National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 32 out of 4,799

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131   next


VAERS ID: 1464132 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

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

Write-up: headache for 9 days


VAERS ID: 1464203 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-07-03
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test negative, 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: Ibuprofen
Current Illness: NO
Preexisting Conditions: NO
Allergies: UK
Diagnostic Lab Data: At home test positive rapid antigen invalid PCR positive
CDC Split Type:

Write-up: became symptomatic, home test positive, rapid antigen invalid, PCR positive.


VAERS ID: 1464215 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-07-03
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

Administered by: Public       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: No
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: at home test positive rapid antigen invalid PCR inconclusive
CDC Split Type:

Write-up: became symptomatic 07/03, at home test positive, rapid antigen invalid, PCR inconclusive


VAERS ID: 1464225 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-07-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry skin, Pruritus, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dry skin reaction all over the body. Itching and peeling of the skin. This symptom lasted for a week.


VAERS ID: 1464482 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-05-28
Onset:2021-07-03
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chills, Cough, Dyspnoea, Electrocardiogram normal, Hypoaesthesia, Influenza like illness, Influenza virus test negative, Myalgia, Nasal congestion, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Neosporin
Diagnostic Lab Data: Flu test negative Covid test negative Chest X-ray clear EKG normal
CDC Split Type:

Write-up: Flu like symptoms. Stuffy nose, cough, shortness of breath, muscle aches, chills. Numbness in the whole right arm from shoulder to fingertips.


VAERS ID: 1464489 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-31
Onset:2021-07-03
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Blood culture, Blood lactic acid, COVID-19, Chest X-ray, Cough, Differential white blood cell count, Dyspnoea, Electrocardiogram, Fatigue, Full blood count, International normalised ratio, Metabolic function test, Prothrombin time, Pyrexia, SARS-CoV-2 test positive, Urine analysis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: citalopram (CeleXA) 10 mg tablet doxycycline (VIBRAMYCIN) 100 mg capsule hydroCHLOROthiazide (HYDRODIURIL) 25 mg tablet lovastatin (MEVACOR) 10 mg tablet nystatin-triamcinolone (MYCOLOG II) cream predniSONE (DELTASONE) 5 mg tablet promethaz
Current Illness:
Preexisting Conditions:
Allergies: Aspirin
Diagnostic Lab Data: Updated Procedure 07/10/21 1713 POCT COVID-19 PCR Collected: 07/10/21 1713 | Final result | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal Lot # 1000266367 Point of Care COVID-19 PCR Testing Method Cepheid Lot Expiration Date 5.15.2022 Patient Care Timeline (7/11/2021 00:00 to 7/12/2021 16:48:05) 7/12/2021 Event Details User 15:12 Patient arrived in ED 15:12:23 Emergency encounter created 15:12:53 Patient (adult) arrived in ED 15:12:53 Arrival Complaint weakness 15:26:16 Patient roomed in ED To room AA334 , RN 15:31:22 Orders Placed Sepsis Communication: Patient undergoing SIRS/sepsis screening ; Vital signs Q30M - While in ED , DO 15:31:23 Lab Ordered URINALYSIS, CULTURE IF INDICATED, BLOOD CULTURE, PROTIME-INR, APTT, CBC AND DIFFERENTIAL, LACTIC ACID, PLASMA, COMPREHENSIVE METABOLIC PANEL , DO 15:31:23 XR Ordered XR CHEST 2 VW , DO 15:31:23 Imaging Exam Ordered , DO 15:31:23 ECG Ordered ECG 12-LEAD: HOSPITAL OR TEST FACILITY , DO 15:31:23 Orders Placed Vital signs Q2H x 2, then Q4H x 48H, then per unit policy - Perform additional vital signs PRN if concern for deterioration, For non-ICU admissions ; Notify provider: Specify: For further fluid orders after bolus fluids completed ; Notify provider: Temperature less than: 96; Systolic blood pressure less than: 90; MAP less than: 65; SpO2 less than: 90; Specify: Or lactate level greater than 4 mmol/L following fluid resuscitation - notify attending provider., Notify for temper... ; Strict intake and output ; Comprehensive metabolic panel - Repeat STAT ; Lactic acid - STAT ; CBC and differential - Repeat STAT ; APTT - Repeat STAT ; Protime-INR - Repeat STAT ; Blood culture ; Urinalysis, Culture if Indicated - Urine, Clean Catch ; Chest X-Ray, 2 Views, PA and Lateral ; ECG 12-lead: HOSPITAL or TEST FACILITY Once Chest pain , DO 15:31:28 Orders Completed Sepsis Communication: Patient undergoing SIRS/sepsis screening , DO 15:31:29 Lab Ordered URINALYSIS CULTURE IF INDICATED, CHEMICAL DIPSTICK , DO 15:31:29 Lab Ordered CBC WITH AUTO DIFFERENTIAL , DO 15:35:15 XR Ordered XR CHEST 1 VW 15:35:15 Imaging Exam Ordered 15:35:15 Orders Discontinued Chest X-Ray, 2 Views, PA and Lateral (07/12/21 1531) 15:35:15 Orders Modified Order Modified - X-ray chest 1 view, Portable (Comment: Modified from Chest X-Ray, 2 Views, PA and Lateral) , DO 15:36:53 Assign Resident DO assigned as Resident , MD 15:36:59 Assign Physician , MD 15:38 Vitals Assessment , RN 15:38 Vitals Assessment , RN 15:38 Vitals Reassessment Vitals Timer Restart Vitals Timer: Yes Restart Vitals Timer: Yes , RN 15:38 Other Flowsheet Documentation Vitals Resp: 20 Other flowsheet entries BP: 121/50Abnormal Temperature: 36.9 ?C (98.4 ?F) Temp Source: Oral Heart Rate: 68 SpO2: 84 %Abnormal Weight: 84.5 kg (186 lb 4.6 oz) Weight Method: Bed Scale Change in Weight (%): 0.00 S/F Ratio: 400 Oxygen Therapy: None (Room air) , RN 15:38:28 Assign Attending , DO assigned as Attending, DO 15:38:28 Assign Physician , DO 15:39:18 Height/Weight , RN 15:39:18 Temperature Reassessment Temperature Reassessed , RN 15:39:18 PMH NOT REVIEWED , RN 15:45 Collect APTT - Repeat STAT Completed APTT - Repeat STAT - Type: Blood ; Source: Blood, Venous , RN 15:45 Collect Blood culture Completed Type: Blood ; Source: Blood, Venous Blood culture ; Blood culture , RN 15:45 Collect CBC auto differential - Once Completed CBC auto differential - Once - Type: Blood ; Source: Blood, Venous , RN 15:45 Collect Comprehensive metabolic panel - Repeat STAT Completed Comprehensive metabolic panel - Repeat STAT - Type: Blood ; Source: Blood, Venous , RN 15:45 Collect Lactic acid - STAT Completed Lactic acid - STAT - Type: Blood ; Source: Blood, Venous , RN 15:45 Collect Protime-INR - Repeat STAT Completed Protime-INR - Repeat STAT - Type: Blood ; Source: Blood, Venous , RN 15:45:21 Print Label for APTT - Repeat STAT Completed APTT - Repeat STAT - Type: Blood ; Source: Blood, Venous , RN 15:45:21 Print Label for Blood culture Completed Blood culture - Type: Blood ; Source: Blood, Venous ,RN 15:45:21 Print Label for CBC auto differential - Once Completed CBC auto differential - Once - Type: Blood ; Source: Blood, Venous , RN 15:45:21 Print Label for Comprehensive metabolic panel - Repeat STAT Completed Comprehensive metabolic panel - Repeat STAT - Type: Blood ; Source: Blood, Venous , RN 15:45:21 Print Label for Lactic acid - STAT Completed Lactic acid - STAT - Type: Blood ; Source: Blood, Venous , RN 15:45:21 Print Label for Protime-INR - Repeat STAT Completed Protime-INR - Repeat STAT - Type: Blood ; Source: Blood, Venous , RN 15:45:29 Specimens Collected Comprehensive metabolic panel - Repeat STAT - ID: 21YH-193C3060 Type: Blood , RN 15:45:35 Specimens Collected Lactic acid - STAT - ID: 21YH-193C3059 Type: Blood , RN 15:45:36 Specimens Collected APTT - Repeat STAT - ID: 21YH-193G0483 Type: Blood Protime-INR - Repeat STAT - ID: 21YH-193G0483 Type: Blood CBC auto differential - Once - ID: 21YH-193H1164 Type: Blood , RN 15:45:37 Specimens Collected Blood culture - ID: 21YH-193M0431 Type: Blood , RN 15:45:44 Print Label for Blood culture Completed Blood culture - Type: Blood ; Source: Blood, Venous , RN 15:45:48 Specimens Collected Blood culture - ID: 21YH-193M0433 Type: Blood , RN 15:47 Peripheral IV 07/12/21 1547 20 G Right Antecubital Placed Placement Date/Time: 07/12/21 1547 Size (Gauge): 20 G Orientation: Right Location: Antecubital Site Prep: Chlorhexidine , RN 15:47:34 Orders Acknowledged New - Sepsis Communication: Patient undergoing SIRS/sepsis screening ; Vital signs Q30M - While in ED ; Vital signs Q2H x 2, then Q4H x 48H, then per unit policy - Perform additional vital signs PRN if concern for deterioration, For non-ICU admissions ; Notify provider: Specify: For further fluid orders after bolus fluids completed ; Notify provider: Temperature less than: 96; Systolic blood pressure less than: 90; MAP less than: 65; SpO2 less than: 90; Specify: Or lactate level greater than 4 mmol/L following fluid resuscitation - notify attending provider., Notify for temper... ; Strict intake and output ; Comprehensive metabolic panel - Repeat STAT ; Lactic acid - STAT ; CBC and differential - Repeat STAT ; APTT - Repeat STAT ; Protime-INR - Repeat STAT ; Blood culture ; Urinalysis, Culture if Indicated - Urine, Clean Catch ; Chest X-Ray, 2 Views, PA and Lateral ; ECG 12-lead: HOSPITAL or TEST FACILITY Once Chest pain ; Modified - X-ray chest 1 view, Portable (Comment: Modified from Chest X-Ray, 2 Views, PA and Lateral) , RN 15:47:45 Peripheral IV 07/12/21 1547 20 G Right Antecubital Assessment IV Assessment: Within Defined Limits Infiltration Score: 0 Phlebitis Score: 0 Site Assessment: Clean; Dry; Intact Dressing Status: Dry; Intact; Clean Line Status: Blood return noted; Flushed Dressing Type: Transparent , RN
CDC Split Type:

Write-up: COUGH, FEVER, FATIGUE, SHORTNESS OF BREATHE


VAERS ID: 1464563 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 fainted and fell on the ground about 10 minutes after the vaccine was administered. We called the ambulance and they came 10 minutes later and checked his vitals. Patient did not leave on the ambulance.


VAERS ID: 1464764 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Heart rate increased, Scalloped tongue
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (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: Yaz birth control
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Elevated heart rate and blood pressure going on 10 days. Blood pressure is 136/85. Heart rate is 103 resting, 153 after exercise. Scalloped tongue starting on 7/12. Tounge has never appeared this way prior to vaccine.


VAERS ID: 1466243 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-03
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210703; Test Name: COVID-19; Result Unstructured Data: POSITIVE
CDC Split Type: USJNJFOC20210718648

Write-up: CONFIRMED CLINICAL VACCINATION FAILURE; CONFIRMED COVID-19 INFECTION; This spontaneous report received from a consumer via a company representative concerned a 42 year old male of unspecified race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown, expiry: Unknown) dose was not reported, 1 total, administered on 13-MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. It was reported that the patient became aware of loss of smell and tested positive on 03-JUL-2021 (confirmed covid-19 infection and confirmed clinical vaccination failure). Laboratory data included: COVID-19 (NR: not provided) POSITIVE. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the confirmed covid-19 infection and confirmed clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This case, from the same reporter is linked to 20210720833.; Sender''s Comments: V0: 20210718648-COVID-19 VACCINE Ad26.COV2.S- confirmed clinical vaccination failure. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1466536 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-07
Onset:2021-07-03
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, Biotin, bupropion, calcium carb-cholecalciferol, capsaicin 0.025% cream, ferrous sulfate, fexofenadine, fluticasone, gabapentin, lactobacillus rhamnousus, levothyroxine, lidocaine foot cream, multivitamin, nicotine gum, olanz
Current Illness:
Preexisting Conditions: Heart failure with preserved ejection fraction, hx of adenocarcinoma of colon, anemia, B-12 deficiency, depression, hx of DVT, factor V deficiency, fibromyalgia, hyperlipidemia, hypothyroidism, neuropathy/peripheral neuropathy, hx of PE.
Allergies: Sulfa antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received both doses of the Moderna COVID-19 vaccine (on 3/1/2021 and 4/7/2021). She subsequently developed COVID, testing positive via PCR on 7/3/2021 and was admitted to our hospital on 7/3/2021. She was never ill enough to be in the ICU, instead staying in the general med/surg COVID unit until she was discharged on 7/7/2021. Her primary discharge diagnosis was "COVID-19 pneumonia with mild hypoxemic respiratory failure".


VAERS ID: 1466617 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diplopia, Loss of personal independence in daily activities, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 6/4/2021 5:00PM Pfizer EW0182 @ Tiffin Walmart Pharmacy
Other Medications: vitamin D, Vitamin C,
Current Illness:
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 6/4/2021 5:00PM first dose Pfizer EW0182, the second day (6/5/2021) morning, eyes see objects were very blurry, and double images for a whole day, cannot do anything that day, then it seemed okay. (6/6/2021 morning is ok, recovered). The second dose at 7/2/2021 5:00PM Pfizer EW0181 , and the next day until now (already 10 days) , see things blurry and double images. but the blurry degree is less than the first time (6/5/2021)


VAERS ID: 1466759 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-07-03
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram head normal, Dysarthria, Dysphagia, Facial pain, Facial paralysis, Ophthalmoplegia
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Ocular motility disorders (narrow), Hypoglycaemia (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: 3 Blood Pressure Medications Humalog, Lantus, Metformin Statins Oxybutynin
Current Illness: None
Preexisting Conditions: COVID-19 disease dx 1-28-2021 passive antibodies on 1-30-2021 Hypertension Diabetes Mellitus
Allergies: Morphine
Diagnostic Lab Data: CT scan of head 7-3-2021
CDC Split Type:

Write-up: On 7-3-2021 the client was at a gathering. Friends noted that her left face was drooping and her words slurred. She has a history of stroke in the family. She went immediately to ER . Her CT of the head was normal. Consultation with OSU neurologist on 7-3-21 by teleconference dx Bell''s palsy. the client has had no improvement of sx. Today she is reporting continued pain in the left side of her face that feels like" a bad sinus infection and toothache at the same time". Her words remain slurred and left side of face paralyzed, Left eye unable to close on own, difficulty swallowing.


VAERS ID: 1466766 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-22
Onset:2021-07-03
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Constipation, Headache, Hypoaesthesia, Lumbar puncture, Magnetic resonance imaging, Paraesthesia, Peripheral coldness, Pyrexia, Urinary retention, Vision blurred
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 14 days after the injection developed severe headache and fever. Went to ER. More symptoms developed: Severe Numbness from the waste down Severe pins and needles sensation from the waste down Severe Burning sensation from the waste down Severe coldness on feet that has moved up past ankles Unable to urinate Unable to have a bowel moment Blurry vision


VAERS ID: 1466919 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Moderate diarrhea on and off beginning 2 days after 2nd dose of vaccination.


VAERS ID: 1466932 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram normal, Electrocardiogram normal, Fatigue, Gait disturbance, Hypoaesthesia, Pain in extremity, Paraesthesia, Pruritus, Rash, Rash pruritic, Sensory loss, Ultrasound Doppler normal
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet compounded medication hydrocortisone (HYTONE) 1 % cream hydrOXYzine (VISTARIL) 25 MG capsule ibuprofen (MOTRIN) 600 MG tablet naproxen (NAPROSYN) 500 MG tablet predniSONE (DELTASONE) 10 MG tablet predni
Current Illness: NA
Preexisting Conditions: tobacco use
Allergies: Norco
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient calling for Acute COVID-19 Vaccine and NUMBNESS. Vaccine given Friday - Symptoms started Sunday. Symptoms include: Patient received her Covid vaccine on Friday in her right arm. Saturday morning, her right leg also felt sore. Sunday morning, she says that her right foot and the right side of lower leg, from about halfway down from her leg to her foot she started to experiencing numbness. She says it came on suddenly. She is still experiencing the numb feeling and says that it makes it difficult to walk. Per Patient Report: On Friday I received my first vaccine dose. On Sunday, Less than 48 hours later, I suddenly lost sensation/feeling in my right foot and half of my lower right leg. I still haven''t gained feeling back so I called the nurse line yesterday. They recommended I call 911. I decided to drive myself to ER. They ran a bunch of blood work, did an EKG, an ultrasound of my leg and did CT scan. All findings were normal with no explanation of what could could''ve caused the sudden numbness. The ER doctor said I needed to follow up with primary. My discharge papers said unexplained paresthesia. Went to ED again on 7/12/21 for rash. History of Present Illness Patient is a 36-year-old female, who presents to the emergency department complaining of pruritus for the last few hours. Past medical history is significant for otherwise healthy female. Patient states that she thinks she is having an allergic reaction she has itching all over her body. Patient states she did try some Benadryl cream without any relief. She expresses that the primary itching area is her torso. She expresses that this began while she was at work earlier today. She denies any new detergents, soaps, lotions, or changes in oral intake. She denies any known exposures. She does express that she got her Covid vaccine over 5 days ago and she did have some described paresthesias of her right lower extremity. She expresses that she was evaluated for this and that it comes and goes. She denies any trauma or injuries. She denies any further systemic symptoms at this time including fevers, chills, cough, congestion, difficulty swallowing describing appropriate tolerance of her secretions, denies difficulty breathing, chest pain, abdominal pain, nausea, vomiting, change in bowel bladder habits, episodes of incontinence, or any other concerns. And Urgent Care visit 7.13.21 - HPI: This is a 36-year-old female who presents to urgent care for evaluation of itchy rash to her torso. Rash started yesterday. She believes this is an allergic reaction to the COVID-19 vaccine which she received on 07/02. She states that she has been having a myriad abnormal symptoms including right leg numbness, fatigue, and this itchy rash. This is the 3rd time she has been evaluated for this. She tells me she had a full work up on 7/6 and was told everything was normal and then was seen in ER yesterday when the rash started and started on benadryl, prednisone, and Pepcid. She has been taking the Benadryl without much relief, but hasn''t yet taken her other medications. She denies any new or worsening numbness/tingling to her foot. She states she does get some pain in the foot when working and standing for long periods of time. She has an appointment to establish with primary care on Thursday. She denies any new exposures, lotions, soaps, or detergents.


VAERS ID: 1467318 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Hypoaesthesia, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Intregra plus Garden of Life Woman Multivitamin Garden of Life Vitamin C Garden of Life Vitamin D Glucosamine Chondroitin MSM
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa Products Latex Cashews Pistachios
Diagnostic Lab Data: Awaiting blood results requested by Dr. to explore autoimmune diseases.
CDC Split Type:

Write-up: Left side of body (the side of the body of the injection site) numbness, pain, and tingling on my Face, Arm, Neck, back, foot and leg. These symptoms have been present every day since the injection 7-3-2021 to current (7-13-2021)


VAERS ID: 1467538 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Fatigue, Hyperhidrosis, Musculoskeletal discomfort, Painful respiration, Renal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Hypoglycaemia (broad)

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

Write-up: discomfort in left shoulder blade area. pain in taking breath in back. tiredness, sweats, and discomfort in both kidney areas.


VAERS ID: 1467541 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-27
Onset:2021-07-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Burning sensation, Crying, Decreased appetite, Gastrooesophageal reflux disease, Muscle spasms, Muscle twitching, Nausea, Pain, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (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: Daily take Melatonin and Ellura.
Current Illness: None
Preexisting Conditions: None
Allergies: Lactose Intolerance
Diagnostic Lab Data: (Pending / Scheduling)
CDC Split Type:

Write-up: Burning pains everywhere that come and go at random, sometimes lasts days. Neurological. First day of "adverse event" was July 3rd, but the night before I had thrown up but felt fine. On July 3rd, had first time bad Acid Reflux, took OTC Prilosec which helped over the course of a few days. Someone suggested trying Claritin for the random burning, but it does not help. Strong back pain. Random bouts of nausea (trying not to throw up to avoid Acid Reflux again). Difficulty eating and drinking as a result of symptoms. Sleeping a lot more than usual. Weak in general. A few days ago started to feel better, still kept diet specific to avoiding Acid Reflux. Overnight, horrible burning in limbs and random parts of body came back. Slept and napped for about 18 hours yesterday as burning was ongoing. Can sleep through pain. Pain is instant upon waking up. Sometimes (like right now as I write this) burning is tolerable, sometimes it is unbearable and crying hurts too. Muscle spasms and twitching occasionally, sometimes in frequent in a session. Primary doctor agrees that all of these symptoms are from the vaccine.


VAERS ID: 1468189 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin (300mg, everyday); Sertraline (25mg, every other day); Ajovy (225mg, 1 shot once a month)
Current Illness: None
Preexisting Conditions: ADHD, depression, anxiety
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness. I''m dizzy, when I am moving or using my computer or just doing nothing. Lips and hands go numb. It kind of just comes out of nowhere. The most recent was when I was eating (all things I know I am not allergic to) and my lips just went numb. Before that, my hands went numb, and I have not pin-pointed why.


VAERS ID: 1468206 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1st dose pfizer vaccine was given to patient on 07/03/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468207 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1st dose pfizer vaccine was given to patient on 07/03/2021. We found out on 07/09/2021 vaccine was stored outside the recommended 31 day expiration window.


VAERS ID: 1468363 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Discomfort, Headache, Tinnitus
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Finasteride, 1mg daily
Current Illness:
Preexisting Conditions: Asthma GERD Removed Gallbladder in February 2021
Allergies: Penicillin, Ceclor, Suprax, Zithromax, Ceftin
Diagnostic Lab Data: Went to hospital -was basically ignored over the tinnitus Referred to cardiologist specialty for cheat pain
CDC Split Type:

Write-up: Constant, roaring, and very loud tinnitus-mostly in right ear, but definitely in both ears Headaches and facial pressure on right side, same side as loudest tinnitus Sparks of quickly arriving and quickly leaving severe chest pain slightly left of center


VAERS ID: 1469607 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-03
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Bronchitis, Chest pain, Chills, Dizziness, Hot flush, Neuralgia
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ATORVASTATIN; AMLODIPINE; METOPROLOL TARTRATE; CLONIDINE; NTG; ASA
Current Illness: Alcohol use (May be 2-3 drink at dinner, a couples of times per month.); Coronary artery disease; Marijuana abuse; Myocardial bridging; Smoker (About 1 pack per day. Trying to cut back.); Variant angina; Vasospasm
Preexisting Conditions: Medical History/Concurrent Conditions: Electrocardiogram (Blockage, but no infarction.); Hospitalisation; Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210708459

Write-up: BRONCHITIS AND DIFFICULTY BREATHING; SHARP BURNING PAIN IN CHEST; DIZZINESS; HOT FLASHES; NERVE PAIN IN LEGS; CHILLS; This spontaneous report received from a patient concerned a 54 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included hospitalized, and electrocardiogram, and concurrent conditions included prinzmetal variant angina, myocardial bridge, non-obstructive coronary disease, vasospasm, alcohol user, smoker, and marijuana abuse, and other pre-existing medical conditions included the patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821281 and expiry: UNKNOWN) dose was not reported, administered on 02-JUL-2021 12:00 for prophylactic vaccination. Concomitant medications included acetylsalicylic acid, amlodipine, atorvastatin, clonidine, glyceryl trinitrate, and metoprolol tartrate. On 03-JUL-2021, the subject experienced bronchitis and difficulty breathing. On 03-JUL-2021, the subject experienced sharp burning pain in chest. On 03-JUL-2021, the subject experienced dizziness. On 03-JUL-2021, the subject experienced hot flashes. On 03-JUL-2021, the subject experienced nerve pain in legs. On 03-JUL-2021, the subject experienced chills. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from nerve pain in legs on 03-JUL-2021, was recovering from chills, and hot flashes, and had not recovered from bronchitis and difficulty breathing, sharp burning pain in chest, and dizziness. This report was non-serious.; Sender''s Comments: V0: Medical assessment comment not required as per standard procedure as case was assessed as non-serious.


VAERS ID: 1469608 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-03
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Back pain, Dizziness
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210709096

Write-up: DIZZINESS OR LIGHT HEADEDNESS; PAIN LOWER BACK; WEAKNESS; This spontaneous report received from a patient concerned a 45 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, and expiry: UNKNOWN) dose was not reported, administered on 02-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-JUL-2021, the subject experienced dizziness or light headedness. On 03-JUL-2021, the subject experienced pain lower back. On 03-JUL-2021, the subject experienced weakness. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from dizziness or light headedness, weakness, and pain lower back. This report was non-serious.


VAERS ID: 1469611 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Unknown  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-07-03
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210710769

Write-up: PRODUCT STORAGE ERROR; PUNCTURED VACCINE DOSE ADMINISTERED TO PATIENT AFTER 6 HOUR HOLD PERIOD IN REFRIGERATOR; This spontaneous report received from a pharmacist concerned a 34 year old of unspecified sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: 07-AUG-2021) dose was not reported, administered on 03-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-JUL-2021, the subject experienced product storage error. On 03-JUL-2021, the subject experienced punctured vaccine dose administered to subject after 6 hour hold period in refrigerator. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the product storage error and punctured vaccine dose administered to patient after 6 hour hold period in refrigerator was not reported. This report was non-serious.


VAERS ID: 1469623 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Nevada  
Vaccinated:0000-00-00
Onset:2021-07-03
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210703; Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210719118

Write-up: CONFIRMED CLINICAL VACCINATION FAILURE; CONFIRMED COVID 19 INFECTION; This spontaneous report received from a patient via a company representative concerned a 49 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 03-JUL-2021, the subject experienced confirmed covid 19 infection. Laboratory data included: COVID-19 virus test (NR: not provided) Positive. On an unspecified date, the subject experienced confirmed clinical vaccination failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from confirmed covid 19 infection, and the outcome of confirmed clinical vaccination failure was not reported. This report was non-serious. This report was associated with product quality complaint Sender''s Comments: V0: Medical Assessment comment not required as per standard procedure as the case is assessed as non-serious.


VAERS ID: 1469679 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Heart Attack one day after vaccine; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart Attack one day after vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 02-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Jul-2021, the patient experienced MYOCARDIAL INFARCTION (Heart Attack one day after vaccine) (seriousness criteria medically significant and life threatening). At the time of the report, MYOCARDIAL INFARCTION (Heart Attack one day after vaccine) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product was not reported. Treatment details was not reported. Patient had a bad experience with the vaccine as had a heart attack one day after vaccine. Company Comment Very limited information regarding this event has been provided at this time. Further information has been requested. Reporter did not allow further contact; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.


VAERS ID: 1470129 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-03
Onset:2021-07-03
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Gingival bleeding, Immunoglobulin therapy, Petechiae, Platelet count decreased, Rash, Thrombocytopenia
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gingival disorders (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Thrombocytopenia resulting in undetectable platelets that improved with 4 days of dexamethasone and IVIG with improvement in gum bleeding and petechial rash of bilateral lower extremities


VAERS ID: 1470449 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-07-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood cholesterol increased, Chills, Cough, Dehydration, Dizziness, Dyspnoea, Fatigue, Glucose tolerance impaired, Hypertension, Muscle spasms, Oropharyngeal pain, Pain, Pollakiuria, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Lipodystrophy (broad), Hypersensitivity (broad), Dehydration (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: Ibuprofen, B12, Magnesium, Potassium, Biotin.
Current Illness:
Preexisting Conditions: Chronic regional pain syndrome, anxiety.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Runny nose, fatigue, muscle spasms, hypertension, pre-diabetes, high cholesterol, body aches, shortness of breath, dizziness, frequent urination, constant coughing, dehydration, sneezing, throat pain, and chills.


VAERS ID: 1470452 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 RA / IM

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

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

Write-up: Pt had 1st Pfizer dose 4/27/2021 then 2nd Pfizer dose 5/18/2021 at the Pharmacy , then presented to us on 7/3/2021 requesting the J & J immunization. Pt stated NO to receiving any previous Covid-19 vaccines. We were unable to access medical record at that moment so immunized customer believing they had honestly answered the questions pertaining to previous immunizations. Went to add this immunization into the medical record and found the previous immunizations.


VAERS ID: 1470519 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-03
Onset:2021-07-03
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Discomfort, Erythema, Insomnia, Liver function test normal, Metabolic function test, Pruritus, Rash, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None at time of vaccination. Was taking terbinafine at time of adverse event (for 29 days).
Current Illness: None
Preexisting Conditions: None
Allergies: Due to adverse event, we have listed terbinafine as a possible allergy
Diagnostic Lab Data: A comprehensive metabolic panel was ordered at the ER, because terbinafine can case side effects to the liver. It was found that my liver function was completely normal. A blood cell count was also taken and everything was normal
CDC Split Type:

Write-up: It was a fully body rash the developed over the course of 24 hours. The night before I noticed a bit of itching an a bump that seemed like a bug bite. The following morning I had many such bumps in clusters on my neck and arm (and a few more bumps on my legs). At the time I thought I had bed bugs. By about 6 PM, I had more bumps and many of them had spread and turned into welts. There were bumps and rashes on all limbs, my neck and redness on my chest and back, The itchiness was severe. While not extremely painful, it was extremely uncomfortable and seemed like it would be hard to sleep or do anything. Around 9 PM I took Allegra to try and alleviate symptoms. I also used hydrocortison cream and calamine lotion all over my body to reduce symptoms of itching. By around 11 PM, I the rash was spreading into my face in the form of some bumps and redness. I visited the ER after consultation with a nurse over the phone, who said that anaphylactic shock could be a possibility and that it would be best to go in. At the ER, I was treated with 50 mg diphenhydrAMINE , 20 mg famotidine , 10 mg dexAMETHasone. I was given a prescription for dexAMETHasone and instructed to take a refill in 3 days if I still had symptoms. I was discharged a couple hours later. I did not need to refill the dexAMETHasone as the sympoms subsided and was almost unnoticeable by day 3 (and completely gone by day 4).


VAERS ID: 1470520 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-07-03
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Laboratory test abnormal
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: at home test positive rapid invalid PCR inconclusive
CDC Split Type:

Write-up: became symptomatic 07/03, at home test positive, rapid antigen invalid and PCR inconclusive.


VAERS ID: 1474228 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-15
Onset:2021-07-03
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN LOT # 202A21A / 1 AR / SC

Administered by: Public       Purchased by: ?
Symptoms: Balance disorder, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: gabapentin, lotrel, lipitor, ambien
Current Illness: Was in recovery from GBS which had occurred in October 2020.
Preexisting Conditions: HTN, hyperlipidemia
Allergies: eggs (nausea), lactose intolerant, bisoprolol ( AV block), coreg, indocin,
Diagnostic Lab Data: No additional tests.
CDC Split Type:

Write-up: Pt noticed increased weakness in legs after receiving COVID vaccine. Had been walking steadily. Now unsteady with walking, feeling like legs will buckle. Pt referred for home PT.


VAERS ID: 1474387 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Inappropriate schedule of product administration, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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: N/A
CDC Split Type:

Write-up: PT PRESENTED TO PHARMACY FOR 2ND DOSE AT 2 WEEKS INSTEAD OF THE RECOMMENDED 4 TO 6 WEEKS. FIRST DOSE GIVEN 6/19/2021. SECOND 7/3/21. PT EXPERIENCED MILD SYMPTOMS AFTER SECOND DOSE (LOW GRADE TEMP, FATIGUE FOR APPROXIMATELY 24 HOURS). NO FOLLOW-UP CARE NECESSARY.


VAERS ID: 1474562 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-26
Onset:2021-07-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: trulicity, lisinopril, metoprolol, levothyroxine, rosuvastatin, and multivitamin
Current Illness: diabetes, high blood pressure, kidney disease, high cholesterol
Preexisting Conditions: diabetes, kidney failure,
Allergies: penicillian
Diagnostic Lab Data:
CDC Split Type:

Write-up: One week after injection, server pain on the whole left arm, arm pit, and back shoulder blade. The pain has not gone away.


VAERS ID: 1474702 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Patient has not been seen by a provider at this time.
CDC Split Type:

Write-up: Patient states that his arm has been and still is sore. He has lost mobility and it''s painful (7 on pain scale) when trying to raise his arm above his head. He can perform pull movements, but cannot perform any push movements.


VAERS ID: 1474807 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-10
Onset:2021-07-03
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Amnesia, Asthenia, Body temperature increased, Chills, Cough, Dizziness, Hypersomnia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Evening of June 10th, slept 4 hours (usual is 2 hour nap). 3 hr naps since then. Day of vaccine, slight cough. Some light-headedness since then. 3 July severe chills at about 3 AM. Severe weakness, lightheaded, 22 hours sleeping through to next day. 101? temp at 3 PM followed by 102.6? temp at 7:40 PM. On 14 July, he called to let his PCP know that he''d "lost short term memory."


VAERS ID: 1446482 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

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

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

Write-up: None stated.


VAERS ID: 1446483 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Headache, Pain, Pyrexia
SMQs:, 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)

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

Write-up: General pain, headache, diarrhea and fever


VAERS ID: 1446493 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram normal, Dysphagia, Enlarged uvula, Pharyngeal erythema, Retching, Sensation of foreign body, Streptococcus test
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: erythromycin
Diagnostic Lab Data: July 3rd - CT of the throat - normal - Rapid Strep Test - negative
CDC Split Type:

Write-up: Patient woke up suddenly at approximately 7:15 am, 22 hours post-vaccine, on July 3rd feeling like there was a piece of meat stuck in the back of his throat. He promptly went into the bathroom and tried to gag it out and at that time found that his uvula was extremely red and swollen. He was unable to swallow and had to spit his saliva into a bowl to prevent further gagging. 911 was called and paramedics confirmed that patient was stable. I, his wife, took him to the hospital at 9am on July 3rd and the ER doctor did a CT of his throat and confirmed there was no object obstructing his throat, did a rapid STREP test which came back normal, and then gave a strong dose of Dexamethasone, which yielded no relief in symptoms. They discharged him on July 3rd around 1:30 pm as stable, giving him a second Dexamethasone tablet to take the following morning. He took a dose of Benadryl at approximately 4pm, and another at 12am. By 7 am July 4th, the swelling had gone down enough that he could swallow and talk again.


VAERS ID: 1443023 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

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

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

Write-up: Pt had syncope, headache about 18 hours s/p vaccination


VAERS ID: 1443083 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Influenza like illness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: HBP, budging disc in back with pinched nerve
Allergies: Tramadol
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: I woke up at about 1:00 am with a fever on 101.1, and body aches and chills, I took Tylenol and lay down for a couple of hours and still had a fever of 100.1, I had kinda like flu symptoms from about 1-5 AM and do feel a little better now several hours later.


VAERS ID: 1443099 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Palpitations, Somnolence
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Pain in the shoulder, feeling tired and sleepy, racing heart


VAERS ID: 1443152 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0169 / 1 LA / IM

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

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

Write-up: patient is only 15 years and receive Moderna in Error. Birthdate was entered wrong in EHR. Mother came back and stated date was wrong on his card. MD at facility notified. Patient showed no signs of distress during his wait time and instructions given to mother to seek treatment if needed.


VAERS ID: 1443154 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 came in to receive vaccine. Nurse did not notice that there was a yellow bar on the screen and administered vaccine, once the nurse went to hit administer a notification came up to say that it was too soon for them to receive the vaccine. Upon investigation it was realized that the patient had already received two vaccines previously making this one the third in the series. When asked the patient stated that he had received the first vaccine and he had spoken to someone at database that stated he needed to recomplete the series since he missed his scheduled follow up date. This RN called Dr. with infectious disease who stated there should not be any harm or adverse reactions to the patient and to document appropriately. Did inform patient of the error and to monitor for symptoms. Also created a new vaccine record card to reflect the actual administered vaccines and their dates and lots.


VAERS ID: 1443165 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 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: Brief Description of Event: A Contract Nurse inadvertently gave a Moderna vaccine to a patient who previously received Pfizer first dose (06/09/2021). This would place the patient 23 Days since first dose. Patient?s DOB: 01/01/86, this DOB would make the patient 35 years of age. The patient was notified and made aware of the error when the error was caught on 07/02/2021.


VAERS ID: 1443169 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Heart surgery in 1999, eye condition (left eye)
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Wears glasses. Notice blurry vision in right eye. Left eye is already blurry . Couldn''t see even with glasses. Put warm compression on eye. Put drops in eye. Call eye doctor. Vision is still blurry. Can''t read vaccine card. Eye doctor should get back to him today.


VAERS ID: 1443171 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / -

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: broke out into hives fading away though


VAERS ID: 1443200 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-13
Onset:2021-07-02
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: patient received 1 dose of coronavirus vacccine in January. He was admitted to the hospital on 7/2/2001 with signs of acute hypoxic respiratory failure on 2 L of oxygen, with nasal pharyngeal swab PCR positive for coronavirus.


VAERS ID: 1443237 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: Patient scheduled to receive their second dose of the COVID-19 vaccine. Patient scheduled to receive the pfizer vaccine. The medical assistant administered the pfizer vaccine but after confirming the patient''s vaccination card she realized that his 1st dose was the Moderna COVID-19 vaccine. Patient was informed that he received the Moderna for his 1st dose and Pfizer for his second dose and waited in the office for his 15 minute observation period. Patient left with the fact sheet and was informed to contact the office if he had any questions. Patient experienced no symptoms.


VAERS ID: 1443250 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

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

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

Write-up: Client came to clinic today for a COVID-19 vaccine. Client was 16 years old and accidently received a Janssen Vaccine. Parent and child were informed that she received vaccine. No other issues noted


VAERS ID: 1443258 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Presyncope
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Mother reports h/o vasovagal reactions after other vaccines.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Approximately 10 min after receiving vaccine, pt experienced vasovagal episode. Became faint, lightheaded, and complained of headache.


VAERS ID: 1443263 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (broad)

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

Write-up: Patient started experiencing chest tightness about 10 minutes after receiving her 1st Moderna shot


VAERS ID: 1443269 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Pain in extremity
SMQs:, 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: Report Left sore arm, HA and fatigue started 12 hours post vaccination. Treatment: none. Outcome: Does not interfere.


VAERS ID: 1443272 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Pain, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (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: na
Current Illness: NA
Preexisting Conditions: Reynaud''s Syndrome/Amplified musculosketal pain syndromes/ G.I. diease and respiratory disorder
Allergies: Penicillin VK, Gabapentin, Duloxetine, Ibuprofen, Morphine Sulfate, Prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient Experienced pain when receiving the vaccination and started shaking/fingers and fingernails started to turn blue. Recorded temperature was 97 and gave patient orange juice. Patient stayed in store for about 20 minutes and felt better. Shaking resolved but finger was still blue. Patient''s father took son to medical facility afterwards.


VAERS ID: 1443283 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: POTASSIUM CL, FUROSEMIDE, SERTRALINE, OXYBUTYNIN, CIPROFLOXACIN, CITRUCEL, PENLAC, METOPROLOL TARTRATE, ENALAPRIL, FIORICET, PROTONIX, ALBUTEROL HFA, ASPIRIN, LOPERIMIDE, APIXIBAN, LEVOTHYROXINE, SPIRIVA, MIRALAX, VITAMIN D
Current Illness:
Preexisting Conditions: PERIPHERAL NEUROPATHY, DISC DEGENERATION, FIBROMYALGIA, ACUTE RESPIRATORY FAILURE, PENUMONITIS, COPD, T2DM, HEART FAILURE, ANEMIA, DEPRESSION, INSOMNIA, SLEEP APNEA, CHRONIC PAIN SYNDROME, GASTRITIS, HYPOXEMIA, DYSPHAGIA, HYPOTHYROIDISM, ANXIETY, HYPRETENSION, AFIB, EMPHYSEMA, GERD, ACUTE KIDNEY FAILURE, EDEMA
Allergies: AMITRIPTYLINE, CARBANAZEPINE, CODEINE, DONEPEZIL, FENTANYL, LORAZEPAM, PROLIA, TEGRETOL, TOPAMAX, ARBS
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nursing home reported that patient needed second dose of Moderna Covid vaccine. Vaccine card indicated the patient had previously had 1 dose on 5/28/2021. Vaccine was administered 7/2/2021. Upon looking in system, it is reported that patient had previously received 2 covid vaccines. 1 dose given by a Pharmacy on 3/26/2021 and 1 dose given by a different Pharmacy on 5/28/2021. 3rd dose administered by another Pharmacy on 7/2/2021. Patient is not experiencing any adverse effects at this time. Nursing home alerted and will monitor patient for any adverse events.


VAERS ID: 1443289 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-09
Onset:2021-07-02
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C219 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: none


VAERS ID: 1443295 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / N/A LA / IM

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

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

Write-up: Pt arrived with a beat up vaccine card and asked for his second dose. We prepared and gave Pfizer to him. His dose was processed after he left the store. It was then realized that he had received a Janssen vaccine on 5/3/21. The phone number on the consent form is deactivated. We have left a message on an alternative number to contact us.


VAERS ID: 1443299 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: Paramedics came in and took patient''s vital and blood glucose level.(7-2-2021). Cleared by the paramedics.
CDC Split Type:

Write-up: Pt fainted and had convulsed then became conscious.


VAERS ID: 1443304 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: none


VAERS ID: 1443306 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / SYR

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: Fainting / Unresponsive-Medium, Additional Details: Pt fainted in waiting area approximately 2 minutes after administration. felt dizzy, had approx 12 oz water after. remained for 20 min. in waiting area. took bp and was normal just before he left.


VAERS ID: 1443311 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

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

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

Write-up: administered past the current refrigeration beyond use date.


VAERS ID: 1443316 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-09
Onset:2021-07-02
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C219 / UNK LA / IM

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

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

Write-up: administered past the current refrigeration beyond use date as listed in EUA


VAERS ID: 1443322 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-09
Onset:2021-07-02
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: administered past the current refrigeration beyond use date as listed in EUA


VAERS ID: 1443325 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Blindness, Dizziness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)

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

Write-up: Patient was sitting down after her vaccine waiting the 15 minutes. About 5 minutes in she stated she was dizzy and losing her vision and then her head rolled backward. The patient did NOT fall or hit her head, she was sitting down. She woke up shortly thereafter and taken to a patient room and laid down. While there she vomited a couple of times. Pt states only had doritos for breakfast and her friend talked to her during the vaccination process about the time she fainted while getting a TB test. Patient was evaluated by a PA who determined there was nothing clinically wrong with her, she was stable. After 40 minutes patient was discharged to home and told to follow-up with any changes or concerns.


VAERS ID: 1443331 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-09
Onset:2021-07-02
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: administered past the current refrigeration beyond use date as listed in EUA


VAERS ID: 1443334 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-06-28
Onset:2021-07-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / IM

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

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

Write-up: While giving Covid Vaccinations, this patient under the age of 18 was given the Moderna vaccine. Patient was monitored for 15 minutes as required after the vaccine and had no problems. Patient was checked on today (7/2/21), and has had no problems.


VAERS ID: 1443335 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: Patient received 1st dose moderna 4 weeks ago, unable to seek care for second dose moderna, will provide patient with Pfizer as second dose, risk outweigh, need


VAERS ID: 1443337 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin discolouration, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Shortly after the vaccine, she lost color in her face, she said her vision went blurry, then she vomited. Just a few minutes after vomiting, she said she felt fine. She waited around with her grandmother for another 20 minutes, then left, feeling well.


VAERS ID: 1443338 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-09
Onset:2021-07-02
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C219 / 2 LA / IM

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

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

Write-up: administered past the current refrigeration beyond use date as listed in EUA


VAERS ID: 1443340 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-10
Onset:2021-07-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: administered past the current refrigeration beyond use date as listed in EUA


VAERS ID: 1443342 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash (no hives) developed on trunk and breast area.


VAERS ID: 1443347 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-10
Onset:2021-07-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

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

Write-up: administered past the current refrigeration beyond use date as listed in EUA


VAERS ID: 1443352 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-09
Onset:2021-07-02
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 RA / IM

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

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

Write-up: Administered past the current refrigeration/beyond use date.


VAERS ID: 1443353 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pallor, Syncope, Tinnitus, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: patient returned to the lobby area and begin to turn pale and fainted briefly but came back to consciousness quickly and complained of blurred vision in the left eye and ringing in ears. patient was given cold water while awaiting service from EMS that was called by the pharmacy department. patients'' color came back and EMS checked the patient vitals.


VAERS ID: 1443355 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-10
Onset:2021-07-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFRIGERATION BEYOND USE DATE.


VAERS ID: 1443357 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 RA / IM

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

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

Write-up: Client was Due for the second dose of Moderna which was given in error (Client is 17 years old) . Parent was made aware of the error at the time of the event. according to Administration and Error documentation the second dose must be given. Deviation and error recommended as off label.


VAERS ID: 1443358 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-10
Onset:2021-07-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFRIGERATION BEYOND USE DATE AS LINKED IN EUA


VAERS ID: 1443365 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-09
Onset:2021-07-02
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C219 / 1 LA / IM

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

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

Write-up: administered past the current refrigeration beyond use date as listed in EUA


VAERS ID: 1443367 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFRIGERATION BEYOND USE DATE AS LISTED BY EUA


VAERS ID: 1443373 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFRIGERATION BEYOND USE DATE AS LISTED IN EUA


VAERS ID: 1443382 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFRIGERATION BEYOND USE DATE AS LISTED IN EUA.


VAERS ID: 1443384 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-10
Onset:2021-07-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C219 / 2 LA / IM

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

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

Write-up: administered past the current refrigeration beyond use date as listed in EUA


VAERS ID: 1443387 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFIGERATION BEYOND USE DATE AS LISTED IN EUA


VAERS ID: 1443388 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

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

Write-up: Patient scheduled for Pfizer dose #2. Upon entering room MA confirmed patients name/DOB/Pfizer #2 the patient answered all questions. Patient was asked for her vaccine card, stated she washed it in her pants. MA proceeded to draw up Pfizer, while another MA created the patient a new vaccine card. MA administered vaccine, while the other MA was creating card upon looking up the vaccine information for the patients first dose. MA realized the patient received Moderna 3 wks prior, MA immediately consulted with a provider. We discussed the anticipated side effects for both mRNA vaccines and there are no additional concerns regarding getting mixed mRNA vaccine series. We also discussed for her to sign up for Vsafe and that PCC will be submitting a VAERS report. In addition I will be having a conversation with Public health to see if additional recommendations are needed at this time. Patient felt more assured at the end of the conversation and all questions answered.


VAERS ID: 1443390 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFIGERATION BEYOND USE DATE AS LISTED BY EUA


VAERS ID: 1443395 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-10
Onset:2021-07-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C219 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: none


VAERS ID: 1443398 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFIGERATION BEYOND USE DATE AS LISTED IN EUA


VAERS ID: 1443404 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NON
CDC Split Type:

Write-up: ADMINISTERED PAST THE CURRENT REFIRIGERATION BEYOND USE DATE.


VAERS ID: 1443408 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTERED PAST CURRENT REFIRIGERATION BEYOND USE DATE AS LISTED IN EUA


VAERS ID: 1443411 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Sensation of foreign body, Throat irritation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: renal condition
Allergies: latex, eggs
Diagnostic Lab Data: BP: 201/102
CDC Split Type:

Write-up: Patient complained of tingling in neck and throat area. We administer 50mg of diphenhydramine orally. Patient then complained of a lump in her throat that did not go away . We check her blood pressure it was 201/102. We then called 911. Patient was assessed and transported to hospital.


VAERS ID: 1443416 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINSITERED PAST THE CURRENT REFIRIGERATION BEYOND USE DATE AS LISTED IN EUA


VAERS ID: 1443421 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFIRIGERATION BEYOND USE DATE AS LISTED IN EUA


VAERS ID: 1443422 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: Patient was administered the vaccine at approximately 10:25 am and advised that he should remain in the store for 15 minutes to monitor for possible adverse reactions. At approximately 10:30 am the patient walked out the front door of the store and immediately fell face first on the side walk. I was contacted and did an assessment. His blood pressure was 110/50 with a pulse of 50. He was fully oriented and stated he continued to feel light headed. An ambulance was called and the patient was taken to the hospital for evaluation.


VAERS ID: 1443427 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFIGERATION BEYOND THE USE DATE AS LISTED IN EUA


VAERS ID: 1443433 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFRIGERATION BEYOND THE CURRENT USE DATE AS LISTED IN EUA


VAERS ID: 1443434 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Grimacing, Painful respiration
SMQs:, Dyskinesia (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt says not taking any medication
Current Illness: none
Preexisting Conditions: history of anxiety 1-2x a year per mother
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: client driven by mother, c/o sharp chest pain 8/10, visibly upset, grimacing during inspiration. paramedics on site were called and took vitals bp 100/65, 02 99%, HR 70. After about 15minutes, pain was 3/10 resting, 5/10 during inspiration. EKG conducted, WNL. Client and mom AMA to be taken to the hospital. Client stated she was feeling "a lot better" at 12p . Mom said that she will drive client home and will go to ER if condition worsens.


VAERS ID: 1443437 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFRIGERATION BEYOND USE DATE AS LISTED IN EUA


VAERS ID: 1443441 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 3 LA / IM

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

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

Write-up: patient seized after getting the shot and fainted.


VAERS ID: 1443447 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-12
Onset:2021-07-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFRIGERATION BEYOND USE DATE AS LISTED IN EUA


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=32&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


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