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

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



Case Details (Reverse Sorted by Onset Date)

This is page 292 out of 7,116

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VAERS ID: 1520719 (history)  
Form: Version 2.0  
Age: 23.0  
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 006D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOWN
Current Illness: CYSTS ON LUNG
Preexisting Conditions: CYSTS ON LUNG
Allergies: NO ALLERGIES REPORTED
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT FAINTED SHORTLY AFTER RECEIVING VACCINE


VAERS ID: 1520722 (history)  
Form: Version 2.0  
Age: 31.0  
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 EW0178 / 1 LA / IM

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

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

Write-up: Patient reported shortness of breath, coughing. Transported to ER in stable condition.


VAERS ID: 1520723 (history)  
Form: Version 2.0  
Age: 17.0  
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 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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


VAERS ID: 1520724 (history)  
Form: Version 2.0  
Age: 34.0  
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 052E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Feeling hot, Presyncope
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Ocular motility disorders (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: LISINOPRIL/HCTZ
Current Illness: NO
Preexisting Conditions: HYPERTENSION
Allergies: NO
Diagnostic Lab Data: BP 109/74 HR 87
CDC Split Type:

Write-up: PT FELT HOT AND DIZZY. HER EYES WERE ROLLED BACK AS IF SHE WERE GOING TO FAINT, BUT SHE DID NOT. VITALS WERE WNL. AFTER DRINKING WATER AND SITTING FOR ABOUT 10 MINUTES, THE PATIENT FELT BETTER. SHE STOOD UP AND WAS OKAY TO LEAVE.


VAERS ID: 1520726 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Minnesota  
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 034C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st dose Moderna COV-19 vaccine on 3/26/21
Other Medications: OTC pre and probiotic, 50mg Benadryl (recommended by personal physician) due to 1st dose reaction
Current Illness:
Preexisting Conditions:
Allergies: PCN, Erythromycin, Azithromycin, IVP Dyes, Ranitidine, Propolis (mild reaction from patch test - Jan 2021)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 5:15 am - I noticed and felt an itchy, blotchy rash 1" below injection site. Rash was approximately 2" in length and 1.5" wide. I applied a thin coat of Fluocinonide (Rx from dermatologist from body rash in Jan 2021). At 6:15am, I took 2 Claritin tablets. Noticed that arm was itchy throughout the day. Tried not to scratch. At no time did I have any breathing problems or any other reactions aside from rash. Rash is still noticeable and itchy (no change from this morning) at 7:31pm same day.


VAERS ID: 1520727 (history)  
Form: Version 2.0  
Age: 25.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 29125BA / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Bone pain, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Osteonecrosis (broad), Sexual dysfunction (broad)

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

Write-up: Backbone pain, tolerable but constant. On the low side, after 4 hours of getting vaccinated. Before, some minutes of numbness in the left side of the head, like 1 hour


VAERS ID: 1520730 (history)  
Form: Version 2.0  
Age: 33.0  
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 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (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), Cardiomyopathy (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none at time of vaccination, unknow prior to vaccination
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient''s girlfriend reported that patient felt lightheaded, fainted and convulsed for 30 seconds later in the day at home after receiving the first Moderna Immunization earlier in the day. Patient is feeling fine now and did not seek medical treatment. Patient''s girlfriend was instructed to notify patient''s doctor to see if he needed to be evaluated.


VAERS ID: 1520732 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-05-19
Onset:2021-08-02
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Tinnitus, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Suboxone, colnazapam, duoluxetine, trazadone, burrowing, lisinopril
Current Illness: None
Preexisting Conditions: Depression anxiety
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 12 days in I just got so dizzy, ears ringing. I was so dizzy that I was vomiting. Went to urgent care they said severe vertigo, give it time & gave me meclizine and promethazine. I have been dizzy ever since. I vomit rarely but I feel like I''m always on a boat with ears ringing 24/7.


VAERS ID: 1520733 (history)  
Form: Version 2.0  
Age: 11.0  
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 / 1 LA / IM

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

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

Write-up: Patient was given a Pfizer COVID-19 vaccination. They are under the recommended age of 12. No adverse effects noted.


VAERS ID: 1520735 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-20
Onset:2021-08-02
   Days after vaccination:13
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: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: Patient''s mother indicated on consent. form that child had a (12 years old). Prior to vaccine administration, verbal confirmation of DOB was given by child. Upon further investigation, it was discovered that the child''s real DOB is 3/3/2010 (11 years old).


VAERS ID: 1520739 (history)  
Form: Version 2.0  
Age: 33.0  
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 EW0198 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Disorientation, Eye movement disorder, Hyperhidrosis, Loss of consciousness, Pallor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient appeared to passout and possibly have a seizure . We called his name and his eyes rolled in his head. he awoke disoriented. He threw up a couple of times . ems was called and patient was monitored in store over an hour as he refused medical treatment. Patient was sweaty with low bp pale 108/78 patient later claimed to have ptsd with vaccinations since age 2


VAERS ID: 1520742 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-08-02
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC vitamins, psyllium, gut cleanser
Current Illness: None
Preexisting Conditions: Joint pain, carpal tunnel. Wonder if I have rheumatoid arthritis
Allergies: None
Diagnostic Lab Data: One
CDC Split Type:

Write-up: 15 days after taking 2nd dose of Pfizer vaccine I noticed a scab on my lip and my face around my mouth got itchy. I?ve had cold sores before so familiar with the symptoms. But haven?t had one in years and had only occur when my immune system is weak from a fever. In the past. And I have not been sick.


VAERS ID: 1520746 (history)  
Form: Version 2.0  
Age: 11.0  
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 FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error
SMQs:, Medication errors (narrow)

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

Write-up: Patient came with mother, after completing form online and making an appointment. I printed the completed form; had the mother go over it and sign it. Obtained copy of mother''s ID and insurance card. Gave mother patient information sheet. Did counseling and administered vaccination to the daughter. When processing the claim, insurance rejected it for invalid DOB. I called insurance and was told the DOB for patient is 01/08/2009. This is not what the mother filled-out on the consent form.


VAERS ID: 1520747 (history)  
Form: Version 2.0  
Age: 25.0  
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 EW0198 / 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:
Other Medications: marijuana
Current Illness: n/a
Preexisting Conditions: m/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient fainted a few minutes after the shot was administered in the vaccine post waiting area


VAERS ID: 1520752 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
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 (MODERNA)) / MODERNA 040C21A / 1 RA / IM

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

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

Write-up: He was very anxious about getting the vaccine. As soon as the vaccine was administered he fainted. He regained consciousness within about 10 seconds. Was disoriented and very pale. He sat in the chair for about 20 minutes after and was given some cold water.


VAERS ID: 1520754 (history)  
Form: Version 2.0  
Age: 25.0  
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: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient passed out while shopping in the store 30 minutes after shot


VAERS ID: 1520758 (history)  
Form: Version 2.0  
Age: 31.0  
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 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hypotension, Paraesthesia, Seizure
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Suboxone and sertraline
Current Illness: no known illnesses
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data: blood pressure 100/64 8/2/2021 5:00pm
CDC Split Type:

Write-up: Patient started feeling "pins and needles". She then had a seizure. Her blood pressure was low and she was extremely hot. The seizure was short. We had her lay on a mat and put ice packs on her and gave her water. She said she hadn''t eaten today so we gave her orange juice to raise her blood glucose. Patient is not diabetic. Patient recovered quickly. She refused offer of ambulance. Her boyfriend arrived and said he was going to feed her then take her home.


VAERS ID: 1520763 (history)  
Form: Version 2.0  
Age: 52.0  
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 EW0186 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Anxiety, Blood pressure increased, Pruritus, Throat clearing
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (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: ibuprofen
Current Illness:
Preexisting Conditions: pt states history cervical disk herniation
Allergies: allergies to unknown substances, pt states thinks it''s to shellfish but can''t confirm
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt states history of two anaphylactic episodes requiring epi-pen use in the past, most recent January of 2021. Does not know what the allergen is. Pt received first dose Pfizer and stated top of head "itch" within 2 minutes followed by resolution of these symptoms several minutes later. Pt''s vitals: 138/92, HR 82, lungs clear, unlabored breathing, no acute distress, no s/s shock, no notable oral swelling. Repeat vitals appx 5 minutes later 150/90 HR 96, states feeling anxious. EMS arrival at 2:37 pt not in distress states feeling well but anxious (states history of anxiety) EMS vitals 150''s/90''s and SpO2 97%. Pt clearing throat but states this is "normal" for her when nervous, daughter confirms this. Pt also states clears throat frequently because it''s always "raw". EMS assessment no airway swelling/redness/compromise at this time. No visible hives/rash. Lungs clear bilateral on repeat auscultation. Pt educated safety of ride to hospital via EMS, states would like to take self to hospital with daughter instead of EMS, has epi-pen with her, declines EMS ride. Pt leaves after 30+ minute observation period, ambulating freely, speaking in clear/coherent sentences and able to swallow water freely, state going to the hospital down the street. States itching at top of head resolved.


VAERS ID: 1520968 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-21
Onset:2021-08-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Was informed today that patient is actually 11 years old. In the appointment scheduler and on form parent/guardian listed date of birth differently.


VAERS ID: 1520969 (history)  
Form: Version 2.0  
Age: 46.0  
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 FA7485 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced numbness of face and tongue; she said it felt like after the dentist. Onset was 15 minutes after administering the vaccine. Per patient was mostly gone after 1 hour of waiting and 50mg benadryl. at 6pm follow up phone call she said it was 90 percent better.


VAERS ID: 1520971 (history)  
Form: Version 2.0  
Age: 37.0  
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 FA7485 / 1 LA / IM

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

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

Write-up: patient felt fine but was itchy on neck. admistered benadryl and patient decided to leave after 20 more minutes of waiting


VAERS ID: 1520973 (history)  
Form: Version 2.0  
Age: 52.0  
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 F? 7485 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mouth haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: as soon as i take the vaccine after 2 minutes my mouth salive test blood.


VAERS ID: 1521178 (history)  
Form: Version 2.0  
Age: 21.0  
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 - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Nausea
SMQs:, Acute pancreatitis (broad), Dementia (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: Cranberry Pills Levothyroxine Enpresse -28 day cycle oral contraceptive (birth control) Macrobid- for recurrent UTI prophylaxis, taken after intercourse
Current Illness: None
Preexisting Conditions: Hashimotos Thyroid Disease
Allergies: Sulfa based medications
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea- top irritating Tiredness/ Fogginess


VAERS ID: 1521182 (history)  
Form: Version 2.0  
Age: 33.0  
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 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Loss of consciousness, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Blood pressure and temperature from EMT''s.
CDC Split Type:

Write-up: Patient passed out about 10-15 minutes after receiving vaccine. I was able to catch him before he completely fell to the ground. EMTs were called and patient was fully conscious when they arrived. They said they thought it was a vasovagal reaction and recommended he go to the hospital but patient decided against it and had a friend come pick him up from the pharmacy.


VAERS ID: 1521187 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Tennessee  
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 - / 2 LA / -

Administered by: Private       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? 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: Numbness on left arm all the way to fingertips, left side of chest, left side of neck, lower left side of face


VAERS ID: 1521188 (history)  
Form: Version 2.0  
Age: 17.0  
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 LA / IM

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

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

Write-up: PATIENT BECAME FAINT & DIZZY WHILE SITTING AND WAITING FOR 15 MINUTES. ED CALLED PARAMEDICS ARRIVED. CHECKED VITALS. PATIENT WAS FEELING BETTER. PARAMEDICS STATED IT WAS OK TO GO HOME BUT CONTINUE TO MONITOR IF CHANGE.


VAERS ID: 1521189 (history)  
Form: Version 2.0  
Age: 53.0  
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 EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19 immunisation, Extra dose administered
SMQs:, Medication errors (narrow), COVID-19 (narrow)

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

Write-up: PATIENT CAME IN LOOKING FOR A 1ST DOSE PFIZER SHOT. REPORTED IT AS FIRST COVID SHOT. UPON BILLING DISCOVERED THAT SHE HAD ALRAEDY RECEIVED A JOHNSON AND JOHNSON BACK IN APRIL


VAERS ID: 1521192 (history)  
Form: Version 2.0  
Age: 11.0  
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 FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intentional product misuse to child, 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n.a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Father admitted that he lied about daughter''s age in order to get child vaccinated before school starts. Patient is still 11 year old


VAERS ID: 1521340 (history)  
Form: Version 2.0  
Age: 15.0  
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 EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Heart rate decreased, Hypotension, Loss of consciousness, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), 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), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Pt passed out after getting the pfizer covid 19 vaccine, the technician got pharmacist right away and she used ammonia to wake the patient up quickly, her mother caught her and she was confused when she woke up, we were about to move her to the floor when she lost control of her bladder and so the father held her legs for her until we could get another chair under her to keep them elevated without getting near the puddle on the floor. After the paramedics arrived she was still dizzy and had low blood pressure and heart rate so the family decided that she would go in with them to get checked out in the hospital.


VAERS ID: 1528431 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
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 (MODERNA)) / MODERNA 020B21A / 1 LA / 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: N/A
Preexisting Conditions: N/A
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1st dose of COVID vaccine Moderna administered not realizing that Moderna was not yet approved for 12 yr + up No adverse reaction at this time


VAERS ID: 1521343 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Disturbance in attention, Feeling abnormal, Headache, Hypoaesthesia, Immediate post-injection reaction, Mobility decreased, Rash
SMQs:, Anaphylactic reaction (broad), 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), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Around 4:15 I noticed a rash on both of my forearms. It wasn''t hives, nor was it itchy, but it start right after I got my vaccine. I left the hospital at 4:35 that''s when I felt a headache. It is midnight and my headache has not gone away. It comes on flares. Around 5 I started feeling confused. I feel like I have brain fog. It''s hard for me to concentrate and stay focused. I feel like I''m in a daze. I can''t lift up my right arm. I also noticed when I turn my wrist it''ll go numb. It''s been doing that since about 5pm as well.


VAERS ID: 1521349 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-24
Onset:2021-08-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dyspnoea, Epistaxis, Productive cough, Rhinorrhoea, Sputum purulent, Upper respiratory tract infection, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad)

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

Write-up: Upper respiratory infection. Bloody nose. Runny nose. Productive Coughing. Coughing up phlem. Vomiting, diarrhea. Bloody nose, wheezing and short of breath,


VAERS ID: 1521350 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-08-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Post menopausal bleeding. Have not had bleeding for almost a year, and as soon as i recieved vaccine it started spotting


VAERS ID: 1521362 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW10198 / 1 LA / IM

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

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

Write-up: Blood running down arm during vaccination. The vaccinator wiped my arm down to remove blood at least 3 times. At the time, I thought she''d spilled some vaccine. Wasn''t until I later removed the bandaid and found it was completely saturated with blood that I realized she''d hit a blood vessel or vein. The bleeding started immediately as soon as she began injecting me, but she did not remove the needle and start again. I''m concerned that she injected the vaccine directly into a vessel or vein.


VAERS ID: 1522444 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Systemic: Tingling (specify: facial area, extemities)-Mild


VAERS ID: 1522452 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Medium, Systemic: Vomiting-Mild, Additional Details: PT FELT DIZZY FEW MINS AFTER INJECTION AND VOMITTING LIGHTLY. 5 TO 10 MINS LATER FELT OK AND WENT HOME WITH HER HUSBAND


VAERS ID: 1522454 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1522458 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: 911 called - patient passed out and fell on floor. unknown if patient hit head during fall.


VAERS ID: 1522459 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Systemic: Seizure-Mild, Additional Details: patient has seizure right after vaccine


VAERS ID: 1522465 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Flushing, Hyperhidrosis, Injection site bruising, Injection site erythema, Injection site pruritus, Injection site swelling, Tremor
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Bruising at Injection Site-Mild, Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Shakiness-Mild, Systemic: Weakness-Mild, Additional Details: Patient fell about 7 minutes after receiving vaccine, did not lose consciousness, kept for 30 minutes under observation, requested water, left after 30 minutes; said he felt better; had been anxious about receiving vaccine; had no primary care prescriber to follow up with per pt.


VAERS ID: 1522467 (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: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1522474 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe


VAERS ID: 1522479 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Anaphylactic reaction, Chills, Dizziness, Dysphagia, Dyspnoea, Eye swelling, Fatigue, Lethargy, Mouth swelling, Nausea, Sensation of blood flow, Skin discolouration, Swelling face, Swollen tongue, Throat tightness, Tremor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Severe, Systemic: Abdominal Pain-Severe, Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Nausea-Severe, Systemic: Shakiness-Severe, Additional Details: decreased perfussion to feet,legs, ankles and feet were slighly discolored blue due to decreased perfussion


VAERS ID: 1522480 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1072 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dysphagia, Dyspnoea, Injection site erythema, Injection site pruritus, Pruritus, Rash, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Itching at Injection Site-Severe, Site: Redness at Injection Site-Severe, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe, Systemic: Allergic: Rash (specify: facial area, extremeties)-Severe, Additional Details: Approx. 3 minutes after injection patient had itching and hives on arm of injection and right side down to her waist. administered 50 mg benadryl orally. Approx. 3 to 5 minutes later patient started coughing and was having trouble swallowing. 911 was called. no Epipen was administered on site. Follow up with patient, she was discharged to home same day within 5 to 6 hours of reaction.


VAERS ID: 1522484 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Patient starting sweating a few minutes after vaccine and had seizure.


VAERS ID: 1522487 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-29
Onset:2021-08-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F87484 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Multi-Vitamin (Centrum Silver Women?s) Vitamin C 1000 mcg Vitamin E 180 mg Vitamin D3 5000 IU Loratadine 10 mg Lansoprazole 30 mg (Prevacid) Meloxicam 15 mg (Mobic) Triamterene-HCTZ 37.5/25 (Maxide)
Current Illness: None
Preexisting Conditions: High Blood Pressure, Acid Reflux, Glaucoma, Psoriasis, Sleep Apnea, Thyroid Nodules
Allergies: Percocet, Cefdinir, Enbrel
Diagnostic Lab Data: None yet.
CDC Split Type:

Write-up: Rash on right arm from injection site down about 6 inches on arm, slightly swollen, red, itchy and sore. This started on Monday, 2 August. When I woke up on Tuesday, 3 August, the right side of my tongue feels swollen as does the area beneath the right side of my tongue and down the right side of my neck. That whole area feels like I''ve been given a Novacaine injection. Not really any difficulty swallowing, my mouth and neck area just feel weird.


VAERS ID: 1522676 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027D21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Additional Details: Patient did not experience adverse event at the pharmacy but called back ~ 1 hour or so later to report tongue swelling and throat itching. Instructed to take liquid benadryl and if it worsened or her breathing became labored to report to an ER


VAERS ID: 1522682 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysmenorrhoea, Electrocardiogram normal, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HYPERTENSION/UTERINE FIBROIDS/MORBID OBESITY
Allergies: NONE
Diagnostic Lab Data: Patient''s EKG shows a rate of 99, normal sinus rhythm, no evidence prolonged QRS or PR intervals. There are no ST segment elevations..
CDC Split Type:

Write-up: 35-year-old female with past medical history of uterine fibroids, hypertension, syncopal episodes. She presents the emergency department after a witnessed syncopal episode at a vaccine clinic. She states she has had a syncopal episodes in the past which involved her being on her menstrual cycle and experiencing very painful menstrual cramps. She states this was no different in the past and she states she is currently on her cycle and was having extreme pain which she describes menstrual cramps before her syncopal episode. Her mother witnessed the syncopal episode and states she did not fall there is no signs of trauma on the patient. Patient states she would not come to emergency room other than staff at the vaccine site urging her to come. After using the Wells criteria on the patient it exhibits a very low risk approximately 2% that the patient has a pulmonary embolism. She had tachycardia upon arrival with a rate of 105, But she is currently having multiple pulse checks that have all been under 100 bpm.Patient was given fluids and lab work was ordered. Patient to be discharged, on physical exam and evaluation of lab work there is no concern for pulmonary embolism or any emergent condition.


VAERS ID: 1522684 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle twitching, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient fainted, assisting patient to the floor, he seized or twitched


VAERS ID: 1522690 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-26
Onset:2021-08-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

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

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

Write-up: Inflammation of the injection site on the 8th day after vaccination. (The injection is swollen, reddened and itchy).


VAERS ID: 1522700 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Headache, Interchange of vaccine products, Lip swelling, Paraesthesia oral, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: latex, pfizer vaccine
Diagnostic Lab Data: vital signs monitored , starting at 3:23 pm when symptoms reported, 3:23 pm BP 190/106 P 77 O2 99% Benadryl 50 mg x 1 given IM 3:30 PM BP 144/85 p 66 O2 98% 3:42 PM BP 156/84 P 61 O2 99% 4:00PM BP 171/90 P 66 02 99-100% 4:04 pm 171/88 P 60 EMS activated per Dr 4:10 pm symptoms persist, not worsening, denies resp difficulty, reports mild throat tightness, headache, lip tingling, reports lips feel swollen. 4:17 pm BP 136/73 P 60 O2 98% EMS arrived 4:20 pm., transported to ED at 4:25 pm
CDC Split Type:

Write-up: Patient administered Janssen , unable to take pfizer #2 due to allergic reaction. Evaluated by Allergist and cleared to receive Janssen vaccine. 10 mins following injection, reported throat tightness, headache, tingling sensation mouth and tongue, lips felt puffy, denied sob. Given benadryl 50 mg IM x1, reports in 10 minutes symptoms improving ., however persisted x 1 hour, milder, still reported lip tingling and mild throat tightness, headache improving. EMS activated and patient transported to Emergency Room for further monitroing.


VAERS ID: 1522705 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-01
Onset:2021-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Dizziness, Feeling cold, Headache, Nausea, Pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Per employee: "Got the second COVID vaccine (Moderna), and a few hours shortly after I felt cold and temp was 103.2 with body aches, nausea, headaches, swelling in the left arm and light headedness. still have some symptoms the next following "


VAERS ID: 1522706 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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:
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site pain. Headache two hours after shot. Ibuprofen helped greatly at 600mg dose.


VAERS ID: 1522728 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Dry mouth, Dry throat, Injection site pain, Injection site reaction, Injection site swelling, Oral pruritus, Pain in extremity, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: It started as severe pain in my right arm around 3:00 which continued to spread through my hand, shoulder, and chest on just my right side. I noticed that evening I had developed whelps on my arm from my shoulder to my elbow. Those became swollen and painful to touch. At the same time, I began having severe stomach cramps; my throat/mouth was also dry and itchy. I took Benadryl and Tylenol which reduced the pain. At this time, the whelps and stomach pain are still present, but lessened. I will be going to my primary care doctor for a check up as soon as they can get me in.


VAERS ID: 1522729 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Tinnitus
SMQs:, Hearing impairment (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: Liquid multi vitamin and mineralnone
Current Illness: None
Preexisting Conditions: Osteoporosis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Ringing in my ears and reduced hearing. Adverse events started 15-20 minutes after receiving vaccine.


VAERS ID: 1522739 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-08-02
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: Unknown


VAERS ID: 1522754 (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: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Musculoskeletal stiffness, Mydriasis, Pallor, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (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: Prozac & Buspiron (Morning) Lorazapan 2:00pm Chlonidine 10 pm
Current Illness: none
Preexisting Conditions: Depression Autism Spectrum PMDD Hypersomnia
Allergies: none
Diagnostic Lab Data: EMS arrived within 10 minutes and examed my daughter. She did NOT appear to bite her tongue and EKG, pulse, oxygen, BP and blood sugar levels were normal.
CDC Split Type:

Write-up: Within 2 minutes of receiving the injection, Eyes dilated, became pale, and passed out. Then both hands clenched. Upper body and arms became stiff and ridged. Arms started to tremor like a convulsion for a period of 20 seconds. Patient has a history of passing out only during bloodwork. She has Not previous passed out during a vaccine. My daughter was calm and not nervous about the vaccination. Never before has had convulsions, shaking or tightening of limbs.


VAERS ID: 1522761 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-18
Onset:2021-08-02
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V asymptomatic POSITIVE
CDC Split Type:

Write-up: unknown


VAERS ID: 1522777 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-01
Onset:2021-08-02
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None known
Preexisting Conditions: DM, Asthma, HLD, Lt eye glaucoma, torn left knee menicsus, UTI.
Allergies: NKDA
Diagnostic Lab Data: 1. COVID 19 Ag (+) 8/2/2021 2. COVID-19 PCR (-) 8/2/2021 3. SARS Cov2 IGG II QT-SPIKE 57.50 (+)
CDC Split Type:

Write-up: Admitted to hospital 8/2/2021 with COVID-19 Antigen +


VAERS ID: 1522784 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia
SMQs:, Guillain-Barre syndrome (broad)

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

Write-up: Patient weak when driving home after vaccination. Advised Patient to lay with feet raised and to seek medical attention if no improvement. Contacted Patient Spouse and she stated patient is doing fine.. today.


VAERS ID: 1522789 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-05
Onset:2021-08-02
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Electrocardiogram normal, Hypoxia, Respiratory rate increased, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Humulin nystatin
Current Illness: none known
Preexisting Conditions: Lymphoma kidney disease diabetes
Allergies: Levaquin
Diagnostic Lab Data: He does have a history of PE and is on Xarelto. EKG shows normal sinus rhythm at 77 with no acute changes. He also has a history of CLL and is in remission he states. He follows up with Dr. We will order CT angiogram thorax and also basic labs. [SH]
CDC Split Type:

Write-up: Patient was seen in the emergency room by myself. Vital signs are noted. Patient is afebrile, nontoxic in no acute distress. Patient came in for shortness of breath and hypoxia. He was 88% per EMS when they arrived on room air. They put him on 10 L and we have decrease that down to 6 L and he is satting at 98%. Patient complains of some rapid breathing after he had a fainting spell while on the toilet. He denies any difficulty breathing currently or any chest pain. He states he does get dizzy spells similar to this. He denies any falls or recent injury. He does have a history of PE and is on Xarelto


VAERS ID: 1522796 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dry eye, Dry mouth
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Dehydration (broad)

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

Write-up: Dry eyes and dry mouth


VAERS ID: 1522798 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-12
Onset:2021-08-02
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fall, Injury, SARS-CoV-2 test positive
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) by NAA, Micro , detected, on 8/2/2021
CDC Split Type:

Write-up: positive covid test SARS-CoV-2 (COVID-19) by NAA, Micro detected by routine screening when patient presented after trauma ( fall) to Emergency Center


VAERS ID: 1522802 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-08-02
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V asymptomatic POSITIVE
CDC Split Type:

Write-up: unknown


VAERS ID: 1522813 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-30
Onset:2021-08-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal distension, Dizziness
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: dizziness bloating upset stomach


VAERS ID: 1522814 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-19
Onset:2021-08-02
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: bipolar disorder
Allergies: no known allergies
Diagnostic Lab Data: PCR COVID positive 8/2/21
CDC Split Type:

Write-up: developed sore throat 8/2/21 PCR COVID positive 8/2/21


VAERS ID: 1522817 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Write-up: the patient collapsed from his sit about 12 minutes after receiving the shot


VAERS ID: 1522840 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-22
Onset:2021-08-02
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V asymptomatic POSITIVE
CDC Split Type:

Write-up: Exposure


VAERS ID: 1522864 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-20
Onset:2021-08-02
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V asymptomatic POSITIVE
CDC Split Type:

Write-up: asymptomatic


VAERS ID: 1522872 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-17
Onset:2021-08-02
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: chlorthalidone (HYGROTON) 25 mg oral tablet Sig: Take 0.5 tablets (12.5 mg) by mouth once daily. fluticasone (FLONASE) 50 mcg/actuation nasal spray Sig: Instill 1 spray into EACH nare twice a day. metoprolol tartrate (LOPRESSOR) 25 mg ora
Current Illness:
Preexisting Conditions: ASCVD s/p CABG. Hypertension Hyperlipidemia Benign prostatic hypertrophy.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST 8/2/21


VAERS ID: 1522877 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Patient was given second vaccine too early. Patient received second vaccine only 13 days after first vaccine.


VAERS ID: 1522885 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Patient received second dose too early. Patient received second dose of vaccine only 13 days after first dose.


VAERS ID: 1522886 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-19
Onset:2021-08-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 LA / SYR

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

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

Write-up: Baseball size knot on site of injection. Swollen with redness and warn to touch. Slightly painful. Very red and circular


VAERS ID: 1522901 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-05
Onset:2021-08-02
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V asymptomatic POSITIVE
CDC Split Type:

Write-up: exposure


VAERS ID: 1522902 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-27
Onset:2021-08-02
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 AR / IM

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

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

Write-up: COVID positive after vaccination


VAERS ID: 1522904 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient 14 years old and received Moderna covid vaccine which is only indicated for 18 and older. No adverse reactions to vaccine.


VAERS ID: 1522913 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

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

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

Write-up: Patient vaccinated before mother and was fine, before I started she asked her son to stand by her to hold her hand; as I started the injection patient fainted. We gently laid him to the ground where he felt better, he was later moved to a sitting position in chairs and recovered. He was given juice and a granola bar.


VAERS ID: 1522926 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-15
Onset:2021-08-02
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Rhabdomyolysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CK
CDC Split Type:

Write-up: Rhabdomyolysis


VAERS ID: 1522932 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-21
Onset:2021-08-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion, Fluoxetine, fenofibrate, atrovastatin, spirolactone, minocycline
Current Illness: None
Preexisting Conditions: High cholesterol
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at injection site


VAERS ID: 1522938 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-17
Onset:2021-08-02
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Fatigue, Palpitations, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive by PCR test on 8/2/21.
CDC Split Type:

Write-up: Patient presented to the emergency department on 8/2/21 with complaints of fatigue, weakness fever, and palpitations. He tested positive for COVID via PCR on 8/2/21. He has been admitted to the hospital and is currently on 4L of Oxygen.


VAERS ID: 1522952 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known--not our patient other than today
Current Illness: none
Preexisting Conditions: none known
Allergies: Tree Nuts, Dairy products
Diagnostic Lab Data: none known at this time
CDC Split Type:

Write-up: Patient was fine receiving vaccine. Was walking out of the vaccine area with her three sisters and Mom. She passed out and collapsed within a few steps of the consultation area. She woke up immediately and was talkative and aware of person, place, and time. We brought her back to vaccine area, laid her down with feet up, put cold wet paper towel on her forehead, gave her cold water to drink and a popsicle to eat slowly. She began feeling better and her color returned to her face within 10-15 minutes.


VAERS ID: 1522961 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 UN / IM

Administered by: Work       Purchased by: ?
Symptoms: Anaphylactic reaction, Chest pain, Discomfort, Ear discomfort, Throat tightness, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec 100 mg/daily Motrin 600 mg PRN Flexeril 500 mg daily Nortriptyline 100 mg/day Colace PRN Fluticasone 50 mcg BID PRN
Current Illness: No recent diagnosis at time of vaccination.
Preexisting Conditions: ADHD and neck/spinal pain
Allergies: No known allergies
Diagnostic Lab Data: Please see prior note
CDC Split Type:

Write-up: Patient received his 1st dose of Pfizer at 1500. Lot number EW0180. Approximately 9 minutes later the patient reported that he felt like his "throat was closing." Brought back to the observation unit. Lung sounds clear, stridor is not audible at this time. VS stable; VS @ 1511 148/79 99% P=63 Resp= 18 Temp= 98.8 Dr. notified. Verbal order received to administer Cetirizine 10 mg PO now. This was done at 1514. Standing order for Epinephrine 0.3mg received as needed for anaphylaxis. Continuing to monitor. Follow up VS 1516 130/85 P=68 O2=99 on RA Resp= 18=20 Lung sounds remain clear, no stridor indicated. Follow up VS @ 1530 124/83 P= 67 O2 99% on RA Resp 18-20 Lung sounds remain clear, no stridor indicated. Pt stated he feels that his "eyelids feel heavy, little eye blurriness, and feels like ears are closing in". Laid patient down and ice pack was applied behind patient''s head. Pt stated symptoms are improving. Continue to monitor. Follow up VS @ 1545 128/67 P= 62 O2= 98% on RA Resp 18-20 Lung sounds remain clear, no stridor indicated. Pt stated eye blurriness and heavy eyelids symptoms are gone. Pt stated the "ear closing feeling" is improving. Continue to monitor. Pt stated he feels a consistent non-radiating "needle point size pain" to left chest that started at 1550. Pain resolved in 2 minutes. No rash/hives indicated. Lungs are still clear. Follow up VS @ 1600 116/76 P=60 O2=98 Resp=18-20 Pt stated previous symptoms are gone and not experiencing any new symptoms. Continue to monitor. 15:15 Contacted Dr. and updated regarding the patient''s status. He requested for the patient to swallow some fluids. If he tolerates it well he is clear to go. Patient tolerated well. Follow up vital signs 15:20 BP= 124/70 HR= 67 O2= 100% Resp = 18-20 Sister drove the patient home.


VAERS ID: 1522973 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-26
Onset:2021-08-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 RA / SYR

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

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

Write-up: numbness in extremities. pins & needle sensation in left hand


VAERS ID: 1522979 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-30
Onset:2021-08-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / SYR

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

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

Write-up: Extremely painful menstrual cramps and very heavy bleeding following period after getting vaccination.


VAERS ID: 1522985 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-01
Onset:2021-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

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

Write-up: patient has red inflamed spot about 2inch in diameter at the injection site


VAERS ID: 1522986 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Myalgia, Sleep disorder, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin after symptoms started
Current Illness:
Preexisting Conditions:
Allergies: egg white, lipitor, talwin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started having muscle aches and a headache, took 2 aspirin 325mg (650mg) with some crackers and water, went to bed, and woke up around 1am and vomited.


VAERS ID: 1522988 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-29
Onset:2021-08-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: unusual spotting before normal period.


VAERS ID: 1522995 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / SYR

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

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

Write-up: complains of chest pain


VAERS ID: 1523002 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-21
Onset:2021-08-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWOL98 / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone increased, Hyperthyroidism, Tachycardia, Thyroxine free
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypothyroidism (broad), Hyperthyroidism (narrow), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 8/3/21: TSH < .006, Free T4 2.1
CDC Split Type:

Write-up: Patient presented to ED with tachycardia, HR 140s, TSH <.006, new diagnosis of hyperthyroidism.


VAERS ID: 1523018 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-06
Onset:2021-08-02
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Decreased appetite, Headache, Nasal congestion, SARS-CoV-2 test, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin donepezil gabapentin losartan metformin Miralax (polyethylene glycol 3350) [OTC] temazepam - Schedule IV tramadol - Schedule IV Tylenol (acetaminophen) [OTC] Endedelto (rivaroxaban)
Current Illness:
Preexisting Conditions: Unspecified intracapsular fracture of left femur, subsequent encounter for closed fracture with routine healing (Primary / Admission) M25.511 Pain in right shoulder Z74.1 Need for assistance with personal care F80.2 Mixed receptive-expressive language disorder G31.84 Mild cognitive impairment, so stated R26.81 Unsteadiness on feet R41.841 Cognitive communication deficit G47.00 Insomnia, unspecified I10 Essential (primary) hypertension E78.5 Hyperlipidemia, unspecified I48.0 Paroxysmal atrial fibrillation Z95.0 Presence of cardiac pacemaker M85.80 Other specified disorders of bone density and structure, unspecified site I35.1 Nonrheumatic aortic (valve) insufficiency G62.9 Polyneuropathy, unspecified M25.552 Pain in left hip M62.81 Muscle weakness (generalized) R29.3 Abnormal posture H04.129 Dry eye syndrome of unspecified lacrimal gland E11.8 Type 2 diabetes mellitus with unspecified complications F33.9 Major depressive disorder, recurrent, unspecified F03.90 Unspecified dementia without behavioral disturbance G60.3 Idiopathic progressive neuropathy Z91.81 History of falling M19.90 Unspecified osteoarthritis, unspecified site
Allergies: lisinopril
Diagnostic Lab Data: POC test on 8/2/21 positive for Covid 19 . PCR pending
CDC Split Type:

Write-up: Resident tested positive for Covid 19 with symptoms of nasal congestion , headache , and poor appetite


VAERS ID: 1523022 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-30
Onset:2021-08-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Atrial fibrillation, Blood electrolytes normal, Blood thyroid stimulating hormone normal, Computerised tomogram thorax, Echocardiogram normal, Full blood count normal
SMQs:, Supraventricular tachyarrhythmias (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: All other labs (CBC, electrolytes, TSH) were within normal limits. Echocardiogram performed also within normal limits. CTPE performed and also normal
CDC Split Type:

Write-up: On 2 August, the 28 yo patient developed atrial fibrillation with rapid ventricular rate necessitating hospitalization for rate control.


VAERS ID: 1523051 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-08-02
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trileptal, Synthroid, Lioresal, Roxanol, Neurontin, Glucophage, Atarax, Lipitor, aspirin, Victoza, Lotrisone, Prinzide
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data: Covid-19 test on 08/02/2021- positive results
CDC Split Type:

Write-up: Patient received 2nd dose of Pfizer vaccine on 04/02/2021. She then developed symptoms of runny nose, chills, and cough on 07/30/2021. Patient tested positive for Covid-19 on 08/02/2021.


VAERS ID: 1523062 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-12
Onset:2021-08-02
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 2 - / IM

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

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

Write-up: Breakthrough COVID Case


VAERS ID: 1523076 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-08-02
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 - / -

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

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

Write-up: Patient received 2nd dose of Pfizer vaccine on 04/02/2021. Then was exposed to his mother who tested positive for Covid-19. He was tested for Covid-19 on 08/02/2021 and received positive results on 08/02/2021. He is currently asymptomatic.


VAERS ID: 1523083 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 AR / IM

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


VAERS ID: 1523093 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2020-12-21
Onset:2021-08-02
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 UN / IM

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

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

Write-up: Breakthrough Covid disease


VAERS ID: 1523096 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 AR / IM

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

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

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


VAERS ID: 1523111 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-08-02
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK AR / SYR

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

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

Write-up: Patient is vaccinated with J&J and has tested positive for COVID 19


VAERS ID: 1523121 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

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

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

Write-up: The patient came in to receive his second pfizer dose. His paperwork was mixed in with some Moderna shots and he inadvertently received Moderna as a second dose instead of pfizer. There has not been any adverse events from this, and according to the CDC, it is okay to receive a different mRNA vaccine as a second dose in certain situations.


VAERS ID: 1523123 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-08-02
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / -

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

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

Write-up: Dose #1 Moderna Lot # 010M20A 01/29/2021


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