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

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



Case Details (Reverse Sorted by Onset Date)

This is page 324 out of 7,116

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VAERS ID: 1515121 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-29
Onset:2021-07-30
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / UNK RA / IM

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

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

Write-up: Patient developed plaque-like rash post vaccine. Rash is full body and pruritic.


VAERS ID: 1515130 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

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

Write-up: About 5 minutes after receiving his first covid vaccine the patient reported feeling very hot. He became pale and diaphoretic. He complained of dizziness and feeling lightheaded. He was immediately given attention by myself and an RN. We turned a fan on him, gave him a mint, and placed cool cloths to his face and neck. He had not eaten anything this morning prior to his vaccine. He was instructed to lay down but declined. He recovered from this event after about 10 minutes and felt comfortable enough to leave the clinic on his own accord.


VAERS ID: 1515136 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

Write-up: Post receiving the vaccine, child was waiting on site with his mother & brother for 15 minute observation. Received vaccine at 9:02 am, had syncope at 9:20 am. Syncope lasted 1-2min. EMS contacted at 9:21 am and arrived at 9:28 am. Child alert & oriented upon their arrival, sitting up. EMS and mother did not express need for child to f/u at or be taken to hospital at that time. Child remained on site at clinic until 9:45 am. Walked out to car on his own, with mom & brother.


VAERS ID: 1515137 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: About 5 minutes after being given his shot he complained of feeling hot and mildly nauseated. He was also dizzy. He looked a little pale. He was immediately attended to by myself and an RN. A fan was directed towards him and he was given cold water and wet cloths to his face and neck. He recovered from the incident within 10 minutes, stated he felt much better, and walked out of the clinic with his mother in no distress about 10 minutes after the event occurred.


VAERS ID: 1515173 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Palpitations, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Patient stated after she left the store she noticed a numb feeling in the right side of the face. Then her heart began racing and she noticed shaking in her left arm. She came back to the pharmacy and the pharmacist checked for one sided weakness and/or facial drooping. The patient had neither of these symptoms. After sitting for an additional 15 minutes, the patient stated she was feeling much better and that there was only a tiny amount of numbness still felt in her face. The patient stated she was going home to rest.


VAERS ID: 1515174 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incomplete course of vaccination, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: After administering the Janssen single dose COVID vaccine at the request of the patient, she stated "it hurt less than my last COVID shot." The patient did not previously make mention she had one dose of Moderna in May. No adverse events were noted and the patient left the pharmacy.


VAERS ID: 1515177 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 6780 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest discomfort, Dyspnoea, Electrocardiogram, Oxygen saturation decreased, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

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

Write-up: Tachycardia, SOB, low O2 saturation, syncope, chest heaviness.


VAERS ID: 1515184 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Private       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: GABAPENTIN 300MG CAP TAKE THREE CAPSULES BY MOUTH ACTIVE THREE TIMES A DAY FOR PAIN OR ANXIETY. IMMEDIATELY REPORT MOOD AND BEHAVIOR CHANGES ** NOTE DOSE INCREASE ** 2) MIRTAZAPINE 30MG TAB TAKE ONE TABLE
Current Illness: None
Preexisting Conditions: None
Allergies: KNA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine that had been drawn up the day prior to vaccination. Vaccine expired at 6pm on 7/29/21 and was given at 9:40 on 7/30/21


VAERS ID: 1515211 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

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

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

Write-up: .Approximately 10 minutes after receiving the vaccine, patient reported feeling light headed and dizzy. Patient was given water and cold towels for his forehead. He refused to put up his feet. Blood pressure was 101/70. Pt stated he had not eaten that day. After cold compresses and portable fan, he felt better and was ablet to stand up without being dizzy and left the pharmacy.


VAERS ID: 1515223 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Patient fainted from the seated position about 5 minutes after vaccine administration. He was carefully placed on the floor and given an ice pack and some orange juice. When he felt better, he was helped in to a chair and remained under observation for another 40 minutes. Patient reported feeling normal before he left. His mother states he did not have anything to eat or drink that morning prior to coming in. She also reported that he has fainted in the past from seeing a papercut on his finger. Patient was going to report to the urgent care to ensure there were not further issues.


VAERS ID: 1515242 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dizziness, Migraine, Swollen tongue, Throat irritation, Tongue pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None 130 pounds Excellent blood pressure Healthy eater (organic / gluten-free )
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: It is currently 11:25 and I am just waiting to see how this goes. I am hopeful it clears up.
CDC Split Type:

Write-up: Received the shot at 8:05 am and initially did not feel anything. I went back to work and at around 10:00 am, I realized I was coughing due to a film in the back of my throat, it was itching, my tongue is slightly swollen and itchy. I have a migraine and I feel dizzy.


VAERS ID: 1515243 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Diarrhoea, Ear pain, Myalgia, Oropharyngeal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Zoloft, CoQ10, melatonin, DHEA-S
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain, sore throat, inner ear pain, diarrhea, muscle pain


VAERS ID: 1515261 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Private       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? 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: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt waited for 15 minutes post vaccine. No adverse reactions noted at that time. Pt mother did contact network this morning, with a fever.


VAERS ID: 1515264 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Anxiety, Dysphagia, Oral pruritus, Pharyngeal swelling, Swelling face, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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 (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Influenza Vaccine (Qval) - SOB Citrus and Derivatives - SOB Almond - anaphylaxis Peanut - anaphylaxis Tree Nut - anaphylaxis Fruits/vegetables produced by flowers - anaphylaxis Latex - itching/swelling
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt is 38 y.o. year-old female status post receipt of second dose of Pfizer Covid vaccine. Patient with hx of allergies to nuts, citrus derivatives, previous reaction to Flu vaccine. Patient had c/o face swelling after the first dose of vaccine which was resolved with oral benadryl and no further symptoms. Patient is brought to triage room after the vaccination due to her allergy hx. Patient stated she had discussion with her primary care provider and allergy specialist regarding getting vaccination in the setting of her allergy hx. Patient says she was counseled on taking the risk of allergy as the benefits of vaccine outweighs the risk of getting covid illness. Patient was advised to take the vaccine in a setting where monitoring is available and to keep Epipen available and current all the time. While in triage room within 10 minutes of getting vaccine patient became apprehensive and reported feeling swelling in throat. Nothing visualized. RN is called to assist. Patient is given 25 mg benadryl oral(10:48 AM) and she was able to swallow this without difficulty. Patient sated she is feeling tight and swollen below the throat and was very anxious. She also reported difficulty in swallowing. Denies dizziness, itching, hives, SOB, cough, wheezing, chest pain, palpitations or abdominal pain/nausea. Radial pulse palpable and 2+. She is given 0.3 mg Epinephrine IM on left mid anterolateral thigh at 10:53 am. Within 2 minutes she felt better. Within 5 minutes symptoms resolved completely. 14 minutes later( 11:07) she stated feeling slight swelling at throat, but able to swallow and no c/o SOB, continued to converse without difficulty. At 11:10 she stated she feels slight swelling at the back of the throat and some discomfort in stomach, but no nausea. At 11:12 am patient stated her stomach and throat feeling better, but feels mild itching in mouth. Patient stated she has hx of waxing and waning of sx with allergic reactions in the past. Patient remained alert and oriented without acute respiratory distress during the entire time. AT 11:25 am EMS arrived and patient is transported to acute care hospital for further monitoring and evaluation.


VAERS ID: 1515276 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: Nausea, bad diarrhea, and fatigue.


VAERS ID: 1515294 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Dyspnoea, Erythema, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient with history of anaphylaxsis - Received Covid Vaccine - In observation area pt wearing home oxygen. Pt observed to become short of breath- states "my throat is tightening" - face red - Nurse stat called. Unable to speak - immediately taken to emergency room


VAERS ID: 1515297 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling of body temperature change, Malaise, Nausea, Pharyngeal paraesthesia
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none listed on PQCF, allergy to citrus fruits reported after vaccination was given, when she started having tingling in the back of the throat
Diagnostic Lab Data: Her BP at the time of benadryl administration was 140/87 and pulse was 61. That was 11:28 am. Urgent care did no treatment and her symptoms resolved soon after being seen.
CDC Split Type:

Write-up: patient indicated on her PCQF that she had been faint or dizzy after previous vaccines, but she indicated that she just gets nervous and she was nervous about this shot, she had a negative response for allergies on PQCF. she waited the 15 min required and left because she needed to go eat before starting her shift. She returned after a few minutes and said the back of her throat was tingling so I administered 25 mg benadryl (oral liquid). She waited a few minutes after that and indicated that she wanted to go to the urgent care because she just didn''t feel well (nausea, hot and cold flashes). Her sister was there to transport her. Her BP at the time of benadryl administration was 140/87 and pulse was 61. That was 11:28 am. Urgent care did no treatment and her symptoms resolved soon after being seen.


VAERS ID: 1515306 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Blood glucose normal, Disorientation, Fall, Feeling abnormal, Head injury, Headache, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: BP was 96/60 immediately after regaining consciousness, 110/68 when EMS arrived. Blood glucose was 68 when EMS arrived, this was 15 minutes after the patient had been given 4 ounces of orange juice. Patient''s father reported the patient hadn''t had anything to eat or drink that day.
CDC Split Type:

Write-up: Approximately 2 minutes after vaccination patient was walking to waiting room with father and fell to ground striking head on concrete floor. Patient was unresponsive for about 30 seconds then regained alertness, however remained disoriented to day/month/year and situation, and was unable to answer simple questions for 25 minutes. EMS was called after 25 minutes, when EMS arrived patient was beginning to be able to answer simple questions better and was fully oriented, however was still complaining of fogginess, unsteadiness, and headache. EMS found patient to be stable but recommended evaluation at ED. Family opted to transport privately to ED.


VAERS ID: 1515327 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram, Headache, Laboratory test, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient developed nausea, vomiting and headache after vaccine. Patient was given steroids, benadry, pepcid, with improvement of symptoms


VAERS ID: 1515328 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient has a history of syncope; vaccine was administered without incident. Pt was advised to wait 15 minutes in store. After 15 minutes, pt walked to vehicle and became unresponsive. Medical clinical staff responded to scene. Pt stated unable to get out of vehicle and into wheelchair to be evaluated inside. EMS was called.


VAERS ID: 1515332 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

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

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

Write-up: Pt had a vasovagal syncope after getting COVID shot. pt passed out for a few seconds. Had pt lie down for 30 mins. pt states that she felt better after 30 mins.


VAERS ID: 1515350 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fear of injection, Hyperhidrosis, Nausea, Nervousness, Pallor, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Unknown
Current Illness: None
Preexisting Conditions: Unknown
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received Janssen vaccine at 11:15 am. Patient was waiting for 15 minutes after vaccination when another customer said that he needed help. The patient called me over and said he was feeling nauseous and then vomited into a trash can. He was very pale, sweating and said he felt dizzy and nauseous and lightheaded. No signs of anaphylaxis/difficulty breathing or allergic reaction. I gave the patient some water and after 5-10 minutes he felt much better. Patient said that he "fainted" bus this was not directly observed. He stayed at the pharmacy for an additional 15-20 minutes and left after he felt better. Patient did mention he was very afraid of needles and nervous prior to vaccination.


VAERS ID: 1515365 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1515369 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1515371 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1515376 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

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

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

Write-up: Systemic: bled more than average-Mild


VAERS ID: 1515377 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
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: 0.3 ml of vaccine given to patient UNDILUTED


VAERS ID: 1515385 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Generalised tonic-clonic seizure, Head injury, Panic attack
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient had tonic clonic seizure activity for 20 seconds after walking back to waiting area post vaccine. Patient also fell out of chair and bumped his head. Patient stated he had feels of a panic attack coming on prior to falling out of his chair. Patient was not well hydrated prior to vaccine. He was brought water, and felt better shortly after getting back into his chair.


VAERS ID: 1515387 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-12
Onset:2021-07-30
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cardiac stress test, Computerised tomogram, Dyspnoea, Electrocardiogram, Fatigue, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Rapid heart neat fatigue shortness of breath


VAERS ID: 1515390 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dysphagia, Dyspnoea, Fatigue, Flushing, Hyperhidrosis, Hypotension, Lethargy, Skin warm, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Exhaustion / Lethargy-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Weakness-Mild, Additional Details: Patient complained of heat on the arm and neck of the left side (side of vaccination). EMS contacted but patient refused treatment. Patient recovered and left under his own power.


VAERS ID: 1515398 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

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

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

Write-up: she started vomiting few minutes after she got the vaccine and she was dizzy. she waited 20 minutes until she felt better the, left with her mother


VAERS ID: 1515410 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysphagia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (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), Hypersensitivity (broad)

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

Write-up: Approximately 10 minutes after administration, patient stated that their throat felt tight and that they were having difficulty swallowing.


VAERS ID: 1515413 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Presyncope, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: vagal response and emesis rest and hydration with snack


VAERS ID: 1515416 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-18
Onset:2021-07-30
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Received Pfizer vaccines on 1/20/21; 2/18/21 Tested positive for COVID by PCR on 7/30/21 Unknown if symptomatic or further details.


VAERS ID: 1515426 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Depressed level of consciousness, Dizziness, Fall, Muscle rigidity, Musculoskeletal stiffness, Nervousness, Presyncope
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: During the monitoring period after receiving the vaccine, the patient was casually chatting with co-workers. Approximately 15 minutes later, she mentioned "I am dizzy" while seated on a chair, then she immediately fell off the chair to the side. The pharmacist rushed to support her head, and she did not hit her head against any objects around. With assistance she was laid flat on the floor. When asked "can you hear me" she responded "yes". She did not entirely lose consciousness, however she had a brief seconds of pre-syncope and body stiffness, rigidity. Pharmacist requested to call 911 to evaluate her. Upon arrival of emergency team, her vitals were stable, BP 130/82 and normal HR and RR. She continued to report feeling shaky but with no difficulty breathing. She was able to stand and walk approximately 20-25 minutes after the onset of symptoms.


VAERS ID: 1515436 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Hypoacusis, Loss of consciousness, Malaise, Muscle rigidity, Neck pain, Pallor, Unresponsive to stimuli, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: During vaccination, patient stated she was anxious about getting vaccinated and exclaimed that it "wasn''t so bad" after administration was complete. Patient and her parent were informed to stay in the store for 15 minutes to monitor for signs/symptoms of a reaction. After about 5 minutes passed, patient stated the back of her neck started to ache and her vision was starting to go black. The mother notified the pharmacy staff that her daughter didn''t feel well, and I left the pharmacy to see what was going on. As soon as I reached the patient, she lost consciousness and unresponsive for about a minute and a half. At that time I noticed her skin was pale and her body had become rigid. She regained consciousness and seemed to be functioning in a normal capacity but explained she still felt off (her earing was muffled and she was still experiencing the visual disturbances). EMS was called to the scene and when they evaluated her, she appeared to have normal vital signs. The mother decided to have her go with EMS to be evaluated at the hospital to confirm everything was okay.


VAERS ID: 1515439 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient stated as a child she had a adverse reaction to the mumps vaccine
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Mumps Vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated she felt tingly and her back felt itchy


VAERS ID: 1515440 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-13
Onset:2021-07-30
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 - / IM

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

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

Write-up: Breakthrough Case. Positive 7/30/21


VAERS ID: 1515459 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Heart rate increased, Malaise, Mydriasis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient reported feeling unwell about 5 minutes after receiving vaccine. She fainted on the seat in the waiting room. Her pupils dilated and pulse was racing. She was able to answer questions regarding name and where she was. She was given diphenhydramine 25mg with water. She was then transferred to wheel chair and brought back to a patient''s room. She stood from chair and immediately fainted the second time. Her blood pressure and pulse were taken and when repeated, they were returning to within normal limits. Upon arrival of the ambulance, they checked blood sugar and vital signs, all were within normal limits. Patient left clinic with her mom to go home.


VAERS ID: 1515464 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EUTHYROX 25MCG DAILY AND BUPROPION XL 150MG DAILY.
Current Illness:
Preexisting Conditions:
Allergies: PENICILLIN AND SULFA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 20 MINUTES AFTER VACCINATION PATIENT COMPLAINED OF FACE SWELLING AND FEELING FUNNY. I SAT WITH HER FOR AWHILE AND I DID NOT WITNESS ANY SWELLING, HIVES, RASH, OR TROUBLE BREATHING. SHE DID NOT COMPLAIN OF ANY ITCHING. SHE DECIDED TO GO TO URGENT CARE BEHIND THE PHARMACY.


VAERS ID: 1515467 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

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

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

Write-up: Pt has history of vertigo and felt lightheaded, dizzy approx. 10 min after Janssen vaccine. Water and graham crakers given, she refused ice pack, states she feels this way "all the time, intensity varies throughout the day." After 25 minutes she felt less dizzy, but because of the history of vertigo she always feels dizzy. She was able to leave clinic on her own with her friend who stated "would drive her home."


VAERS ID: 1515474 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-07-30
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt admitted to the hospital for covid symptoms post vaccination.


VAERS ID: 1515480 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Crying, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient just ate one hour ago before the vaccination
Current Illness:
Preexisting Conditions: Patient has history of anxiety paanic attack
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s mom says patient had shakes and not knowing where she was for 1 minutes. Fingers and chest feel slightly tingling. After 1 minute patient has anxiety attack and was crying . After taking 5 deep breaths and drinking water and gatorade for 10 minutes she was ok. Ambulance was called and take to hospital. Patient seem to be ok when in stretcher.


VAERS ID: 1515482 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: He felt ok afterwords, only made phone calls to (private) and doctors office
CDC Split Type:

Write-up: Passing out / lips turned white/ fingers drew up/ locked up


VAERS ID: 1515489 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Claustrophobia, Dyspnoea, Flushing, Headache, Palpitations, Pruritus
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG Tab Take 1 Tablet by mouth once daily. lisinopril (PRINIVIL, ZESTRIL) 40 MG Tab Take 1 Tablet by mouth once daily. Albumin Bovine Powder Bovine Colostrum powder-1 tsp daily Cyanocobalamin (VITAMIN B-12 OR) Inject
Current Illness:
Preexisting Conditions: Hypertension Autoimmune disease, possible MS Abnormal brain MRI
Allergies: Sulfa Penicillins Metronidazole Cefaclor Peginterferon Beta-1a
Diagnostic Lab Data: blood pressure, pulse, temperature, respiration
CDC Split Type:

Write-up: headache, flushed in face, itching on face, heart racing, chlostrophobic, chills about 15 minutes after Pfizer vaccine administered in left deltoid muscle. Patient felt need to remove protective mask to breathe more easily. Pfizer vaccine administered at 11:15am; Vital signs: 11:30 - 179/84, 134, 22, 98.3 1:L40 - 180/86, 87, 20, 87 11:50 - 180/80, 74, 20, 12:10 - 160.84, 71, 19, 98.1


VAERS ID: 1515505 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation 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: Cold/flu symptoms 2 weeks prior
Preexisting Conditions:
Allergies: No severe allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 6 dose vial was diluted with 0.8mL of NS instead of 1.8mL. Patient was given a 0.3 mL dose of under diluted vaccine before the error was discovered. The patient was notified of the error and instructed to watch for any unexpected side effect or adverse events. He had no ill effects or addition treatment given to him at the time of notification (approximately 2 hours after the event)


VAERS ID: 1515506 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939893 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Feeling cold, Headache, Hyperhidrosis, Hypoaesthesia, Pallor, Vision blurred
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Patient was sitting down after his vaccine. ~5 minutes later he complained of blurred vision, loss of hearing, numbness, feeling cold, and headache. Patient was sweating and appeared very pale. Patient was told to remain seated, maintain breathing. he was given water, pepsi, peanut butter crackes, kit kat, and peanut m&ms. Blood pressure of wrist was 111/49. 911 was called.


VAERS ID: 1515512 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-16
Onset:2021-07-30
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

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

Write-up: No Adverse event. Pt received Moderna as first dose per immunization registry. Pt signed up for pfizer and received pfizer vaccine as second dose.


VAERS ID: 1515522 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Feeling hot
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: ZOFRAN, IBUPROFEN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT LEFT PHARMACY AFTER SHOT AND WENT OUTSIDE TO HER CAR. SHE CAME BACK TO PHARMACY APPROXIMATELY TEN MINUTES AFTER INJECTION AND MENTIONED FEELING FAINT. PATIENT TOOK A SEAT INTHE LOBBY AND THEN GOT DIZZIER AND SLID/FELL OUT OF CHAIR AT 2:12 PM. WE CALLED 911 AT THIS TIME. PATIENT SAID SHE FELT "HOT " AND WAS GIVEN WATER TO DRINK AND A COOL WATER BOTTLE TO APPLY TO HER NECK. PATIENT SAID SHE WAS FEELING BETTER JUST BEFORE EMTs ARRIVED. PATIENT DOES NOT HAVE ANYONE LOCAL TO CONTACT AND CHOSE TO LEAVE WITH EMTs AT APPROXIMATELY 2:35PM.


VAERS ID: 1515537 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none that are known
Current Illness: none that are known
Preexisting Conditions: none that are known, pts mom later stated after vaccination and reaction that pt tends to pass out at dentist''s office
Allergies: none that are known
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Pt received his first dose of Pfizer covid vaccine and was advised to wait and sit in the waiting are for 15 minutes for post vaccination monitoring. Shortly few minutes after, pt''s hand started shaking (almost seizing) and pt started sweating shortly after. Pt was given Benadryl & water and 911 was called. In the mean time pt was being monitored. EMS/EMT arrived few minutes after , monitored the pt and gave oxygen, monitored O2 levels and blood pressure. Few minutes after, pt was feeling fine and left to go home. advised pt to stay well hydrated and rest


VAERS ID: 1515543 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cold sweat, Hyperhidrosis, Pain
SMQs:, Neuroleptic malignant syndrome (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: Day after vaccine, I experienced body aches and chills followed by clammy skin and sweating; took 440mg of naproxen and 1000mg of acetaminophen at onset of symptoms, symptoms subsided within four hours.


VAERS ID: 1515545 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-07
Onset:2021-07-30
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

Administered by: Private       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: Metformin, lisinopril, atorvastatin, lantus, novolog,
Current Illness: None
Preexisting Conditions: DM II, HTN
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine given out of expiration date range from being removed from freezer to refridgerator


VAERS ID: 1515548 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Gaze palsy, Pain in extremity, Photosensitivity reaction
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypersensitivity (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: No
Current Illness: No
Preexisting Conditions: Hypothyroid, orthostatic hypotension with postural tachycardia
Allergies: Birch tree - apples, pears, plums, cherries
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Adverse events after second dose only: Moderate arm pain radiating down to wrist, within 6hrs after vaccine and present still at 24hrs Moderate constant headaches 12hours after vaccine and still present at 24hrs. Moderate nausea starting at 12hrs and still present at 24hrs. Shortness of breath 18 hrs after vaccine, still present at 24hrs after. Dizziness and photosensitivity at 16hrs after and still present at 24hrs after.


VAERS ID: 1515555 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: T2DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received COVID Pfizer shot and switched chairs to allow daughter to get shot. When he switched places, he felt dizzy and fainted, hitting his head on the wall and the floor. He came back to immediately and stated he felt fine. He seemed sweaty. We called 911 for him to get checked out after hitting his head and did not end up getting transported.


VAERS ID: 1515556 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: healthy not sick at the time of vaccination
Preexisting Conditions: no
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt shaky and fainted but still remain conscious. I ran out to put patient on the floor and monitor her condition closely. i kept asking her if she has trouble of breathing and she said that she''s OK while my tech had already called the 911 for help. 5 minutes later the paramedic arrived and performed vital checks on her. they said she''s ok nothing wrong with her so she doesn''t need to go to the hospital for any further check up.


VAERS ID: 1515563 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Unknown  
Location: Minnesota  
Vaccinated:2021-07-07
Onset:2021-07-30
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 UN / IM

Administered by: Private       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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: wool wax, mushrooms
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine given out of expiration date range from being removed from freezer to refridgerator


VAERS ID: 1515565 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / UNK - / IM

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

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

Write-up: fainted after shot (syncope)


VAERS ID: 1515575 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-21
Onset:2021-07-30
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg Fish Oil 1000mg per day Vitamin D3 2000 iu per day
Current Illness: None
Preexisting Conditions: High blood pressure about 135/85
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had shortness of breath and chest pain


VAERS ID: 1515583 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-07
Onset:2021-07-30
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21 / 3 RA / IM

Administered by: Private       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: Unknown
Current Illness: None
Preexisting Conditions: Unknown
Allergies: Mosquito Bites
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine given out of expiration date range from being removed from freezer to refridgerator


VAERS ID: 1515585 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: none
CDC Split Type:

Write-up: patient received 2nd dose of Pfizer Biotech vaccine instead of receiving Moderna vaccine. Patient previously had 1st dose of Moderna elsewhere at another facility


VAERS ID: 1515588 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-24
Onset:2021-07-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ivermectin; Hydroxyzine; Azithromycin
Current Illness: Tooth infection
Preexisting Conditions: Lyme disease
Allergies: Fish; Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient woke up on 7/30/2021 with a full body itchy rash. Patient took diphenhydramine to help with itch and went to urgent care. Received prescriptions for prednisone and hydroxyzine.


VAERS ID: 1515599 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age, Underdose, Wrong 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: 15 YEAR OLD RECEIVED 0.1-0.2ML OF JANSSEN VACCINE. WHEN THE NURSE REALIZED IT WAS THE WRONG VACCINE, SHE PULLED IT OUT OF HIS ARM. I CALLED JANSSEN TO SEE IF THEY HAD ANY DATA ON THIS SCENARIO THAT REFERENCE NUMBER WAS 02403017 AND THE 2ND REFERENCE NUMBER WAS 02403165


VAERS ID: 1515608 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA 7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: none listed
Preexisting Conditions: none listed
Allergies: none listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: He had immunization, waited for 15 minutes in the lobby area and collapsed in an aisle half way out of the store. His father was with him and requested ice and a cool washcloth for his head. He was lying down in the aisle and had not hit his head. He remained there with his feet elevated on a chair until he was ready to leave. His father said this happens to himself, his other son and the patient with every vaccine . After about 10 minutes he was fine and they left.


VAERS ID: 1515612 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event, Wrong 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Pfizer Biotech vaccine as second covid19 vaccine. She received Moderna vaccine as her first dose elsewhere at another facility. Patient was made aware of error. No adverse reactions in terms of patient''s health. Patient made awre that vaccine series is complete although not as indicated by EUA


VAERS ID: 1515626 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

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

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

Write-up: Patient received Pfizer as a second dose instead of Moderna


VAERS ID: 1515630 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-15
Onset:2021-07-30
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blood creatine phosphokinase increased, Cardiac stress test, Diaphragmatic spasm, Dizziness, Electric shock, Electrocardiogram, Fatigue, Feeling abnormal, Initial insomnia, Insomnia, Laboratory test, Panic reaction, Sleep disorder, Tension headache
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Accidents and injuries (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Every lab imaginable Can list them all if anyone is interested. The only one that came back abnormal was Creatine Kinase Total Activity 37 U/L 62 to 325 U/L62 - 325 U/L
CDC Split Type:

Write-up: Day 1 (5/15/21) 5 minutes after second shot. Overwhelming feeling came over me, felt like I was going to pass out. Almost like going into shock. My head fogged up. These feeling would come every 5 to 10 minutes. I had to be driven home. 4-6 hours after shot. Fatigue, foggy brain 14 hours after shot (2:30am). Woken violently to the same panic feeling earlier in the day. Couldn''t sleep the rest of the night Day 2 through 7 Tension headach, diaphram spasms, dizzyness, fatigue Night 2 through 7 Severe Insomnia. Couldn''t fall asleep. Body would try repeatedly, but would get electrical shocks to the diaphram chest area that would immediately wake me back up. wouldn''t fall asleep for a few hours around 4am. Went to urgent care 5/19. They ran labs, EKG, blood pressure stress tests and prescribed hydroxyzine. I never took the medication. Day 8 through 21 Tension headach, dizzyness Night 8 through 21 Slept pretty well averaging 7-8 hours a night Day 22 6/5/21 Woke with severe anxiety (never felt this before). Went to urgent care again. They told me to take hydroxyzine. Night 22 6/5/21 through Present 7/30/21 Chronic Insomnia Day 23 through present Tension Headache and dizzyness Medications that have helped to sleep but have not cured Trazodone (couldn''t take side effects) Alcohol (getting severe rebound anxiety) Ambien (5mg only gets me 4 hours max) Xanax (.375mg only gets me 4 hours max) Clonozepam (.125mg only gets me 4 hours max) Medication that didn''t work Doxepin 3mg/6mg


VAERS ID: 1515636 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

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

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

Write-up: Pfizer was given as second dose instead of Moderna


VAERS ID: 1515645 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-06
Onset:2021-07-30
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Exfoliative rash, Rash erythematous
SMQs:, Severe cutaneous adverse reactions (narrow), 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? 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: erythematous scaly patch on leg, treated with triamcinolone cream


VAERS ID: 1515652 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / -

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? 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: NDKA
Diagnostic Lab Data: no medical or lab tests have been performed/ ordered at this time.
CDC Split Type:

Write-up: The patient received a Moderna vaccine as her 2nd dose in the COVID-19 Vaccine series, the patient had a Pfizer for her first dose.


VAERS ID: 1515653 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

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

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

Write-up: Patient waited 15 minutes in front of pharmacy without incident. As she was leaving the store at 20 minutes after the shot she began to feel faint and requested a chair to sit down. Patient appeared pale and was sweating profusely and complained of nausea. After about 10 minutes of sitting down she states she was feeling better and left the store on her own accord.


VAERS ID: 1515654 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / SYR

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

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

Write-up: pt just felt light headed and felt nauseous; had patient lay on floor, was given an ice pack on back of neck; propped up feet, once feeling better, sat patient up and made him stay a bit longer, was monitored for a half hour before he left


VAERS ID: 1515657 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort, Dry mouth, Dyspnoea, Malaise, Paraesthesia, Somnolence, Throat irritation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient was at the COVID Vaccine clinic today for her first dose of the COVID Vaccine, Pfizer. Due to her allergy hx, pt. Was advised by vaccinating RN to wait in the observation area for 30 minutes. Patient was waiting for a few minutes and raised her hand to let the observation RN that she was not feeling well. Patient told observation RN that "I feel a little something in my chest. It feels like when I have SOB with my other medications." She also stated "my throat feels scratchy." HVA was asked to take Vital Signs on patient. At 1600, BP was 158/98mmhg, HR was 74bpm and SpO2 was 99%. Patient was given 25mg of Benadryl IM in the R deltoid. Afterwards, patient was feeling sleepy and stated that her symptoms were improving. VS 30 minutes after benadryl dose at 1634 were: BP 152/86mmhg. HR 74, SpO2 99%. Patient stated that she was "feeling ok, but I am having slight tingling on the left side of my face." Patient then called her doctors office to discuss after vaccine clinic care for about 20 minutes. After this patient stated the tingling was gone, but her mouth was dry. At 1655 VS were: BP 162/90, HR 77, SpO2 100%. Patient stated "I feel fine to leave." Observation RN checked with patient, and patient stated she will not be driving home, she has a ride, after receiving IM Benadryl. Patient was able to independently leave clinic.


VAERS ID: 1515665 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-07
Onset:2021-07-30
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

Administered by: Private       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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: ibuprofen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine given out of expiration date range from being removed from freezer to refridgerator


VAERS ID: 1515666 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

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

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

Write-up: THE PATIENT CAME TO THE CLINIC - HE CAME TO GET THE PFIZER VACCINE - WHEN ASKED IF IT WAS HIS FIRST DOSE HE SAID YES - DID NOT PRESENT A CARD - GAVE HIM HIS FIRST PFIZER DOSE - HE WAITED HIS 15 MINUTES THEN LEFT. UPON ENTERING THE DOSE, IT WAS BROUGHT TO THE NURSES ATTENTION THE PATIENT ALREADY HAD A J&J DOSE. WHEN GETTING BACK TO THE CLINIC, SUPERVIOSR WAS CONSULTED THE PATIENT WAS CONTACTED. HE REPORTED HE DID NOT WORK AT (LOCATION REDACTED) WHEN ASKED. WHEN ASKED IF HE HAD RECEIVED A J&J IN MARCH HE SAID YES. HE SAID HIS DOCTOR RECOMMENDED HE GET A PFIZER. THE PATIENT WOULD NOT SAY WHO HIS DOCTOR IS..PATIENT WAS INSTRUCTED TO NOT GET ANYMORE DOSES. UPON FURTHER REVIEW AS WELL THE PATIENT DID NOT ANSWER IF HE HAD RECEIVED A COVID VACCINE YET OR NOT - HE LEFT IT BLANK.


VAERS ID: 1515675 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (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: Vasovagal syncope 3-5 minutes after administration. Started to resolve after 20 minutes with administration of oral water, ice pack to neck and head, laying on ground with feet elevated. EMS evaluated patient after 20-25 minutes and found systolic BP to be 98, blood glucose 112. They offered to take patient to emergency department, but said patient will most like be ok after resting more and continuing to hydrate. Patient declined going to ED.


VAERS ID: 1515676 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Electrocardiogram normal, Eye movement disorder, Gait disturbance, Hypotonia, Nausea, Seizure
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient and Family State she has a history of asthma
Allergies:
Diagnostic Lab Data: Patient transferred to Hospital
CDC Split Type:

Write-up: Patient received vaccine and walked over to the observation area when she started to stagger and had to be held up by her father. Brother was with family as well. Nurse noticed immediately the status of the patient and assisted. Patient was placed in chair in observation next to father, at which point patient went limp and was placed on the floor on mat. Once on the mat nurses state patients eyes rolled back and she started to convulse on the floor. Patient placed on side, 911 called. Patient vitals BP 103/65, HR 90, SaO2 98%, Temp: 97.4 F. Patient able to sit up on her bottom without feeling dizzy or nausea. Paramedics arrived at 1318. Vitals and EKG within normal limits. BG 91. Paramedics recommended patient be taken to the emergency room since patient did not have a previous history of seizures. Father agreed. Patient left site at 1325 without further incident.


VAERS ID: 1515679 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Flushing, Hyperhidrosis, Nervousness, Pallor, Rash, Skin warm, Tachypnoea
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

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

Write-up: Attendee received first dose Pfizer vaccine at 11:51 in the left arm. Lot# FA6780. Attendee was assisted to the vaccine area by the vaccinator to observation area, as the attendee was so nervous. At 11:52 voiced complained of dizziness, slight chest tightness and was pale. Attendee''s skin was warm and diaphoretic. Attendee''s respirations were tachypneic. Cot brought to the attendee to lie down, legs elevated, icepack applied to face and neck. Flushing on her chest noted. Chest tightness reported. Declined Benadryl and Zyrtec.


VAERS ID: 1515687 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Dizziness, Dyspnoea, Electrocardiogram abnormal, Headache, Hypoaesthesia, Sinus tachycardia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Episode of syncope, anxiety
Preexisting Conditions: General anxiety
Allergies: NKDA
Diagnostic Lab Data: EKG: sinus tachycardia
CDC Split Type:

Write-up: Patient reported SOB, headache, dizziness, numbness of right arm, soreness of left arm, feeling of fainting and weakness approximately 1 hours post vaccination. Vital signs initialized11:08 AM (HR 130, R 18, BP 121/73, Sat 80%) Instructed to remain calm, encouraged deep breathing exercise, elevated legs, icepack provided on the injection site. Patient is able to talk and swallow. Patient revealed history of fainting and FH of stroke. EMS called, vital signs at 11:31 AM: HR 130, R 18, Bp 144/104, O2 Sat 100%. 3 Lead EKG: Sinus Tachycardia. Able to ambulate to the ambulance, Patient verbalized feeling better and showed no respiratory distress when EMS arrived and was sent to Hospital.


VAERS ID: 1515690 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (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: Tingling and flushing


VAERS ID: 1515691 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: she states every time she has injections she faints
Other Medications: na
Current Illness: na
Preexisting Conditions: na
Allergies: epinephrine and cilantro
Diagnostic Lab Data: na
CDC Split Type:

Write-up: After 5 minutes the patient felt as though she might faint, hot and sweaty . we laid patient on the floor and gave her cold packs for back of neck and on forehead. AFter about 15 minutes she started feeling better and we sat her up. After 5 more minutes we moved her to a chair. and continued to watch for 15 more minutes. She was feeling better when she left and called when she made it home ok


VAERS ID: 1515693 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: 1320- Patient reports that she gets dizzy with injections. Vasalvagal precautions advised. Patient ambulated to triage room and was supine for injection 1325- Patient reporting dizziness. Pt brought to triage room to help interpret. BP 107/77, HR 66, O2 sat 99%. Patient denies nausea, headache or other symptoms. 1329- BP 107/71, HR 74; O2 sat 99%. Patient offered water and sat up and took some sips of water. Denies dizziness while sitting up. 1333- BP 105/71; HR 62; O2 sat 100%.. Patient HOB raised 30 degrees. Denies dizziness, SOB, or other symptoms. Encouraged patient to drink water. Offered crackers, declined. 1335- Patient HOB raised to 90 degrees. BP 108/75; HR77, O2 sat 100%. Patient denies dizziness. Advised patient to discuss dizziness with providers prior to injection. Patient stated understanding. Patient stating she feels ''much better''. 1338- Legs dangling- BP 110/74; HR 65; O2 sat 100%. Denies dizziness. Patient stood without difficulty and ambulated to chair, gait steady, denies dizziness. 1345- Patient ambulated to private vehicle, gait steady, denies dizziness.


VAERS ID: 1515696 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-07
Onset:2021-07-30
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / IM

Administered by: Private       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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: naproxen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine given out of expiration date range from being removed from freezer to refridgerator


VAERS ID: 1515697 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / SC

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: ROSUVASTATIN, VITAMIN D3 25MCG. CYCLOBENZAPINE 7.5, CLONAZEPAM 0.5MG, METFORMIN 500MG, ROPINIROLE 0.5MG. HYDROCODONE/APAP 5/325, NEXIUM 40MG AND PROAIR
Current Illness:
Preexisting Conditions: HEART ISSUES, DIABETES AND WAS JUST RECENTLY PUT ON OXYGEN
Allergies: AZITHROMYCIN AND PREDNISONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT HAD TIGHTNESS OF CHES - SHE SAID IT FELT LIKE THERE WAS A WEIGHT ON HER CHES


VAERS ID: 1515698 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: dizziness - pt was given applesauce, cold compress and water. - able to walk on own accord 30 minutes later


VAERS ID: 1515703 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Fear of injection, Hunger, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: after being vaccinated patient became faint upon walking to the observation area. Patient was assessed and presented with vitals as follows (82/41, 66bpm, 16rr, 99% RA, 97.8 temp). Patient stated that this is a normal situation for him due to his fear of needles. patient also stated that he had not eaten today and only drank one bottle of water this morning and was feeling weak and hungry. Writer pushed fluids including 2 bottles of alkaline water and a Gatorade. the patient''s BP had risen over the course of 30 min as follows 102/64, 107/60, 110/69. Patient stated that he felt better and just needed to eat. Patient has no underlying conditions per patient.


VAERS ID: 1515704 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / UNK - / IM

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

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

Write-up: Patient came to mass vaccinating event today, reports received 1 dose of Moderna COVID19 Vaccine only this year. Our staff verified on MIIC - misread MIIC and did not see 2nd dose on there. Patient received his "2nd" dose of Moderna today. However, towards the end of the day during documentation, we noticed that today we may have given patient a 3rd dose of Moderna. Called his clinic to verify - they manually entered in the 2nd dose in his chart. Tried connecting with patient as well, but unable to connect with him today to verify information again. Unsure if documentation at doctor''s clinic is incorrect or patient did not disclose info correctly. Unsure if patient is experiencing SE from additional Moderna COVID Vaccine.


VAERS ID: 1515709 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-07
Onset:2021-07-30
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / SYR

Administered by: Private       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: Unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine given out of expiration date range from being removed from freezer to refridgerator


VAERS ID: 1515711 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Malaise, Nausea, Pain, Vomiting, Wrong product administered
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: age 50 april 5, 2021 j&j chills achy arm
Other Medications: levothyroxine, oxcarbazepine, perphenazine, vitamin d2, b12
Current Illness: anxiety, depression, panic disorder , bi polar disorder
Preexisting Conditions: anxiety, depression, panic disorder , bi polar disorder, thyroid, ibs
Allergies: latex, pennicillin, keflex, sulfar, tylenol with codene, vicodine dairy
Diagnostic Lab Data: non were offered
CDC Split Type:

Write-up: i was given pfizer vaccine instead a shingles shot which is why i was at the pharmacy i already had the J & J shot in April they made a huge error i became ill in the middle of the night nausea vomiting extremely achy


VAERS ID: 1515712 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Confusional state, Feeling abnormal, Loss of consciousness, Seizure like phenomena
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), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient?s mother reported at age 12 that she had passed out after receiving a vaccination. No seizure like activity was recorded
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/a none completed on site
CDC Split Type:

Write-up: Pt. receive vaccination at 14:10 PM. Patient was requested to remain on site 15 minutes for further observation as is our policy. Approximately five minutes later when patient was receiving her paperwork she looked at her mother and stated ?I don?t feel good? . Patient then lost consciousness and was caught by her mother and the nurse, patient was then lowered to the ground. Once patient was on the ground, Patient was still unconscious and appear to have approximately 3 to 5 seconds of seizure like activity, patient was then turned onto her side to protect her airway. Approximately two seconds later she regained consciousness and was completely lucid. Patient remained laying on the ground while nurse and EMT acquired vital signs. 02 saturation was 98% heart rate 98, blood pressure 110/74. Temperature was not taking its time. Patient did not complain of any dizziness or any other symptoms she stated that she felt OK and wanted to know what happened. Patient remained on the ground for approximately five more minutes and then was helped to a sitting position and reassessed at that point. Vitals continued to be stable and patient continue to be lucid. Patient was frequently reassessed throughout the event, and after approximately 10 minutes post event she was assisted to a chair and then back to her vehicle where she waited an additional 10 minutes to ensure that she continued to feel OK. Nurse instructed patient?s mother things to watch out for and also instructed patient to stay inside the rest of the day remain hydrated and avoid the heat. Also recommended to patient?s mother to follow up with primary care provider to inform them of the incident and also of the seizure like activity exhibited.


VAERS ID: 1515715 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: 10 MINUTES OR SO AFTER RECEIVING PFIZER VACCINE, PATIENT DEVELOPED TINGLING AND NUMBNESS ON HER LEFT ARM. SHE RECEIVED COVID VACCINE IN LEFT ARM.


VAERS ID: 1515717 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-10
Onset:2021-07-30
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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? 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 came into store at 7/30 asking for his 2nd Pfizer shot. After some small talk, he said this would be his 3rd shot in the series. Upon further questioning he said he got 1 JJ shot prior at another clinic. By this time we had already administered 1 Pfizer shot on 7/10.


VAERS ID: 1515718 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Wrong 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: Synthroid estradiol cholesterol. rofudastation leva thyroxin
Current Illness: no
Preexisting Conditions: thyroid
Allergies: codeine many years ago
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Pt came in to get The Shringix vaccine and was given a first dose of phizer instead. Pt has already had 2 vaccines of moderna and did not request vax for Covid. ADMIN ERROR ON PHARMACY


VAERS ID: 1515719 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / IM

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

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

Write-up: Following vaccine administration, client did not have vaccination card so staff went to write out a new card with today''s dose. Client affirmed that today was his second (2nd) dose of Pfizer. Upon further review of Immunization Registry client had received 2 previous doses of Pfizer back in January and February. Client defrauded POD and claim to have only received 1st dose and presented with no vaccine card but an appointment in the system. Provider , NP was made aware. During post-vaccine observation, client did not exhibit any adverse reactions to vaccine, no signs or symptoms of allergic reaction. Client ambulated out of clinic.


VAERS ID: 1515722 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate irregular, Hyperhidrosis, Malaise, Presyncope, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiac arrhythmia terms, nonspecific (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: Fainted previously, not sure which vaccine (but it was not Covid vaccine)
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt has a history of passing out after a vaccine and was very nervous. After administering vaccine, pt stayed seated in the same chair for observation. After a few minutes pt wasn''t feeling well and vommitted in small amounts about 3 or 4 times. He then took some small sips of water. After a few more minutes, he was sweating, and looked like he was passing out. (Minimal response when talking to him.) His mom and I lowered him to the floor. He was now flat on his back, knees elevated, his eyes were open and he was moving his head a little, but no responding to direct questions. His heart rate was at 71. Within about a minute, he began responding normally and said that he felt fine, just very sweaty. Over the next several minutes, his heart rate fluctuated between the 70''s and 90''s. We kept him in this position for several more minutes. We then had him sit up while on the floor for a few minutes when he was ready. Then we moved him (by his own power) to the chair. He remained in the seated position for several minutes. He said that he then felt fine. He continued to sip water and we continued to monitor his heart rate. After several more minutes when he was ready, he stood, said he still felt fine. We walked with him to the waiting area, he said that he still felt fine. I recommended that they stay for as long as he needed. After about another 10 to 15 minutes, he was still feeling fine. His mom is a nurse and said that she would continue to monitor him. I recommended that they stay a little longer, but they felt that he was fine to go. I asked that they stay in the general area (we are a large store) and that they come back or call me if there are any further concerns.


VAERS ID: 1515724 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: Patient appeared nervous/anxious prior to vaccine. Shortly after administration, patient got up and felt nausea and vomited 5-8 minutes after receiving vaccine.


VAERS ID: 1515729 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Feeling hot, Flushing, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin Calcium 5mg Prozac HCL 20mg Norvasc 10mg Metformin HCL 1000mg
Current Illness: Denied
Preexisting Conditions: Diabetes, HTN
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was showing symptoms of a systemic reaction to the vaccine. She reported feeling warm, was flush, and broke out in hives. She also c/o itching all over. Doctor was notified and gave orders for Methylprednisolone 80mg IM x 1 dose and 25mg tab of Benadryl. Patient''s VS were taken. BP 159/89 HR 93 RR 20, SP02 on RA 96%. Patient did not exhibit any difficulty breathing, swallowing or SOB. Medications were given as ordered, without difficulty. Patient''s was monitored 1:1 for worsening symptoms. Symptoms resolved after 45 minutes VS returned to normal limits, BP was checked again and was at 150/83, HR 82, SP02 on RA 97% RR 18. Patient had no other complaints, and no other symptoms. Patient was informed if symptoms return or worsen to be evaluated in the ED. Patient had no other problems and walked out on her own without difficulty. RN


VAERS ID: 1515737 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091021A / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Injection site pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rasagiline (1 mg), multivitamin, vitamins K2, B6, E, D3, B12,
Current Illness: Parkinson?s
Preexisting Conditions: Treated for reoccurring prostate cancer from August 2017 until May 2021.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at injection, fever, chills,tiredness,headache, joint pain and muscle pain


VAERS ID: 1515747 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknow
Current Illness: None- Had COVID on April
Preexisting Conditions:
Allergies: Not that the patient know
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt Dizzy and passed out for about 30 seconds to a minute. Also patient vomit after vaccination about 3-5 minutes after vaccination.


VAERS ID: 1515760 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / N/A LA / IM

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

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

Write-up: Rash on face


VAERS ID: 1515762 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: No adverse events but administered vaccine to a patient who is under 12 years age


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