt initially staying for 15 minutes observation s/p injection; however, encouraged by clinic supervisor to stay until 12:45PM for further monitoring. Pt compliant.


VAERS ID: 1519721 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-08-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NO ADVERSE REACTION REPORTED BUT PATIENT WAS ONLY 15 AND SHOULD NOT OF RECEIVED MODERNA VACCINE


VAERS ID: 1519732 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient arrived for 2nd dose. It was not noted that he arrived one week early for his second dose. His first dose had been administered while he was inpatient at the local hospital. His second dose was due 8/9 and it was administered today in error.


VAERS ID: 1519747 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-28
Onset:2021-08-02
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Myalgia
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None? I have Muscle aches daily since having received the Covid vaccine. Just wanted to report.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I have Been experiencing muscle aches since having gotten the second vaccine in June. It is now August and I continue Our to have muscle aches. Very strange


VAERS ID: 1519754 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

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

Write-up: Patient received first dose of Moderna and second dose of Pfizer


VAERS ID: 1519810 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot -2012
Other Medications: One-a-day women''s multivitamin. D3.
Current Illness: sinus issues.
Preexisting Conditions: lupus.
Allergies: dust. mold. chocolate.
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Extreme nausea, tiredness, dizziness, injection site pain. Took a Tylenol 500mg and Meclizine HCL 25mg.


VAERS ID: 1519814 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
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: n/a
CDC Split Type:

Write-up: Vaccine administration error. Vaccine was not diluted with sodium chloride and was given to patient undiluted. 0.3ml of undiluted vaccine given to patient. I attempted to call patient to update about event and left a voicemail. I will continue to contact for update.


VAERS ID: 1519819 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Nausea, Pruritus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, Allegra, Singulair, Nasonex, Azelastine
Current Illness:
Preexisting Conditions: Patient states has chronic hives.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of itching on chest. Chest appears slightly red; Benadryl 50 mg po given. 0846 BP 138/80, HR 83, R 14, SpO2 98%. 0900 c/o nausea; Pepcid 20 mg po given. BP 137/82, HR 82, R 14, SpO2 98%. 1000 - Patient states feels better and okay to go home. She is released home with her husband. She is to call 911 for trouble breathing, itchy throat of fullness in throat.


VAERS ID: 1519820 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site swelling, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: Site: Swelling at Injection Site-Severe, Systemic: swelling of injection site-Severe, Additional Details: swelling on arm immediately after injection


VAERS ID: 1519821 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Guillain-Barre syndrome, Lumbar puncture
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin
Current Illness: high blood pressure , diabetes
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: SPINAL TAP, CT Scans
CDC Split Type:

Write-up: GBS


VAERS ID: 1519824 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

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

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1519828 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Asthenia, Blindness, Deafness, Dizziness, Skin discolouration
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: anxiety , specific fear of needles/injections
Allergies: none
Diagnostic Lab Data: paramedics arrived. check blood pressure, pulse and other vitals. patient was ok.
CDC Split Type:

Write-up: patient felt faint, skin color turned white. patient complained she could not see or hear anything and she felt weak. we assisted patient back into our immunization, placed her on the floor, elevated her feet, and placed a pillow under her head. called 911. within 5 minutes the patient''s color was returning to her face and she was able to see and hear again. it appears the patient had an anxiety attack as a result of the immunization.


VAERS ID: 1519835 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Nervousness
SMQs:, Dementia (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: n/a
CDC Split Type:

Write-up: 1006 BP 157/92, HR 133, R 22, SpO2 98%. Patient stated she felt :funny" but gets nervous at the doctor. 1009 - HR decreasing. 1015 - BP 144/92, HR 92, R 22, SpO2 98%- patient talking and breathing with ease. 1020 - BP 175/91, HR 91, R 20, SpO2 98%. patient reports feeling much better, instructed to hydrate, sent home with husband who is a physician.


VAERS ID: 1519839 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Approximately 2 hours after the vaccination, started experiencing vision changes. She attempted to google similar symptoms but had a hard time reading computer screen. Thinks it may be kaleidoscope vision. Describes it as a blob in the middle of her field of vision that is changing.


VAERS ID: 1519851 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: 1:36pm dizziness. Pt. receiving 1st dose of COVID-19 vaccine. Shows dizziness right away after administration. Pt. has severe allergies to nuts and was recommend to wait 39 minutes after vaccine administration. Pt. refuse to go to hospital and seem stable. Pt. stay extra 10 mins. to discard any complication and verbalize feel better.


VAERS ID: 1519877 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

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

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

Write-up: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Medium, Systemic: Weakness-Severe


VAERS ID: 1519898 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cyanosis, Dizziness, Eyelid function disorder, Hyperhidrosis, Immediate post-injection reaction, Nausea, Pallor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Pt reported feeling nauseous, diaphoretic, dizzy immediately after receiving second dose of Pfizer vaccine around 1033. Per mother, pt looked pale and lips were bluish in color. Ice pack was applied to back of neck, ice water, apple juice brought to patient. RN tried to take BP twice with VS machine and was unsuccessful, pt was sweating more than normal and could not keep eyes open. RN STAT was called immediately. VS were attempted again at 1043 reading the following 74/34 (45), HR 55, SpO2 98% on RA. RN Treatment nurse arrived and patient was placed on gurney and taken to nurse treatment room for further observation. Upon arrival, pt states he is feeling better and mother states pt''s color and lip color has returned to normalcy. VS are taken at 1052 - 101/53 (73) HR 65, SpO2 99% RA. Pt is now drinking apple juice on hospital bed.


VAERS ID: 1519908 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Sensation of foreign body
SMQs:, Anaphylactic reaction (broad)

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

Write-up: After vaccination patient felt lump in throat. RN gave Cetirizine 10mg PO x1, patient felt lump subsided and went home.


VAERS ID: 1519911 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Loss of consciousness, Photopsia
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), Retinal disorders (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient was given Pfizer vaccine and then asked to walk down the hall way to get vitals. While walking down the hallway patient reports that she felt "light headed" and like she was "seeing stars" but did not alert nursing staff. Once patient sat in chair and the MA put blood-pressure cuff on patient''s arm, she started to feel even more faint and she slumped over and briefly lost consciousness. Another MA put ammonia under patient''s nose and she instantly regained consciousness. Patient reported feeling a little weak. Patient drank water and returned to room. Patient was observed for 40 minutes afterwards, no additional syncopal events. Patient left feeling well.


VAERS ID: 1519930 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Hyperhidrosis, Malaise, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (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: None
Current Illness: None
Preexisting Conditions: GERD, Acquired scoliosis, Hx of sexual abuse, Vasovagal syncope
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: @1055 Post vaccination, pt complained of not feeling well, dizzy. Pale. Assisted to the gurney and pt had a syncopal episode, which lasted for about few seconds. No injuries noted. Placed on supine position with feet elevated. Pt became diaphoretic, pale. VS 109/60 HR 70 RR16 100%RA. Left in supine for few minutes. Gradually sitting pt up. Denies nausea. Started introducing PO fluids. Tolerating well. Pt started feeling better, diaphoresis stopped. Per pt, dizziness is better and starting to go away. @1110 Pt drank a juice box and full bottle of water. Pt''s color is better. Denies dizziness. Looking at the phone. Instructed pt to let wife know to meet him by the entrance. Wife is waiting in the parking lot. @1120 Sat pt at the side of the bed with feet dangling. Pt feeling back to baseline. Skin WNL. @1123 Ambulated well. Denies any symptoms. Pt is confident on going home. Wife waiting by the entrance.


VAERS ID: 1519950 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-08-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PA7484 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Disorientation, Dizziness, Migraine, Pruritus, Rash, Rash erythematous, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Sudden Hives, red rash with itching on arms, hands, legs, neck Migraine Headaches x3 days. Dizzy, disoriented


VAERS ID: 1519952 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-29
Onset:2021-08-02
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 UN / IM

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

Write-up: Our billing associate identified an issue from 3/29/21 and 4/21/2021. On 3/29 the patient received a Moderna vaccine. She received a call 3 weeks later from our automatic message system saying she should be due for a 2nd vaccine. She arrived on 4/21/21 and received Pfizer. Wrong on 2 levels, 1st our clinic didn''t catch that she was a week early and 2nd we gave Pfizer NOT Moderna. I contacted the patient and she verified this was correct. She said she was feeling ok and never experienced any issues. Just thought I should document since our clinic messed up


VAERS ID: 1519961 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: gave vaccine that had expired 20 minutes prior to administration.


VAERS ID: 1519967 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

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

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

Write-up: Moderna vaccine administered to a 14 year old. No adverse effects at this time.


VAERS ID: 1520041 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dysphonia, Nausea, Oropharyngeal pain, Throat clearing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Had stopped taking her rheumatoid arthritis medication a week prior per her doctor''s recommendation. Motrin PRN.
Current Illness: Rheumatoid arthritis
Preexisting Conditions: Rheumatoid arthritis
Allergies: Bee stings, peanuts, TNZ (medication per pt)
Diagnostic Lab Data:
CDC Split Type:

Write-up: On arrival to pt''s house, spoke with family about possible side effects of vaccine. Pt stated she did have previous allergic reactions with anaphylaxis but spoke with PCP. Pt agreeable to pfizer vaccine lot ew0185 to L arm. Pt reported dizziness and nausea about 5 to 10 minutes after receiving vaccine. Family got pt water and cold cloth. About 10 minutes later pt reported chest heaviness. This nurse drew up epinephrine but pt did not feel epi was needed just yet as she could still breath fine and opted to take inhaler with some relief instead. Ten minutes later pt reported soar throat, hoarseness, and chest heaviness again. While pt was talking with this nurse, she began to be unable to complete full sentences and was clearing her throat. No cyanosis noted. Pt stated "it''s time" and this nurse agreed and administered 0.3mg of epinephrine into the pt''s R thigh @ 1421. 911 was notified. Vital signs were taken. 97% o2 on room air, heart rate 90, breaths per minute 18, blood pressure 128/94. Pt experienced near immediate relief from symptoms. Alert team remained to monitor pt and await EMS. EMS arrived @ 1432. Pt able to ambulate to ambulance with EMS to be checked out and taken to hospital for observation.


VAERS ID: 1520057 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-24
Onset:2021-08-02
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: morbid obesity (bmi 57), OSA on CPAP
Preexisting Conditions: OSA on CPAP
Allergies: sulfa (hives), opioids (GI intolerance)
Diagnostic Lab Data: SARS-CoV-2 +
CDC Split Type:

Write-up: fully vaccinated patient contracted covid from caregiver symptoms: fever, cough, chills, headache, fatigue


VAERS ID: 1520058 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: according to mom, patient was given an anti-anxiety medication prior to vaccination due to past history
Current Illness: history to seizure per mom
Preexisting Conditions: not aware
Allergies: none according to mom
Diagnostic Lab Data: heart rate was 97. oxygen level was 98
CDC Split Type:

Write-up: Female parent informed us patient had history of anxiety; stating she had no other medical conditions or allergies. Immediately after patient received vaccine, patient started shaking as if she had convulsion. mom said patient never shook before but she had history of seizure. mom stated patient was given an anti anxiety medication before hand. patient was conscious, normal heart rate (97), and oxygen level (98). we called 911 within 30 seconds. Fire department and EMT were on site within 4 minutes. They stayed for about 20 minutes. Patient recovered enough and as mom insisted, they didn''t take her in.


VAERS ID: 1520070 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-31
Onset:2021-08-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cough, Fatigue, Oropharyngeal pain, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: About 36 hours after injection, woke up with sore throat, runny nose, dry cough, chest pain and fatigue


VAERS ID: 1520073 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Confusional state, Dizziness, Eye movement disorder, Hypotonia, Nervousness, Pallor, Presyncope, Somnolence, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (narrow), 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: NO
Current Illness: None
Preexisting Conditions: None
Allergies: NO
Diagnostic Lab Data: performed by ems staff
CDC Split Type:

Write-up: Patient reported feeling very nervous about the vaccine prior to receiving. Immediately after administration, his eyes closed/fluttered and his head tilted back. He reported feeling very drowsy and dizzy. He appeared very pale, limp, confused and had tremors, but he remained responsive. We offered him some gatorade which he had some sips of. We then assisted him out of the chair, and he laid down on the ground. We dialed 911, and EMS was already in the store so they immediately came over to assist. It was determined patient''s blood pressure, blood glucose, and blood oxygen levels were within normal limits and that he most likely had a had a vasovagal response that resulted in his symptoms. He started feeling some better after about 15 minutes and declined transport to a hospital. He had a friend pick him up so that he did not have to drive. We checked with him 6 hours later and he reported having slept several hours as well as overall feeling better.


VAERS ID: 1520077 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / 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: Lisinopril 20 mg po q am; Ibuprofen 800 mg po bid
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No adverse events at the moment- however the inmate was inadvertently laid in as needing his first dose, however he received his first dose on 7/20/21- his card looked like he got it on 7/2/21 as the 0 was not legible. He received the dose today too soon. No complaints at present time


VAERS ID: 1520085 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Condition aggravated, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

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

Write-up: 15 mins after first COVID-19 shot, pt developed CP, left arm numbness and tingling. denies sob.


VAERS ID: 1520087 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back injury, Dizziness, 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), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: After receiving the Janssen Covid-19 Vaccine, patient stood up and got light headed and passed out. His brother caught him and guided him to the floor. Patient hit his back on the way down. The patient began to seize after being on the ground. He then got up and sat in a chair and proceeded to have another seizure. The EMT was called and patient was evaluated. He went to the hospital to have further evaluation.


VAERS ID: 1520090 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: I gave pt his 1 st COVID vaccine dose about 315 to 320pm in his left arm. He got up and stood next to his partner while I gave her shot. The pt lost his footing and fell over. He banged his head on the pharmacy door; however, he stood right up and said he think he just fainted. We sat him down in the immunizing chair and he sat for about 10 minutes. He said he felt ok right away but his head was soar from the fall. He did not have any physical cuts or lacerations on his scalp. He said not to call 911 and he left on his own with his partner after about 15 minutes.


VAERS ID: 1520094 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Erythema, Feeling abnormal, Palpitations
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient reports last time she had a vaccine with the tetanus she had joint pains within 1 hour
Other Medications: Azelastine HCl 0.1 % Solution Azelastine-Fluticasone (DYMISTA) 137-50 MCG/ACT Suspension Beclomethasone Diprop HFA 40 MCG/ACT AEROSOL, BREATH ACTIVATED Cholecalciferol (VITAMIN D3) 1.25 MG (50000 UT) Cap Clobetasol Propionate 0.05 % Cream C
Current Illness: Mild persistent asthma with acute exacerbation Allergic rhinitis due to dust mite Allergic rhinitis due to mold Allergic rhinitis due to animals Mild persistent asthma without complication
Preexisting Conditions: Asthma Ehlers-Danlos Syndrome Elevated IgE level- intolerance to allergy immunotherapy
Allergies: Sulfa Antibiotics ; allergy to Pollen; Food intolerences
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 1st dose of COVID vaccine (Moderna) IM in Left arm in medical facility on 1st floor here medical facility. Patient was brought by staff member to Allergy office area to wait due to history of anaphylaxis. Patient utilized emergency phone outside of office at approximately 1:38pm. Patient c/o of heart racing and chest tightness, face and arms noted reddish in color. BP 144/100 P143 SpO2 99% doctor immediately assessed patient and 0.3 ml of Epinephrine SQ was administered in right arm. 1:42pm Benadryl 50 mg IM administered in right arm. 1:50pm Patient reassessed by doctor immeidately BP 141/85 P103 SpO2 98% patient stated she is feeling better, noted face and arms now paler in color. Patient offered and accepted can of orange juice. 2:05pm Patient reassessed by doctor. 2:20pm BP 133/85 P107 SpO2 98% Patient reassessed by doctor 2:30pm Patient reassessed by doctor Administered Depo-Medrol 40 mg IM right arm BP 129/78 P102 SpO2 99% Patient stated she is feeling better however feels a bit cloudy. 3pm BP 129/74 P 74 SpO2 99% 3:15pm BP 124/80 P 101 SpO2 98% Patient was assessed by doctor and left office in no apparent acute distress. Patient advised not to drive after dose of Benadryl, patient in agreement, patient''s father gave patient ride home


VAERS ID: 1520099 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not reported
Current Illness:
Preexisting Conditions: anxiety, sympathetic nervous system issues
Allergies: not reported
Diagnostic Lab Data: BP 108/52 and HR 84 directly following syncope; lung sounds clear throughout; no reports of itching, rash, difficulty breathing; pupils dilated; A&Ox4 BP 114/52 and HR 64 15 min later
CDC Split Type:

Write-up: Pt became diaphoretic, pale and experienced syncope while sitting


VAERS ID: 1520126 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 3 LA / IM

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

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

Write-up: Patient received Moderna first dose in April. Patient came back July 12 asking for 1st dose Pfizer. Patient received 2nd dose of Pfizer today (8/2/21) Patient states that she did not mention that she had the Moderna because she called in and someone told her she had to start over and get a 1st dose again. The patient was scheduled for 1st dose Pfizer but was documented for second dose pfizer. documenter didn''t notice the vaccine type only that a 1st dose was given. the incident was noticed today because when documenting patient''s 2nd dose there was already a second dose in the system.


VAERS ID: 1520128 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Dizziness, Feeling hot, Malaise
SMQs:, Anticholinergic syndrome (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: K-Dur supplement clonopine 0.5 mg 1 tab at HS
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa, tetracycline, ampicillan, macrodantin, effexor
Diagnostic Lab Data: After staying in our clinic about 1hour - she went to the ER as continued to feel weak.Reports she had an "ill feeling". We did monitor her and her blood pressure was 140/72, 140/80 and then 158/88. She reports her normal blood pressure is 110/70.
CDC Split Type:

Write-up: 5 minutes after getting shot she felt hot and faint. Also felt weak like she needed to lay down.


VAERS ID: 1520139 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dysstasia, Fall, Head injury, Mouth haemorrhage, Syncope, Tongue injury
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt fainted and fell over the side of the arm chair about 10 minutes post vaccination. He hit is head on the floor. He bit his tongue and was bleeding from the mouth. Pt was dizzy and confused. This was not resolving so 911 was called by the Pharmacy. Fire/Rescue arrived and did assessment. Upon trying to stand, pt fainted again. EMT advised pt be checked out in the ambulance due to consistent presentation of fainting. Pt left with EMT.


VAERS ID: 1520147 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vaccine was given 1 week early should of been administered 8/9/21


VAERS ID: 1520150 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-01
Onset:2021-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Deafness, Head titubation, Hyperhidrosis, Loss of consciousness, Presyncope, Skin discolouration, Unresponsive to stimuli, Vision blurred
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), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient first reported loss of vision (everything turning dark) followed by loss of hearing. Then began to sweat and lose color. She was nodding off and losing consciousness. When she would open her eyes she was not looking at me and was not responding to any questions like she couldn''t see or hear me. After 5-10 minutes we got her lying in the floor with her feet up in a chair and she regained consciousness. Ultimately, we feel it was a vasovagal response.


VAERS ID: 1520157 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-25
Onset:2021-08-02
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin 150 New Chapter Every Man''s One Daily Multivitamin Turmeric Onnit B Complex Zyrtec
Current Illness: Period of feverish illness three weeks after vaccination lasting for a week. Not bedridden. PCR test for covid came back negative on July 21st 2021
Preexisting Conditions: Suspected covid infection early March 2020, 1.5 weeks long, relatively mild symptoms. Tested positive for covid antibodies late March 2020. Felt sick again July 2020, tested positive for covid August 2020. Finally tested negative mid September 2020. Heart pain, sharp and dull developed in the late summer-winter 2020. Pain went away completely December 2020 until post vaccination recurrence. I got a chest x-ray in February 2021 and my GP said he didn''t see any inflammation of the heart or any lung issues.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocarditis recurred one month after 2nd vaccine shot. Going to see the doctor this week.


VAERS ID: 1520159 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Pruritus, Rash, Seizure, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient received the Jonson & Johnson COVID vaccine at 11:37am and was waiting in the lobby for the 15-minute observation period. The patient began to feel dizzy, then short of breath. A code was called and the clinic team responded to the patient. Patient appeared to have a seizure lasting ~90 seconds (patient has known history of seizures) and was unresponsive for 30 - 45 seconds. Was moved to the floor from sitting to prevent a fall. Became responsive after lying on the floor ~15 seconds. Was observed to have a rash on her neck that resolved. Reported that her face felt itchy. 911 was called and fire department arrived on scene. FD escalated to paramedic response and patient was ultimately transported to ED for concern of allergic reaction and seizure. Patient departed unit via ambulance at 12:23pm (38 minute code duration). Vitals: 11:48am: BP 152/95, pulse 112, O2 100% 11:54am: BP 141/84, pulse 80, O2 100% 11:58am: BP 138/85, pulse 79, O2 100% 12:03pm: BP 135/84, pulse 76, O2 96%


VAERS ID: 1520175 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (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: N/A
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient and her husband came into pharmacy for their 1st dose of moderna covid19 vaccine. they expressed that they''re very anxious and nervous about getting the vaccine and waited this far to get it. I gave the patient the shot at 12:40pm and right after the shot she excitedly stated "wow, I did not feel anything at all. thank you!". I then told her to join her husband and have a seat at the post-vaccination monitoring area. At 12:51, I checked her on her and husband. Her husband stated that she was happy when she got out of the room but now it looks like she''s very tired and not responding to him when he asked her some questions. I made a suggestion to give her some water and to have him taking back to our immunization room so it''s more private for her to rest. He had to dragged her into the room while I carried her back. He then said please call paramedics because it seems like she''s passing out. Our pharmacy staff checked with her husband again to make sure he wanted us to dial 911. At soon as he said yes ! please call 911, she suddenly gained consciousness, opened her eyes and started talking and told us she wants a soda. We tried to check her blood pressure with the automated machine and it read 75/57 twice. We gave her some chips and soda to help. She spent over 1 hour in our room then stated she felt much better and left with her husband around 2 pm.


VAERS ID: 1520178 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip swelling, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: pt had a tingling tongue about 30 minutes following the vaccination. pt mom said her lips looked a little swollen. Pt blood pressure was taken and was 119/77 and HR of 76 BPM. She took oral benadryl 10 ml = 25 mg once in the pharmacy, and symptoms resolved after 15 minutes.


VAERS ID: 1520179 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol albuterol (PROAIR HFA) azithromycin (ZITHROMAX) fluticasone (FLONASE) fluticasone-vilanterol (BREO ELLIPTA) guaifenesin (ROBITUSSIN) ibuprofen (MOTRIN) loratadine (CLARITIN) montelukast (SINGULAIR)
Current Illness: n/a
Preexisting Conditions: asthma, seasonal allergies, depression
Allergies: Codiene
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt. had mild generalized itching and requested a benedryl Benedryl given. No other complaints.


VAERS ID: 1520192 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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), 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 3 minutes after receiving her injection, the patient was standing and ready to walk to the waiting area. She got dizzy and passed out. Within a minute, she became alert again. She then remained seated for about a half hour (1st on the floor, then a chair). After about a half hour, she still felt fine and left with her family with instructions to continue to monitor her.


VAERS ID: 1520198 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-14
Onset:2021-08-02
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Headache, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Noninfectious diarrhoea (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: SYMBICORT 160-4.5MCG/ACT AERO INHALER MONTELUKAST SODIUM 10MG TABS FAMOTIDINE 20MG TABS SODIUM FLUORIDE 5000 SEN 1.1-5 TOOTHPASTE ROSUVASTATIN CALCIUM 5MG TABS BISOPROLOL-HCTZ 5-6.25MG TABS GABAPENTIN 300MG CAPS BUDESONIDE 0.6MG 120ML NASAL
Current Illness:
Preexisting Conditions: ASTHMA SINUSITIS GERD COLON POLYPS SCIATICA VITREO-MACULAR TRACTION SYNDROME
Allergies: BACTRIM? INGREDIENTS IN OTC GLUCOSAMINE/CHONDROITIN, SENNA, FISH OIL, AND OTHERS
Diagnostic Lab Data: PENDING PHYSICAL THERAPY AND ENT TESTING OF VERTIGO
CDC Split Type:

Write-up: EXPLOSIVE DIAHRREA 3/24/21 VERTIGO, DIZZINESS, HEADACHE, NAUSEA 3/25/21 DIZZINESS, HEADACHE, NAUSEA FOR 1 WEEK SYMPTOMS RETURNED 10 DAYS AFTER 2ND VACCINATION 4/8/21, CONTINUING SPORADICALLY SINCE


VAERS ID: 1520202 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-31
Onset:2021-08-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient called and is complaining of nausea and vomiting. Patient does not report any other changes in lifestyle or food consumption in the last few days.


VAERS ID: 1520205 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device connection issue, Syringe issue
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: SULFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syringe and needle were not tightly secured resulting in vaccine leaking from syringe. The proportion of the dose could not be estimated. Administer the authorized dose immediately in the left arm.


VAERS ID: 1520224 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Per mom, in the past with flu vaccine, he had the same effect (he fainted after getting vaccine for a minute or two)
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: After getting the vaccine, patient fainted for about 1 minute. Mom told me at that time, this did happen with his flu vaccine in the past. We kept his head between the knees and also laid him down with legs up, he came back to normal within a minute after. Ice pack was also provided per mom''s request. Patient felt really good and normal after. We kept them under observation at pharmacy and he was totally normal.


VAERS ID: 1520228 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stood up after receiving vaccination and fainted into mother''s arms. Patient regained consciousness after a few minutes. 911 was called. EMT arrived and took patient to hospital for evaluation.


VAERS ID: 1520229 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (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: denies
Current Illness: denies
Preexisting Conditions: denies
Allergies: denies
Diagnostic Lab Data: 5:02pm- 127/83, HR 85, R22, O2 99% 5:05pm- 130/82, HR 77, 99% 5:07pm- 126/85, HR 72, 99% 5:10pm- 124/82, HR 75, 99% 5:13pm- 130/84, HR 75, R 18, 99% 5:14pm- EMS arrived
CDC Split Type:

Write-up: MODERNA Received dose at 4:59pm 5:01pm- patient c/o dizzy and fell onto wall then parents caught her before hitting the ground; EMS called. Patient immediately became alert and placed on ground to rest until ambulance arrived. BP, P, O2 remained stable. A/Ox3. EMS assessed and offered to take to hospital- patient refused.


VAERS ID: 1520232 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 4 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, 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: He stated that he just have overall anxiety
Preexisting Conditions: No known chronic condition
Allergies: Per the patient, he does not have any allergies to any medication
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received the vaccine and was advised to stay around 15 minutes to make sure that medical attention can be provided if they need it. The patient stated that he was not anxious before the vaccine. However, the patient stated that after the incident he felt a bit anxious prior to fainting. The patient said that he was trying his best not to think about his anxiety, but the more he thought about it the more he got anxious and the next thing he knows he passed out.


VAERS ID: 1520240 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: Patient should have received Pfizer manufacturer based on age.


VAERS ID: 1520250 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 7+ LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PROZAC 40MG -1 CAPSULE DAILY LORAZEPAM 0.5MG -2 TABS ONCE A DAY
Current Illness: He has cerebral palsy
Preexisting Conditions: Cerebral palsy
Allergies: NONE LISTED
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a episode of syncope and vomiting. Had to call 911, but patient refused to go to hospital. Patient said he has passed out in the past when gives blood.


VAERS ID: 1520255 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Pallor
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (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: penicillin
Diagnostic Lab Data: Blood pressure taken
CDC Split Type:

Write-up: Patient received immunization and proceeded to waiting area for 15 minutes. After a couple minutes, patient was very pale and appeared to be possibly passing out. Patient was transferred to floor with feet elevated. Blood pressure and pulse were taken and were within normal range. Patient''s lips appeared to be turning blue which was alarming. EMS was activated. Patient stayed conscious entire time and kept talking to me. Patient stated that his lips didn''t feel tingly or numb. Right before EMS arrived, patient gained more color and was able to tell me he had a blue slushy drink before he came to pharmacy, which explained blue lips. EMS checked him out and patient sat up in chair for 15 minutes after they left. He was fine and left store on his own.


VAERS ID: 1520259 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zyrtec 5 mg, stool softener
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: accidentally administered vaccine to unauthorized age group (14 yrs old)


VAERS ID: 1520265 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Gaze palsy, Hypotonia, Movement disorder, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness:
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient appeared normal before the vaccination. After administering the vaccine, she was able to walk out of the immunization room to go have a seat in the waiting area. About a minute later her grandma shouted that something was wrong and upon looking at the patient, I saw that her arms were up and rigid, her eyes were rolled to the back of her head, and she was slouched over to one side. I told the technician to call EMS and I went to grab our emergency bag, but she regained consciousness and an epi-pen was not administered. I gave her a coke to drink in case her sugars were low and the patient drank it but then threw up everything about a minute later. The paramedics arrived and took her vitals. They said her blood pressure was about 70/50 so they took her on the stretcher to the hospital to administer fluids to raise her blood pressure.


VAERS ID: 1520267 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Hypoaesthesia oral, Pharyngeal hypoaesthesia
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Levoxyl, sertraline, lyrica
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Shellfish, cinnamon, Imitrex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tongue numbness, throat numbness, difficulty swallowing


VAERS ID: 1520268 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Feeling of warmth and itching
Other Medications:
Current Illness: States she had similar reaction to first dose of covid vaccine
Preexisting Conditions:
Allergies: Vancomycin, Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Before vaccinating patient she reported that she had warm feeling and itching after receiving first vaccine for Covid. She was total she should premedicate with Benadryl before arriving for her second vaccine. She reported that she forgot to take it and I offered that she come back on a day when she had premedicated. Patient stated, "I am here and I don''t want to come back. Just give me the vaccine. 5 minutes after receiving vaccine, patient reported itching. Medicated with Benadryl 25 mg po. Vital sign: BP 133/52, HR 84, RR 16 and pulse ox 95%. Within 10 minutes of receiving Benadryl patient states that her symptoms were resolved. At discharge, BP 152/ 68, HR 92, RR 18 and Pulse ox 99%. Patient discharged with family member


VAERS ID: 1520272 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
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: We inadvertently administered Pfizer to a patient who previously received the Moderna vaccine 7/9/21. Patient was informed and counseled and has not noticed any adverse effects as of yet.


VAERS ID: 1520275 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 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: Denies
Current Illness: Denies
Preexisting Conditions: Denies
Allergies: Denies
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 2nd dose given 6 days before 21 days


VAERS ID: 1520278 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chest discomfort, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ocrevus (DMT)
Current Illness:
Preexisting Conditions: Multiple Sclerosis
Allergies: Dilaudid and Black widow antivenin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was complaining about her chest filling hot after taking the shot, the patient also was complaining that her hands and feet were swelling up. The patient decline all medical assistance. The patient stated that she was a nurse, and she believes her adverse reaction was due to her having Multiple Sclerosis. The patient left on her own, no further actions were taken.


VAERS ID: 1520285 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dizziness postural, Pallor, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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: vitiligo
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt dizzy and lightheaded upon standing up after receiving the vaccine. Patient became very pale and reported foggy vision. The patient was sat down and given some water and juice.


VAERS ID: 1520286 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Altered state of consciousness, Cardio-respiratory arrest, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (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: No illness reported
Preexisting Conditions: unknown
Allergies: NKDA or No vaccine allergies reported during screening.
Diagnostic Lab Data: BP-101/58, Pulse 68, Temp 36.8c, SPO2 100%
CDC Split Type:

Write-up: About three minutes after administering the 1st dose of the Pfizer vaccine the patient fainted to the floor, no head injury was reported. The patient was still alert and oriented, so we placed her in a chair. While in the chair the patient was in and out of consciousness. Since the pharmacy is in a hospital building a Rapid Response code was initiated. Patient became unresponsive for a moment so a Code Blue was initiated. Oximeter was utilized and showed normal readings, patient was still alert. After the physician onsite evaluation was done, patient was taken to the Emergency Room for observation and further testing etc. Patient was in the ER for about an 1.5 hour and was discharged home with a Syncope diagnosis.


VAERS ID: 1520463 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-01
Onset:2021-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Covid virus diagnosed on July 9,2021
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fatigue, headache, fever


VAERS ID: 1520465 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-31
Onset:2021-08-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Smarty Pants Vitamin for men, Nexium and Metoprolol Succ ER 50 mg
Current Illness: none
Preexisting Conditions: High blood pressure
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two days after the shot I developed large, raised, itchy welts all over my body. It was the worse in my groin area.


VAERS ID: 1520475 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

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

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

Write-up: Patient had wanted to receive the Tdap vaccine. We accidentaly gave her the moderna vaccine. She had already received both doses of the pfizer vaccine back in april. We followed up with her doctor, they said just to monitor her for side effects. I followed up with her later today, she said she was only experiencing a headache. I will continue to follow up with her over the next couple days and also next week to see if she is experiencing anything else.


VAERS ID: 1520482 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Fall, Feeling abnormal, Feeling hot, Hyperhidrosis, Pallor, Speech disorder
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient sat in waiting area after administration of Moderna Vaccine. Patient fell to the floor about 7-8 minutes later. I ran to her she was conscious. She was mumbling a bit said she felt hot. I took her temperature was at 98.1 F. Patient said she felt weird she also thought it was her anxiety. She wanted to make sure her son was ok he was sitting next to her.She was able to slowly get up and sat on chair. We fanned her down as she was sweating and was pale. She drank some water. Paramedics were called they asked her if she wanted to go to the hospital she said she was ok. Her uncle arrived and took her home.


VAERS ID: 1520488 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 RA / IM

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

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

Write-up: Pt received Moderna at a Facility in April in error, she 16 and only eligible for the Pfizer vaccine. Pt''s parents have been inquiring about receiving the 2nd dose but could not obtain any information. They called the Pharmacy after being referred. RPh''s did research and found CDC guidance allowing for Moderna use in those under 18 if the first dose had been given inadvertently. Parents were informed and patient received 2nd dose of Moderna.


VAERS ID: 1520489 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-01
Onset:2021-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BLOOD PRESSURE AND CHOLESTEROL MEDICATIONS
Current Illness: HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL
Preexisting Conditions: HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL
Allergies: SULFA DRUGS
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: PATIENT WAS GIVEN A DOSE IN THIS PHARMACY AS HE TOLD US HE HAS NOT GOTTEN THE COVID SHOT YET. HE CAME BACK AFTER ONE DAY AND SHOWED A VACCINATION CARD WITH 2 PREV DOSES AT CVS FROM JAN AND FEB 2021


VAERS ID: 1520498 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Fatigue, Headache, Injection site erythema, Joint stiffness, Malaise, Muscle tightness, Neck pain, Pain, Vaccination site pain
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), 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: NA
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: CLARITHROMYCIN, HYDROCODONE, PREDNISONE
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: WITHIN 5 MINUTES OF ADMINISTRATION PATIENT NOTED PAIN/TIGHTNESS IN LEFT SHOULDER JOINT. AFTER 10-15 MINUTES THE PAIN SPREAD TO BACK OF PT''S NECK. HE DESCRIBED THE PAIN AS A STABBING PAIN MIXED WITH A BURNING/STINGING SENSATION IN THE LEFT SHOULDER/NECK AREA. AFTER THE INITIAL OBSERVATION PERIOD PATIENT SHOPPED IN THE STORE A BIT AND BEGAN TO EXPERIENCE TIGHTNESS IN THIGH MUSCLES, HEADACH, FATIGUE , AND MALAISE. THE PATIENT TOOK TYLENOL UPON ARRIVING HOME AND SAID THE SHOULDER PAIN WAS STARTING TO SUBSIDE. HE OBSERVED PAIN AND REDNESS AT VACCINATION SITE


VAERS ID: 1520512 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Disorientation, Nausea, 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), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Per his mother, he had reactions vasovagal reactions to vaccines throughout his life, which usually resolve in about an hour.
Other Medications: Lion''s Mane (Hericium erinaceus) 1 gram taken every morning including today.
Current Illness: None
Preexisting Conditions: None
Allergies: Tree pollen (seasonal for a couple weeks in the spring), animal dander in the past (as a child).
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 3 minutes of the vaccination, he felt disoriented with sounds, cold sweat and nausea. Progressed to vomiting.


VAERS ID: 1520713 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 RA / IM

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

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

Write-up: NONE-Patient received Moderna vaccine that has not been approved by age group.


Result pages: prev   192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=291&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166