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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 301 out of 7,116

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VAERS ID: 1518967 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Pallor, Unresponsive to stimuli
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt had previously fainted after routine childhood vaccinations
Other Medications: None
Current Illness: N/A
Preexisting Conditions: History of Leukemia
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient''s mother warned pharmacy staff that she often passes out from vaccinations. Immediately after receiving the vaccine, the patient became pale and unresponsive which lasted ~5-10 seconds. Patient then opened her eyes and said her stomach and head hurt. The patient was laid down and placed a damp towel on her head and back of neck. She drank water and had crackers. Pharmacist monitored her for responsiveness and improvement in symptoms for 25 minutes. She remained in the exam room for ~30 minutes until she felt better and was able to safely stand up.


VAERS ID: 1518971 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Seizure like phenomena, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received dose 1 vaccine. While sitting in waiting area for observation patient fainted and fell to floor. Patient briefly had seizure activity in limbs for 5-10 seconds then became alert. Paramedics were contacted and assessed patient. Patient was recommended to follow up with primary care.


VAERS ID: 1518972 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-24
Onset:2021-08-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Rash papular
SMQs:, Extravasation events (injections, infusions and implants) (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: Multi vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I woke up on 8/1/2021 (1 week after vaccination shot) with mild itching and redness at the injection site. It is a raised, red area approximately 3 inches in diameter. No soreness, but it is ?hot.? No other issues.


VAERS ID: 1518977 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: The patient did state that a few months ago he felt faint after receiving another vaccine. The vaccine and date is unknown.
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: No Known Drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: After administering vaccine patient asked to stay in chair for a few minutes. When his mother came over to him he was seated on the floor. After laying down for a few minutes and drinking some gatorade the patient said he would like to get up and leave. While standing at the counter the patient is believed to have fainted and fallen to the ground hitting his head. He was awake and alert but stated "I don''t know where I am". I called 911 and while waiting for EMS to arrive the patient laid down with an ice pack on the back of his neck. He was able to sit up and drink some orange juice. EMS took vitals and his blood glucose. They believe since the patient had not eaten anything today that that could be the cause. After being released by EMS and refusing to go to the hospital the patient left the pharmacy. EMS later came in to inform me that they were contacted again by the patients mother while in the parking lot. The patient again refused to be taken to the hospital.


VAERS ID: 1518981 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blood glucose normal, Chest discomfort, Condition aggravated, Dizziness, Dyspnoea, Hyperhidrosis, Hyperventilation, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Glucose-106 BP- 118/83
CDC Split Type:

Write-up: Patient felt faint, laid down on the ground. Started sweating perfusely. Said he had tingling in his arms difficulty breathing and chest felt heavy. Ice pack was given. Epipen was not administered. EMS was on site by then very quickly. EMS stated possibly due to anxiety. Patient was hyperventilating and EMS stated this was not a reaction to the shot and this could be anxiety induced/related. Patient did not seem anxious during the shot but got very anxious when he experienced these symptoms. Patient stated he had eaten only two strips of bacon the entire day and had some anxiety with getting the shot.


VAERS ID: 1518985 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: Patient received dose of vaccine and sat down at the pharmacy waiting area to wait the recommended 15 minutes after vaccination. About 5 minutes after vaccination patient was feeling very light headed, pale and lost consciousness. Patient fell to the floor and was unconscious for about 15 to 30 seconds. While falling to the floor patient potentially hit his head. Patient then regained consciousness and was attended to by the pharmacist on staff while waiting for EMTs. EMTs evaluated the patient and took BP and other vitals. After being evaluated by the EMT patient began to feel better and was able to walk on his own and was driven home by a friend that accompanied him.


VAERS ID: 1519004 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-08-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot 2004
Other Medications: Vitamin D
Current Illness: No
Preexisting Conditions: Hashimoto?s
Allergies: Flu shot, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives/urticaria in torso, neck, and arms. Ongoing at this time. Taking normal doses of Benadryl.


VAERS ID: 1519005 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-29
Onset:2021-08-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, C-reactive protein increased, Chest pain, Echocardiogram, Electrocardiogram abnormal, Magnetic resonance imaging, Myocardial necrosis marker increased, Myocarditis, Prohormone brain natriuretic peptide increased, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Cardiac enzymes elevated as above, CRP elevated at 7.5. Echo pending. MRI pending.
CDC Split Type:

Write-up: Myocarditis- woke up with chest pain. Eval in ER and found to have abn ekg, elevated cardiac enzymes (trop 0.38, ck 634, mb 35.1, proBNP 328).


VAERS ID: 1519008 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Panic attack, Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient had trouble breathing, blurred vision within 15 minutes after injection. 911 paramedics came and believed she was having a panic attack. After breathing exercises she started feeling better but was taken to the hospital for further assesment.


VAERS ID: 1519018 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-30
Onset:2021-08-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Dizziness, Muscle fatigue, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol 100mg QD Amlodipine 10mg QD Creator 20mg qd
Current Illness: None
Preexisting Conditions: High BP
Allergies: NKDA NKFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Joint ache, muscle fatigue, feeling close to fainting, louder tinnitus than usual.


VAERS ID: 1519023 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Minor headache with accompanying fatigue of equal intensity. Very minor muscle soreness in the area directly below the injection site, not the site itself. Headache and fatigue began roughly three hours after injection. These subsided with one over the counter headache pill and an hour nap. They returned a short time later, but we slightly less intense. As of 6 hours after the injection, no other side effects have been noted.


VAERS ID: 1519024 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Deafness, Disorientation, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient became severely disoriented, lost hearing, pale, after vaccine administration. Called 911 but after evaluation, patient did not go to the hospital with 911 team.


VAERS ID: 1519027 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hypersensitivity, Local reaction
SMQs:, Angioedema (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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type: 8505

Write-up: Localized allergic reaction on neck and chest.


VAERS ID: 1519028 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Patient became light headed shortly after receiving the vaccine. She briefly fainted, but quickly became responsive. She was sweating profusely, but had no chest tightness, shortness of breath, or swelling of the throat. She laid down for 20-30 minutes while we called 911. When the ambulance was slow to arrive, she made the decision to have her friend drive her to the emergency room. She was able to walk out of the store with her friend''s assistance.


VAERS ID: 1519029 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-28
Onset:2021-08-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Migraine, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (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: Migraines
Preexisting Conditions: Migraines
Allergies: None
Diagnostic Lab Data: Blood pressure measured while at the pharmacy: BP 120/83 HR 60
CDC Split Type:

Write-up: Patient presented with half of her left eye red in color. It appears as though a blood vessel ruptured. She states there is no pain associated with the eye. She had been suffering with a migraine the day prior.


VAERS ID: 1519031 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Incoherent, Loss of consciousness, Pallor
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), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Patient passed out immediately after shot given, patient came to within 10 to 15 seconds, pale in color and incoherent at first. Cold compress applied to neck and forehead. patient passed out second time after 1 to 2 minutes and EMS contacted. Patient came to within 10 to 15 seconds and still very incoherent. patient was laid down flat on back with cold compress. EMS arrived , pulse no other vitals taken EMS determined patient was ok to leave after approximately 30 minutes. Patient refused any further treatment.


VAERS ID: 1519039 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Delirium, Fall, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: patient received a vaccine and was informed to wait 15 minutes. While I was administering the vaccine to someone else, we heard a crash, when I jumped up, I see him on the floor. I told a tech to call 911 and the manager. A customer called 911 for me on her cell phone. The patient asked for a bottle of water which we quickly got for him. He was delirious and sweating for a while but after drinking the water appeared to recover. Rescue came but I think the patient was ok by the time they arrived. He had gotten help up from off of the floor and to the chairs. I asked him where he was going because he was supposed to wait 15 minutes and he replied that he was going to get something to drink


VAERS ID: 1519058 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Pt came in for her first dose of the pfizer vaccine. At vaccination,showed that the pt received a first dose of moderna on 7/27/21. When asked, the pt stated that she had not received any covid vaccine. Pt was informed that having mixed covid vaccines is not approved by CDC, and her immunization record would not be accurate, resulting in her not being able to receive further doses (given that there are two records of separate vaccines present on her ). Pt reiterated not having taken any covid vaccine. AP Nurse Hotline was called to ask how to proceed at 2:19 PM. After calling the hotline, we reviewed the latest AP update from 7/28/21 that stated to escalate the issue if a pt discloses having received another covid vaccine. Due to this, we proceeded with the Pfizer vaccine at approximately 3:30 PM and noted in pts EMR record (pt denies having received another covid vaccine) as we were previously instructed to do so, being that the EMR CIR is not 100% accurate. At 3:46 PM the hotline called back and informed that reflected that there was a Moderna dose from 7/27/21 and a Pfizer dose from 8/1/21. Pt was still in observation, and when questioned again, she continued to attest to not receiving the moderna vaccine. Pt denied having received any Covid vaccine throughout the entire process. Pt left at 3:55 PM.


VAERS ID: 1519059 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyskinesia, Musculoskeletal stiffness, Presyncope, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (narrow), 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 (narrow), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Seconds after receiving Pfizer covid 19, pt had a vasovagal episode with stiffening and jerking movements of extremities. Few second duration. Father stated upon arrival that Pt''s mother had a "Bad reaction to Moderna" (seizure). She also has these reactions frequently and with botox injections. Pt "ate very little for breakfast. He was given water to drink. He drank 2 bottles. Vital signs x2 and walked in clinic without difficulty.


VAERS ID: 1519060 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: At 1457 client alerted EMT she was dizzy and hearing ringing on both ears. PHN and RN arrived at 1459, client sitting upright on chair, alert and oriented x4, pale, mild diaphoresis. First vitals at 1459: blood pressure 69/54, pulse 56, oxygen sat 99%. At 1500 client transferred to anti-gravity chair with help from EMT. Grandmother present with client, stated no medical history, no medications and no known allergies. Client stated she had ate and hydrated prior to vaccine. Per client felt dizzy from the moment she stood after vaccine administration and still walked to observation room without alerting staff. At 1504: pulse 78, oxygen sat 96%. Vitals at 1505: blood pressure 114/71, pulses 89, oxygen sat 97%. Skin normal for ethnicity, client reported ringing of ears and dizziness improving. Client denied blurry vision, headache, nausea, or shortness of breath. RN gave client Capri-Sun juice, client began drinking in small sips. Vitals at 1513: blood pressure 100/68, pulse 78, oxygen sat 98%. Client reported dizziness and ringing of ears resolved. EMT placed anti-gravity chair on 45 degree angle, client tolerated well, no complaints. Vitals at 1522: blood pressure 105/61, pulse 72, oxygen sat 98%. Client stated no symptoms at this time. EMT placed anti-gravity chair at 90 degrees, client reported no changes. Last vitals at 1533: blood pressure 107/70, pulse 75, oxygen sat 98%. PHN gave client and client''s Grandmother ER precautions and advised to follow up with primary medical provider. PHN asked client to stand up and walk a few steps at 1534. Client walked with no complaints.


VAERS ID: 1519061 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: No known allergies
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Syncope occurred immediately after injection. Patient was seated and physically supported with no injury sustained. Patient was non-responsive for 10-15 seconds. Patient became alert shortly thereafter and was given water and sugar. After 15 to 20 minutes, the patient was able to move and recovered appropriately.


VAERS ID: 1519065 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-16
Onset:2021-08-01
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Hyperventilation, Laboratory test normal, Obstructive airways disorder, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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: Theophylline 100 mg/day Prilosec 20 mg/day Ventolin Losartin 25 mg/day
Current Illness: None
Preexisting Conditions: Asthma, acid reflux, hypertension
Allergies: No
Diagnostic Lab Data: All results came back normal
CDC Split Type:

Write-up: This Morning (Sunday 8/1/2021) at around 9:30 am, I felt tightening in the left side of my chest and my airways were closing. My wife rushed me to the emergency room at . During the ride I was very dizzy and started having blurred vision. I measured my oxygen using an oximeter, it was 77 SPO2. My oxygen is usually between 96 and 100 SPO2. I started to hyperventilate as fast as possible until we reached the hospital.


VAERS ID: 1519074 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oral mucosal eruption, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Hives and a rash around the mouth and neck starting 1 hour post administration


VAERS ID: 1519077 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3189 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthritis, Axillary lymphadenectomy, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOSARTAN 50 MG
Current Illness: HYPERTENSION
Preexisting Conditions: HYPERTENSION
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myalgia, arthritis, lymphadenopathy left axillary, fever.


VAERS ID: 1519081 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Hypotension, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Client requested water prior to vaccination. Client requested for a snack just after receiving vaccination. Fruit bar and gold fish crackers were provided to client as he was sitting in vaccination chair. Client appeared diaphoretic, face was becoming pale, and eyes were fixated directly to his front. Client dropped water bottle and then client was safely transferred from chair to the ground at 3:20 PM with two person patient transfer. Client was instructed to take deep breaths while client had his eyes closed. Reporter asked client if he was still present with us and client stated, "Yes, I am feeling fine now." Reporter assessed client to which he was alert and oriented to person, place, time, and situation. Client''s face mask and beanie were removed to assist client with cooling down. When client was ready to get up, he stood up immediately and then sat down into the gravity chair at 3:22 PM. Client was advised to continue eating snacks and drinking water and to wait in the gravity chair for a 30 minute observation. Reporter took vitals at 3:22 PM which were the following: blood pressure of right arm 108/58, pulse 60, O2 SAT 96%. Client stated verbally, "my blood pressure always runs low, that is a regular reading for me." Client denied taking any medications and denied having any diagnosed medical conditions. Client revealed, "I''ve had syncope episodes in the past. Needles make me anxious and makes my blood sugar drop. I just need to eat something to feel better." Reporter recommended for client to follow up with his primary care physician and notify them of the syncope episode. Client was also referred to V-SAFE. Client called his brother at 3:29 PM to drive him home which is a 10 minute drive from the vaccination site. Second blood pressure reading at 3:45 PM on right arm 108/50. Client was escorted by reporter as a standby assist to the entrance. Client left facility safely alert and oriented x4 with steady gait at 3:46 PM.


VAERS ID: 1519083 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-07-28
Onset:2021-08-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Heart rate increased, Heart rate irregular
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiac arrhythmia terms, nonspecific (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:
Other Medications: Ibuprofen as needed, supplement magnical D
Current Illness: undiagnosed stomach virus from approximately July 10th to July 17th
Preexisting Conditions: Cancer survivor, Osteosarcoma
Allergies: Tegaderm glue
Diagnostic Lab Data:
CDC Split Type:

Write-up: My heart has been beating very strangely all day. It feels weak, fast, and off a lot of the time.


VAERS ID: 1519091 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: per pt wife, pt was experiencing vomiting at 12 am post first vaccine dose. spoke to pt today says that vomiting overnight and that he is fine now. told pt to go to the doctor and get it checked out. pt is drinking fluids. pt will do so. So far pt only has sore arm.


VAERS ID: 1519095 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-25
Onset:2021-08-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast sodium; Birth control; Xyzal; Multivitamin
Current Illness:
Preexisting Conditions: Seasonal allergies; Allergy induced asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Significant arm swelling and pain that began one week after the vaccine. Both the swelling and pain are 2-3 times worse compared to the first 24 hours post vaccination.


VAERS ID: 1519097 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Bone swelling, Condition aggravated
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (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: joint and bone pain to 1st dose
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She is experiencing swelling and pain on top of clavicle bone.


VAERS ID: 1519122 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-22
Onset:2021-08-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingles vaccine, severe itching at vaccination site for approximately 3 weeks, age 56, 1996, brand name unknown. Swine flu vac
Other Medications: Metformin, Metoporal ER Succinate, Omeprazole
Current Illness:
Preexisting Conditions: Diabetes, GERD
Allergies: Sulfa, Iodine, Tricor, Neosporin, adhesive tape, shellfish.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe headache. Ten days after vaccine. First headache lasted about 1 1/2 hours, waking me from sleep in the morning. Second one lasted about 1 1/2 hours, occurring in the late afternoon. I took 2 Tylenol to alleviate the symptoms the second event.


VAERS ID: 1519127 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Unknown  
Location: Texas  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Delusion, Dysphoria, Paranoia
SMQs:, Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (narrow)

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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Adderal Lamotrogine Clanazipam
Current Illness: Cold like symptoms, coughing, congestion, fatigue, low appetite, headache. (I think contributed by the transition from the air conditions while in treatment facility to the air quality in transitional center
Preexisting Conditions: ADHD/without hyperactivity Chronic acne IBS MDD
Allergies: Penicillin Envega (non-generic) , anything with respredone, resperidal, or any derivative thereof, milk
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dysphoria, delusional thoughts, paranoia, signs from god.


VAERS ID: 1519128 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-28
Onset:2021-08-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Nose bleeds, and out of cycle menstruation.


VAERS ID: 1519132 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW015 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Condition aggravated
SMQs:, 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: She was anxious before getting the shot @ 1615. Appears anxiety attack after shot. Denied shortness of breath, headaches and dizziness. At 1630 heart rate 116 bpm. Offered ice pack and cold water. At 1637 heart rate 87 bpm. OR Sat 99%. Stated feeling better. At 1645 Went home with stable conditions.


VAERS ID: 1519141 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-27
Onset:2021-08-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Epilepsy, Irritability, Malaise, Metabolic function test, Pallor
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Too many to list here. My son suffers from multiple co- morbidities as well as lung scarring from Covid last November and suffering from a collapsed lung in May-June where he required a ventilator and was admitted to hospital PICU.
Current Illness: Chronic pulmonary issues; right lung volume is diminished, and severe OSA. Patient requires oxygen at night.
Preexisting Conditions: Patient is medically complex. He has a very rare genetic condition called Alstroms Syndrome.
Allergies: Patient is at low risk for long QT intervals.
Diagnostic Lab Data: CMP, BMP, chest X-ray, EKG, required O2 due to his Sats dropping from the 3rd seizure.
CDC Split Type:

Write-up: Patient has epilepsy but has not had a seizure in 6 weeks. Today, 5 days after his second dose of Pfizer vaccine he had 3 seizures. Pt. was taken to the local ER and after the nurse spoke with pt. neurologist, the doctors felt the seizures were caused by the 2nd dose. He has been pale, irritable and generally unwell looking. The neurologist felt that due to the immune response from the vaccine and the fact that pt. has been feeling crummy these past 5 days, that it lowered his seizure threshold.


VAERS ID: 1519148 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-24
Onset:2021-08-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Breaking out in hives in a circle around the area that I received the shot. Arm very red and itchy


VAERS ID: 1519270 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-26
Onset:2021-08-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient developed a large, red splotch on at the injection side. The red site is about the size of a deck of cards. On researching it appears to be "Covid Arm". It doesn''t itch, but is warm to the touch and swollen and red. His lymph nodes in his arm pit and neck are also swollen. Redness came up on day 7 after 1st dose.


VAERS ID: 1519271 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cold sweat, Dizziness, Flushing, Hyperhidrosis, Hypotension, Nausea, Paraesthesia, Tremor, Vision blurred, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Visual Changes/Disturbances-Medium, Additional Details: shortly after receiving vaccine, pt had blurred vison,sweating,nausea,clammy feeling,dizzinesss, felt like about to throw up, felt like passing out, tingling in the arm where vaccine administered. gave pt bottle of water, wet paper towels on neck. after sitting for about 30 minutes, he felt better and was able to go home. he was not driving, had another person with him.


VAERS ID: 1519298 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 RA / IM

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

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

Write-up: Systemic: Lymph Node Swelling-Medium, Additional Details: Patient noticed uncomfortable feeling in right armpit area during the evening/night after receiving vaccine. In the morning, patient noticed a bump/swollen area under his right armpit. Patient reports that bump doesn''t hurt, but is uncomfortable; reports that bump is soft to touch. Patient reports no other symptoms and has no other complaints. Pharmacist visually observed bump, looked like a swollen lymph node. Advised patient to seek care from PCP/ER if swelling doesn''t resolve in 1-2 days.


VAERS ID: 1519299 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-01
   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, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient waited 15 minutes then checked out. She then walked to the water fountain/restroom area where she fainted. Patient woke up shortly afterwards and we had her remain laying down and elevated her legs. When she felt better we had her sit on the floor for a bit, then moved her to a chair when she felt comfortable. Patient drank 3 small bottles of water and felt better. Patient''s husband came to the pharmacy to assist patient in getting home.


VAERS ID: 1519300 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Dizziness, Hypotension, Injection site paraesthesia, Injection site warmth, Mouth injury, Seizure, Tongue biting, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Hypotension-Mild, Systemic: Seizure-Mild, Additional Details: after a few minutes of monitoring patient started convulsing it appears like. she was sitting in a chair and started shaking with her head back for about 10 seconds. she does not remember this happening and reported she bit her mouth or tongue in the process. she slightly felt dizzy but that resolved in a few seconds. she reported felt some hotness and tingling at injection site, gave her water monitored more and she felt normal again, no history of seizures she reports. not sick either


VAERS ID: 1519301 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-08-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

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

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

Write-up: Systemic: Pain and swelling at the left armpit-Mild, Additional Details: Patient stated swelling and pain at left armpit area since today morning (08/01/2021). The area is slowly migrated downward. She feels pain when pressing the area. Patient took Advil this morning, but no help on migration. Suggested to have a doctor visit tomorrow (08/02/21, Monday)


VAERS ID: 1519481 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-30
Onset:2021-08-01
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007BB21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Menstrual disorder, Menstruation delayed, Migraine, Pain
SMQs:, Fertility 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: Birth control, nettle supplement for hay fever
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Did not experience menstrual cycle until June 28th, 3 months after vaccination. After the second dose, experienced migraine and body aches with chills.


VAERS ID: 1519532 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Urinary retention
SMQs:, Anticholinergic 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: omeprazole
Current Illness:
Preexisting Conditions:
Allergies: bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: unable to urinate


VAERS ID: 1519550 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syringe issue, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Syringe did not deploy appropriately and patient did not receive full dose. Patient was given full dose after this was realized the same day.


VAERS ID: 1519605 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-01
   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: Chills, Heart rate increased, Hyperhidrosis, Hypertension, Nausea, Pallor, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 5 minutes after the Covid 19 Vaccine was given, the patient started to have reactions. Patient started shivering, break into hive, sweating, nausea and vomiting, and also very pale. Ambulance was called after the reaction started. When they arrived, they checked blood pressure/heart rate and both were very high. After the examination, patient was released. Patient was okay to leave with his mother without being transported to hospital.


VAERS ID: 1519611 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

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

Write-up: patient parent informed vaccinating staff that pt DOB was 1/23/2009 which would have made her 12 years old and eligible to receive Pfizer Covid-19 vaccine. upon reviewing Alert iis- pt DOB is 1/23/2010 pt was 11 when given the vaccine.


VAERS ID: 1519614 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-06
Onset:2021-08-01
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Heavy menstrual bleeding, Menstrual disorder, Menstruation irregular, Platelet count decreased, Polymenorrhoea, Thrombosis
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Fertility disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine, Propranolol
Current Illness: None
Preexisting Conditions: None
Allergies: Some sulfa medications
Diagnostic Lab Data: Blood tests, Ultrasound. Blood tests low platelet levels but not low enough for transfusion. Ultrasound not completed at hospital facility and will be done by OBGYN.
CDC Split Type:

Write-up: After my se one dose I began having abnormal blood clotting during my period beginning on 5/8/2021. Each cycle has gotten progressively worse- cycles shorter and irregular, and very heavy menstrual flow with significant clotting. Culminated with event on Aug 1. Began my period on Sunday 25th, light bleeding, then stopped, and period began again on July 31st with heavy bleeding on August 1st I was bleeding through super tampons and pads every time I would stand. Went through tampons every 30min. Contacted my physician and she called in prescription and advised I go to ER if bleeding continued, it continued with very large clots and so went to ER on 8/1 at 15:56 PM. Indicated possible fibroid and have never had issues with fibroids. Follow up appointment in process of being scheduled with my OB/GYN for further testing.


VAERS ID: 1519621 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-01
Onset:2021-08-01
   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 - / 3 RA / IM

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

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

Write-up: Dr scheduled an appt. at the vaccine clinic for a third booster vaccine of the Pfizer vaccine and it was administered he had no adverse out come for reaction after monitoring.


VAERS ID: 1519626 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-08-01
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / N/A - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Back pain, Headache, Pain, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: presents to the ED complaining of feeling feverish (did not check) headache, loss of smell and taste (started yesterday) and lower back pain for the past 3 days. Pt states the back pain worsened tonight to the point he was unable to sit or sleep. He states he was vaccinated x2.


VAERS ID: 1519628 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-28
Onset:2021-08-01
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Nasal congestion, Nausea, Productive cough, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

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

Write-up: 08/01-Patient arrives to ED with c/o productive cough, fever, nasal congestion, fatigue, nausea without vomiting, and diarrhea beginning this morning at 0800.


VAERS ID: 1519694 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-08-01
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: The patient states she was administered the Johnson & Johnson vaccine in March 2021 and was tested COVID-19 positive on 8/1/2021.


VAERS ID: 1519701 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-22
Onset:2021-08-01
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / UNK LA / IM

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

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

Write-up: Pt is hospitalized for COVID 19 post vaccination.


VAERS ID: 1519759 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-01
Onset:2021-08-01
   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: Anxiety, Confusional state, Derealisation, Dizziness, Feeling hot, Headache, Mental disorder, Nasopharyngitis, Nausea, Palpitations, Panic reaction, Thirst
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), 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), Cardiomyopathy (broad), Vestibular disorders (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: Levothyroxine 88mcg earlier that morning
Current Illness: None
Preexisting Conditions: Hypothyroidism, TBI
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe headache almost immediately after shot, so I took 1 extra strength Tylenol for pain. Was woken up at approximately 4:00am with symptoms of a racing heart, severe anxiety & panic (worse than I have ever felt in my life), severe dizziness, and a un-quench-able thirst. Also felt cold inside my body, but skin was hot. I felt extremely confused. I also felt like I was literally going to go insane. Touching objects felt unreal. My brain did not feel like it was mine if that makes sense. I felt in complete lack of control of my body and mind. I also have severe nausea. It?s 1:15pm the next day, and the symptoms are not as bad, but all still there like a dog in my head


VAERS ID: 1519780 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site pain, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Pt experienced vomiting at 12 am post vaccine dose 1. Pt was better by morning and is now only experiencing pain at injection site.


VAERS ID: 1519811 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Hyperhidrosis, Pain, Pain in extremity, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? 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: Extreme pain on the left side of the body in chest and legs, shaking, sweating and difficulty breathing


VAERS ID: 1519829 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-01
Onset:2021-08-01
   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: Blood test normal, Condition aggravated, Confusional state, Dehydration, Dizziness, Nausea, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (narrow)

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: Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Headache-Medium, Systemic: Nausea-Medium, Systemic: Vomiting-Medium, Additional Details: after pfizer vaccine administration,patient started to feel dizzy, nausea, confusion. She was unresponsive for few seconds,but started to respond after smelling alcohol. She vomited as well.We called 911 right away, rescue came and assisted her, she was transferred to urgent care and was there for 2 hours.She was dehydrated, but bloodwork and electro was ok, nausea med given. Patient had hx of fainting. Patient currently at home,healthy and feeling well.


VAERS ID: 1519900 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-06
Onset:2021-08-01
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, SARS-CoV-2 test positive, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not sure
Current Illness: Not sure
Preexisting Conditions: Not sure
Allergies: ARB
Diagnostic Lab Data: SARS-CoV2 COVID-19 (Panther) test was performed on 8/1/21 and came back positive.
CDC Split Type:

Write-up: Presented to our hospital with evaluation of blurred vision that started 2 days ago. No symptoms for COVID-19 but test came back positive.


VAERS ID: 1519912 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-26
Onset:2021-08-01
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Anaemia, Bladder spasm, COVID-19, Chest X-ray abnormal, Chronic kidney disease, Chronic respiratory disease, Condition aggravated, Cough, Electrolyte imbalance, Fluid retention, Haematuria, Lung consolidation, Pneumomediastinum, Pyrexia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tubulointerstitial diseases (broad), Respiratory failure (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: HCTZ, telmisartan, metoprolol, atorvastatin, metformin, ASA, prednisone, flomax, abiraterone, monthly degarelix and every three months denosumab
Current Illness:
Preexisting Conditions: DM, gleason 10 adenoCA of prostate w/mets to bone, AKI on CKD (stage 3), BPH, bladder CA, CAD, s/p CABG
Allergies: bactrim
Diagnostic Lab Data: 7/17 & 7/29: SARS CoV2 RNA PCR- negative; 8/1: SARS CoV2 RNA PCR- positive 8/1: CXR- minimal pneumomediastinum vs. consolidated lung abutting heart border 7/18: increased interstitial markings which may be on the basis of chronic lung dx. No focal consolidation.
CDC Split Type:

Write-up: Inpt rehab pt w/complex hx including stage IV gleason 10 adenocarcinoma of prostate w/mets to bone admitted for related debility & recent complications (hematuria, bladder spasms, acute on chronic anemia, acute on chronic kidney dx stage 3 w/underlying electrolyte disturbances. Developed fever and cough on 8/1 and has tested positive for COVID (8/1) despite having tested negative twice prior and having had received Pfizer vaccinations on 2/4 & 2/26. Pt has not required any respiratory support at this time. Will continue to monitor for resolution of symptoms as pt is no longer febrile.


VAERS ID: 1519936 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site warmth, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dextroamphetamine-amphetamine 10 mg tab TAKE 1 TABLET IN THE MORNING AND 1 TABLET AT NOON norethindrone (MICRONOR) 0.35 venlafaxine (EFFEXOR-XR) 37.5 MG 24 hr capsule TAKE 1 CAPSULE BY MOUTH EVERY DAY IN THE MORNING Vyvanse 60 mg capsule
Current Illness: none
Preexisting Conditions: ADD Anxiety Depression Mingraines/Cluster headaches
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received covid vaccine on 07/31/2021 around noon. States saw a little redness the following morning. This morning woke up and was a lot of redness around injection site with tenderness, warmth, skin feels a little firm. Upper arm is achey. Received Moderna Vaccine - this is her second vaccine. States with first vaccine had a delayed reaction about 1 week later which was fairly mild. Was more concerned this time as it is more red, firm and painful. Has not been applying anything or taking anything for symptoms.


VAERS ID: 1519960 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: over 42 days, 1st dose 05/21/21, 2nd dose 08/01/21


VAERS ID: 1520039 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-04
Onset:2021-08-01
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: NKA
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: patient reported being symptomatic, unsure of symptoms


VAERS ID: 1520052 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-06
Onset:2021-08-01
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-08-02
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: 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: Sulfa
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: Unknown


VAERS ID: 1520061 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-01
Onset:2021-08-01
   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: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: The vaccine was not properly diluted prior to injection. There was only 0.8ml of sodium chloride added to the vial instead of 1.8ml.


VAERS ID: 1520079 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-02
Onset:2021-08-01
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Nervousness, Panic attack, Seizure like phenomena, Syncope, Visual impairment
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), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: At approximately 10:45 am, someone came to the pharmacy counter and said there was a person passed out in the floor. When I arrived there was a teenage female on the floor. It first appeared that she was having a seizure but as I approached her she was beginning to sit up and was able to communicate what was going on. I cleared the aisle with the exception of mom, pharmacy personnel and customer who is also a nurse. RPh came and assessed the situation and then ran to grab some water. The patient had just received a Covid-19 vaccine, she stated she was really nervous and worried about what the vaccine would do to her. It appeared that she may have been having a panic/anxiety attack. She did not wait the 15 minutes outside of the pharmacy after receiving the vaccine. It is unclear at this time if she was instructed to do so. She stated she walked out of the room and then she started seeing spots. Mom thought she was being dramatic until she fainted (mom''s account). Patient was alert and able to communicate when I got to her. She drank some water and we sat with her until she felt strong enough to stand up. After regaining her composure she walked with her mom to get a drink and to sit for a few more minutes before leaving the store.


VAERS ID: 1520092 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-01
Onset:2021-08-01
   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: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: The Pfizer vaccine vial was not diluted properly. There was 0.8ml added to the vial instead of 1.8ml.


VAERS ID: 1520148 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-08-01
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: COVID TESTED ON 8/1/2021 THE RESULT CAME POSITIVE


VAERS ID: 1520149 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-05-12
Onset:2021-08-01
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Dyspnoea, Fibrin D dimer, Hypoxia, Oedema peripheral, Pulmonary embolism, Ultrasound Doppler
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Genvoya Crestor Sildenafil Adderall Diazepam Diclofenac Duloxetine Gabapentin Norco Lamictal Risperdal Trazadone Dyazide Breo elipta Ozempic
Current Illness: No acute
Preexisting Conditions: Asthma HIV + BPD
Allergies: Divalproex sodium lurasidone
Diagnostic Lab Data: D-Dimer 1.79 CT Chest Angiogram: Right upper lobe and left lower lobe (bilateral) pulmonary embolism. Venous DPLX Ultrasound pending
CDC Split Type:

Write-up: Patient reportedly received, in his own words, "Johnson-Johnson vaccine" on 5/12/21. Believe he meant Janssen. Patient presented for worsening dyspnea and shortness of breath with relative hypoxia recorded on home pulse oximeter; at 94%. He has had progressive worsening dyspnea for over two-weeks attributed to asthma, but unsuccessfully treated with current home-regimen. CTA showed sub-segmental pulmonary embolism in right upper lobe and left lower lobe. Prior to 2-weeks ago, he had reported to rheumatologist and complained of lower extremity edema, which was attributed to diclofenac treatment, per patient, at that time; and he was started on diuretic HCTZ/Triamterene. - Ultrasound of lower extremity is pending. Patient denies travel, decreased activity or prolonged inactivity. Denies history or family history of clotting or pulmonary embolism . Med list was reviewed and no obvious instigating medications are identified. B-symptoms for potential neoplasia were denied on ROS. Additionally patient denied any recent trauma to extremities.


VAERS ID: 1520156 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-01
Onset:2021-08-01
   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: Extra dose administered
SMQs:, Medication errors (narrow)

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

Write-up: no known adverse events. patient was given a pfizer covid vaccine after she had already completed the series for moderna


VAERS ID: 1520161 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Gingival pain, Headache
SMQs:, Retroperitoneal fibrosis (broad), Gingival disorders (narrow)

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

Write-up: Moderate lower back pain, requiring ibuprofen Moderate headache Gum pain Chills


VAERS ID: 1520162 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-20
Onset:2021-08-01
   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 FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Chest pain, Computerised tomogram thorax abnormal, Dyspnoea, Echocardiogram, Pulmonary embolism, Ultrasound Doppler
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ortho Evra (birth control), albuterol, Zyrtec, ginger, turmeric
Current Illness: none
Preexisting Conditions: none
Allergies: No known allergies
Diagnostic Lab Data: CTA chest 8/2/2021 Ultrasound RLE 8/2/2021 Echo pending
CDC Split Type:

Write-up: Pt presented to the ED with c/o chest pain and SOB. She received vaccine on 7/20. CT scan of chest showed extensive extensive bilateral PE, right $gleft. She is currently hospitalized receiving anticoagulation and is in stable condition.


VAERS ID: 1520221 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-07
Onset:2021-08-01
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / SYR

Administered by: Private       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderrall - 10 mg daily; Lasix - 20 mg daily; dietary supplements - Thyroxal, Gabatone, Renelix, Itires, Vitamin D
Current Illness: None.
Preexisting Conditions: Obesity.
Allergies: None known.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: On Sunday, August 1, 2021, I started my menstrual cycle after being post-menopausal and not having any cycle since April 19, 2020 - more than 15 months ago.


VAERS ID: 1520230 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-11
Onset:2021-08-01
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-02
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
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. Patient was fully vaccinated.


VAERS ID: 1520245 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-01
Onset:2021-08-01
   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 EW0196 / 1 RA / IM

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

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

Write-up: No adverse event. Pt said he never got covid vaccine and nothing was listed. Pt had J and J covid19 in March.


VAERS ID: 1520270 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-02-09
Onset:2021-08-01
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

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

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

Write-up: Fully vaccinated and tested positive for COVID-19


VAERS ID: 1520474 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (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: Alprazolam, Citalopram, Estrace
Current Illness: Na
Preexisting Conditions: Na
Allergies: Na
Diagnostic Lab Data:
CDC Split Type:

Write-up: The day after the shot, I experienced severe joint and muscle pain. It was excruciating. I was able to finally get comfortable around midnight that night with some Tylenol. Woke up on day 2 with Moderate joint and muscle pain. Was able to help with Tylenol.


VAERS ID: 1520486 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-08-01
   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: Unknown       Purchased by: ?
Symptoms: Dizziness, Dry skin, Skin warm
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Attendee received first dose Pfizer vaccine at 09:20 am in the left arm. Lot# FA7484. Attendee was directed to observation area. At 09:25 voiced complaints of dizziness. Attendee''s skin was warm and dry. Attendee''s respirations were not tachypneic or dyspneic. Attendee assisted to the cot to lie down. Water given. 09:27 ? Lying on the cot. HR: 52 BP: 98/70 O2Sat%: 98 09:37 - Attendee stated he felt better and wanted to go home HR: 75 BP: 100/80 O2Sat%: 96 09:40 ?Sat up in the cot without dizziness. Then to standing position without dizziness. 09:45 - Care Practitioner educated on home discharge/adverse reaction instructions and attendee was discharged to home with their mother.


VAERS ID: 1520490 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

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

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

Write-up: Attendee received first dose Pfizer vaccine at 11:54 am in the right arm. Lot# FA7484. Attendee was directed to observation area. At 12:15 voiced complaints of nausea. Attendee assisted to the cot to lie down. HR: 68 BP: 124/70 RR: 14 O2Sat%: 99 Temp: 98.1 12:22 - Attendee stated she felt better and wanted to leave. EOA called for assistance. 12:25 - Attendee attempting to leave. Refused to let the site get another set of vital signs. EOA spoke with attendee, but she was adamant that she was leaving. 12:26 - Care Practitioner educated on home discharge/adverse reaction instructions and attendee was discharged to home with her mother and her child, who were in attendance with her at the site.


VAERS ID: 1520493 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-08-01
   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: Unknown       Purchased by: ?
Symptoms: Blood glucose normal, Cold sweat, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Attendee received first dose Pfizer vaccine at 12:00 pm in the left arm. Lot# FA7485. Attendee was directed to observation area. At 12:10 voiced complaints of dizziness, pale and clammy. Attendee''s skin was cool and clammy. Attendee''s respirations were not tachypneic or dyspneic. Attendee assisted to the cot to lie down. Didn''t eat or drink prior to vaccination. Gave him some sugar water. HR: 51 BP: 92/54 RR: O2Sat%: 99 12:15 - Attendee stated he felt better, color started to come back. HR: 53 BP: 100/62 RR: O2Sat%: 99 12:25 ?EMS called, as he was not improving. HR: 48 BP: 90/60 RR: O2Sat%: 99


VAERS ID: 1520496 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-08-01
   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: Unknown       Purchased by: ?
Symptoms: Chills, Cold sweat, Feeling cold, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Attendee received first dose Pfizer vaccine at 12:07 pm in the left arm. Lot# FA7485. Attendee was directed to observation area. At 12:16 voiced complaints of nausea, feeling cold and shivering. Attendee''s skin was cold and clammy. Attendee''s respirations were not tachypneic or dyspneic. Attendee assisted to the cot to lie down. Sips of water given. HR: 60 BP: 100/60 RR: O2Sat%: 99 12:25 - Attendee stated he felt better, no longer nauseous but still visibly shaking. HR: 80 BP: 98/62 RR: 20 O2Sat%: 99 12:30 ? Still shivering. 12:35 ? EMS was on site for a different attendee and so they came to evaluate and take over care of the attendee. 2:45 ? EMS had him standing and attempting to walk a bit. Still visibly shaky, developed nausea again. Another ambulance was called to transport the attendee. 12:55 ? Taken to emergency room by ambulance.


VAERS ID: 1521184 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-27
Onset:2021-08-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fibrin D dimer increased, Heart rate increased, Live birth, Pregnancy
SMQs:, Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Normal pregnancy conditions and outcomes (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatals
Current Illness: None, developed tachycardia on day 5
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 08/02/2021 Elevated DDimer 1.0 All other labs normal Stats 130/80 PR 125
CDC Split Type:

Write-up: 3 pregnancies, 2 live births, pregnancy#3 due January 15 2022


VAERS ID: 1521185 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-08-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 - / IM

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

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

Write-up: Pt''s representative (spouse) came to pharmacy and reported discoloration on the palm of patient''s hand. Only one hand is affected. She described it as dark purple discoloration covering the entire palm. She said it looks as if it was "bruised," but there is no pain when pressure is put on the area. No other sensation such as itching. Just dark disoloration.


VAERS ID: 1521186 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-21
Onset:2021-08-01
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7206 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysmenorrhoea, Menstrual disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not long-standing but I did have thrombosis (not deep vein) in a varicose vein in my left leg. I also have undiagnosed asthma I don''t need a puffer but I am prone to lung infections when I get a cold.
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Menstrual cycle arrived 2 weeks early. I am always outside the 28 window mark. Anywhere from 30-40 days is my regular. I''ve never been early. Cramps are usually minimal for me, no need for medication and only one day of real discomfort. Cramps where instant and I needed a pain killers yesterday and today. Today subsided in the evening.


VAERS ID: 1521347 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-12
Onset:2021-08-01
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/01/21 tested positive for COVID
CDC Split Type:

Write-up: Patient asymptomatic, did pre travel COVID test on 08/01/21 that was positive for COVID


VAERS ID: 1521358 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-08-01
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise, 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: positive covid19 PCR test, 8/1/21
CDC Split Type:

Write-up: fully vaccinated (moderna, 3/5/21, 4/9/21); onset of symptoms 8/2/2021


VAERS ID: 1521368 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-04-15
Onset:2021-08-01
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medication for diabetes, cancer
Current Illness: no
Preexisting Conditions: history of lung cancer, asthma, DM2, hypertension and Afib,
Allergies: no
Diagnostic Lab Data: covid swab ordered on 8/1/21
CDC Split Type:

Write-up: pt tested positive for covid on 8/1/21. had cough starting for 1 week


VAERS ID: 1522446 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-28
Onset:2021-08-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Chest X-ray, Chest pain, Computerised tomogram thorax, Dizziness, Dyspnoea, Electrocardiogram, Full blood count, Metabolic function test, Troponin
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: glipizide, pantoprazole, lisinopril
Current Illness: none
Preexisting Conditions: T2DM,, HTN
Allergies: ASA, sulfa, temazepam
Diagnostic Lab Data: EKG, CBC, CMP, troponin, CXR, CT angiogram of chest
CDC Split Type:

Write-up: chest pain, dizziness, shortness in breath. Has non-ST elevation myocardial infarction


VAERS ID: 1522457 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Difficulty breathing, unable to take deep breath without coughing, airway feels constantly irritated


VAERS ID: 1522692 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site induration, Injection site pain, Injection site warmth
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: FETZIMA, MIRTAZAPINE, ADVAIR, ALBUTEROL MDI, METOPROLOL, ELIQUIS, LEVOTHYROXINE, PANTOPRAZOLE, QUETIAPINE, PRAMIPEXOLE, FLUTICASONE PROPIONATE, HCTZ, ATORVASTATIN, METHOCARBAMOL, MONTELUKAST, ASPIRIN 81mg, VITAMIN C, GLUCOSAMINE CHONDROITIN
Current Illness: None
Preexisting Conditions: HYPERTENSION, HYPOTHYROIDISM, RESTLESS LEG SYNDROME, BIPOLAR DISORDER, CVID, ASTHMA, CHEINIC BRONCHITIS, BLOOD CLOTTING DISORDER, HYPERLIPIDEMIA, GERD, OSTEOARTHRITIS
Allergies: SPORONOX
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Painful injection site that is firm and warm to touch. No treatment.


VAERS ID: 1522703 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-28
Onset:2021-08-01
   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 EW0198 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bell's palsy, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hearing impairment (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: meds - Adderall xr 10mg, Flovent 110 mcg, Xopenex 45 mcg
Current Illness: on 7/24/21 c/o body aches, feeling awful, temp up to 102 x 24 hours and then sx. resolved
Preexisting Conditions: ADHD, predominantly inattentive type Mild persistent asthma without complication Pupil irregularity, bilateral Seasonal allergic rhinitis due to pollen
Allergies: NKDA
Diagnostic Lab Data: patient is being evaluated this am w/ pcp office - ? lyme
CDC Split Type:

Write-up: Patient developed L sided numbness, bells palsy on 8/1 - current. no other sx


VAERS ID: 1522716 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-08-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C12A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Lymph node pain, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 1) Pain & tenderness at injection site began within 24 hours. 2) Tenderness and swelling of the lymph nodes in the armpit of the same arm of the injection began within 72 hours and has since expanded into tenderness and swelling of lymph nodes in chest to collarbone within 96 hours of injection. Side effect still present at time of submission. 3) Fatigue and muscle pain began within 24 hours of injection and last for approximately 24 hours.


VAERS ID: 1522745 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-10
Onset:2021-08-01
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, aspirin, atorvastatin, bimatoprost eye drops, calcium carbonate vitabin D, cetirizine, cholecalciferol, empagliflozin, glipizide, insulin degludec, liraglutide, olopatadine eye drops, omeprazole, primidone, propanolol, rivaro
Current Illness:
Preexisting Conditions: long term anticoagulant use, DM type 2, hyperlipidemia, OSA, abnormal serum lipase level, allergic rhinitis, BPV, chronic otitis media, ED, gastritis, glaucoma, hepatic steatosis, GERD, intermittent asthma, bilateral chronic knee pain, essential tremor, vitamin D deficiency, Restrictive airway disease, bilateral venous insufficiency, osteoarthritis of both hands, thromboembolic disorder, obesity, CKD stage 3
Allergies: Brimonidine, adhesive tape, Ether, acetaminophen-codeine, cat hair extract, environmental, farxiga, latex, pollen extract, tobacco, simvastatin, brimonidine tartrate, dust mite extract, metformin.
Diagnostic Lab Data:
CDC Split Type:

Write-up: **No lot number in patient record for 1st dose lot number** Pt received both doses of the Moderna vaccine, on 1/14/21 and 2/10/21. Pt later became ill with COVID 19 , tested positive on 8/1/21, and then was hospitalized at a med level of care.


VAERS ID: 1522747 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-27
Onset:2021-08-01
   Days after vaccination:5
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: Pruritus, Rash, 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:
Other Medications: -
Current Illness: -
Preexisting Conditions: -
Allergies: -
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient came into pharmacy and described a possible allergic reaction after second dose of Pfizer Vaccine. Patient had small bumps on the wrist and thighs. Bumps were described as itchy and patient states she is ,"itchy all over body."


VAERS ID: 1522749 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-05
Onset:2021-08-01
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Confusional state
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: CVA, CHF, Obesity Tabacco user
Allergies: codiene
Diagnostic Lab Data:
CDC Split Type:

Write-up: Increased confusion and weakness


VAERS ID: 1522780 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-01
Onset:2021-08-01
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Pyrexia, Respiratory symptom, Respiratory tract congestion, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: hyperlipidemia, migraines, insomnia
Allergies:
Diagnostic Lab Data: 08-02-2021, rapid antigen covid test was positive
CDC Split Type:

Write-up: Patient was fully vaccinated for COVID 19, receiving Pfizer vaccine on 4/9/21 and 5/4/21. She developed URI symptoms on 8-1-21 and tested positive for COVID-19 at our clinic with rapid antigen test on 8-2-21. She is having mild symptoms including cough, fever, and congestion with her breakthrough case.


VAERS ID: 1522827 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-07
Onset:2021-08-01
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Occupational 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:
CDC Split Type:

Write-up: Tested positive for COVID on 08/2/2021 had an exposure at work and is having some mild symptoms.


VAERS ID: 1522848 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-01
Onset:2021-08-01
   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 RA / IM

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

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

Write-up: Pt received 1st dose Pfizer covid vaccine on 8/1/2021. on VAR form pt misspelled her name which was not caught until after vaccine was administered. on chart/Alert iis review- pt has received Moderna Covid vaccine on 1/15/2021 and 2/16/2021 completing her series.


VAERS ID: 1522897 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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: Hydrocodone , Celebrex Allegra
Current Illness: no
Preexisting Conditions: Pain in Large muscle
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Severe intestinal issues


VAERS ID: 1522905 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-08
Onset:2021-08-01
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: TETANUS - NAUSEA (UNKNOWN AGE, DATE, BRAND)
Other Medications: ASPIRIN, CALCIUM WITH VITAMIN D, FERROUS SULFATE, ADVAIR INHALER, IPRATROPIUM-ALBUTEROL NEB, METOPROLOL, OMEPRAZOLE, SIMVASTATIN, TYLENOL, VENTOLIN INHALER
Current Illness: NONE
Preexisting Conditions: ALLERGIC RHINITIS, ASTHMA, GERD, HYPERLIPIDEMIA, LOW FERRITIN, OBESITY, OSTEOARTHRITIS, OSTEOPENIA, PAROXYSMAL ATRIAL FIBRILLATION, RESTLESS LEG SYNDROME, SUPRAVENTRICULAR TACHYCARDIA
Allergies: PENICILLINS, TETANUS VACCINE
Diagnostic Lab Data: COVID-19 Virus Molecular Test POSITIVE (Abbott ID NOW COVID-19 test) 8/2/21
CDC Split Type:

Write-up: POSITIVE COVID TEST WITH HOSPITALIZATION FOLLOWING BEING FULLY VACCINATED


VAERS ID: 1522919 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-23
Onset:2021-08-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Oropharyngeal pain, Pharyngeal swelling, Rash, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartin, Atorvastatin, Clopidogrel, Amlopipine, Carvedilol,
Current Illness: None other than Hypertension
Preexisting Conditions: High Blood Pressure
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore throat evolved into swelling of the throat and difficulty swallowing, next day hives developed under both arms and arm pit areas as well as some on hands and feet.


VAERS ID: 1522950 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 RA / IM

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

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

Write-up: rash on arms that pt received 2nd covid vaccine on saturday 7/31/21 and noticed the next day (sunday) that he developed a rash on his arms. Did not have this issue with first vaccine. Does not have any other symptoms or trouble breathing. Seemed to be worse when laying down. He has took benadryl and instructed to follow up with his doctor.t com es and go


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