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

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



Case Details (Reverse Sorted by Onset Date)

This is page 33 out of 4,799

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VAERS ID: 1443451 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-12
Onset:2021-07-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTED PAST THE CURRENT REFRIGERATION BEYOND USE DATE AS LISTED.


VAERS ID: 1443453 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-12
Onset:2021-07-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443454 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chills, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: PCN, CATS
Diagnostic Lab Data: BLOOD PRESSURE TAKEN
CDC Split Type:

Write-up: ANIXETY, FEVER, CHILLS, TROUBLE BREATHING, POSSIBLE SWELLING IN MOUTH/TONGUE ALL OCCURED VERY QUICKLY AFTER VACCINE.


VAERS ID: 1443457 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-12
Onset:2021-07-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443462 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-12
Onset:2021-07-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443464 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-12
Onset:2021-07-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

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


VAERS ID: 1443470 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-12
Onset:2021-07-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443479 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-12
Onset:2021-07-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443486 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-12
Onset:2021-07-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443490 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Breast swelling, Feeling hot, Lymphadenopathy
SMQs:, Angioedema (broad), Lipodystrophy (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: not known
Current Illness: none
Preexisting Conditions: not known
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two days after receiving the vaccine she complained of swelling, heat, and pain in her left arm pit and side breast area.


VAERS ID: 1443493 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-14
Onset:2021-07-02
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443494 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-07-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Post-acute COVID-19 syndrome
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: not known
Current Illness: not known
Preexisting Conditions: not known
Allergies: not known
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID ARM RED SWOLLEN SUGGESTED TOPICAL STEROID COOL COMPRESS APAP


VAERS ID: 1443496 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-14
Onset:2021-07-02
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

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


VAERS ID: 1443503 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: The patient has not experienced any adverse events, the patient received a dose of vaccine that was not diluted to the proper amount.


VAERS ID: 1443504 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-14
Onset:2021-07-02
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443507 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chills, Cough, Headache, Joint stiffness, Lymphadenopathy, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Original side effects were chills, fever, headache, and cough. Current side effects are swelling of armpit region and stiffness of joints.


VAERS ID: 1443510 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-14
Onset:2021-07-02
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

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


VAERS ID: 1443515 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 4 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Disorientation, Hyperhidrosis, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Immediately after administration of vaccine as we were discussing scheduling an appointment for his second dose in 28 days, patient''s fainted. He was sitting in a chair and slumped over. I caught him and was able to get him to floor in lying position while having my technician call emergency number. Patient came to in a couple of minutes and seemed a little disoriented. We got him a bottle of water and a cold rag for his face. He was clammy and sweating. When EMT arrived, they checked him out and cleared him to leave on his own.


VAERS ID: 1443517 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-15
Onset:2021-07-02
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443522 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-15
Onset:2021-07-02
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443523 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 2 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Joint swelling, Migraine, Nausea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril Cymbalta spironolactone birth control, tylenol, advil, and benadryl allergy
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: Flu shot
Diagnostic Lab Data: Covid arm
CDC Split Type:

Write-up: Pain in right and left arm, redness, swelling in wrists, migraine, nausea,


VAERS ID: 1443527 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-16
Onset:2021-07-02
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443534 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-16
Onset:2021-07-02
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443537 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling hot
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness overheated Oxygen 99 Heartrate 73 BP 110/62


VAERS ID: 1443539 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-17
Onset:2021-07-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443545 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-17
Onset:2021-07-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443548 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM

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

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

Write-up: Patient stated that his arm/underarm had a knot on it at the injection site and was extremely sore. He was concerned because he had no issues with his 1st dose.


VAERS ID: 1443551 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-17
Onset:2021-07-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

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


VAERS ID: 1443554 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM

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

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


VAERS ID: 1443559 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-17
Onset:2021-07-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443563 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-17
Onset:2021-07-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443567 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 - / -

Administered by: Unknown       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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness Vitals - oxygen 99 heartrate 73 BP 110/62


VAERS ID: 1443568 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-17
Onset:2021-07-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443571 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 - / IM

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

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

Write-up: Or received MODERNA VAX


VAERS ID: 1443574 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-18
Onset:2021-07-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: ADMINISTERED PAST THE CURRENT REFRIGIRATION BEYOND USE DATE AS LISTED.


VAERS ID: 1443575 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / 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: None
Current Illness: No illness at the time of vaccination or one month prior
Preexisting Conditions: No chronic or long-standing health conditions.
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to pharmacy for a COVID vaccine and requested a dose of the single dose Janssen vaccine. Per her vaccination consent form she indicated that she had not received any first doses of COVID vaccine. After reviewing any questions or concerns she agreed to have the vaccine. We completed all of the necessary documentation for the federal COVID vaccine program but when entering the vaccination information into the state vaccine registry it was discovered that the patient had received a dose of pfizer vaccine at another facility on 6/26/21. We contacted the other facility and they confirmed that the vaccine had been administered. After confirming this with the facility we then contacted the patient. She said that she received the first dose of a vaccine but was confused as to when she was to receive her second dose and which vaccine she needed receive. We confirmed that she had not had any reactions to the vaccine. We also asked if she had a primary care doctor that we could contact to inform of the incident and she disclosed that she has not seen a doctor in nearly two years. I reviewed the side effects that the patient should be aware of from the Janssen vaccine and made sure the patient had the EUA as reference should any issues arise. I also made sure that the patient had the smartphone tool available on her phone so that she could report any adverse events to the CDC. We advised the patient to not receive the second dose of the pfizer vaccine as she had completed the Janssen single dose therapy and would not need any more vaccines. We also asked that she please contact us if she has any questions or concerns.


VAERS ID: 1443579 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 RA / IM

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

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

Write-up: Patient fainted, awoke, and was dizzy.


VAERS ID: 1443580 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO186 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Decreased appetite, Migraine, Paraesthesia, Pharyngeal paraesthesia, Pharyngeal swelling, Swelling, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Volteran, metformin, baclofen, cymbalta
Current Illness: migraine
Preexisting Conditions: migraines, diabetes
Allergies: nuts, aspirin, PCN, statins, effexor
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt began complaining of tingling and swelling of left face, neck and throat about 15 minutes of vaccine. VS: 156/ 89, HR 84, O2 sats 99% on RA. Paramedics called after IM Benadryl 50 mg given. She was transported by ambulance to the ER. Pt also c/o migraine and of not eating all day.


VAERS ID: 1443581 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-18
Onset:2021-07-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

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


VAERS ID: 1443584 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-18
Onset:2021-07-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

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


VAERS ID: 1443587 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-18
Onset:2021-07-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

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


VAERS ID: 1443602 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-07-02
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Fatigue, Myalgia, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advodart
Current Illness: none
Preexisting Conditions: Hep C (cured in 2016)
Allergies: none
Diagnostic Lab Data: I have seen my doctor once so far, on June 24 to complain about the lingering side effects.
CDC Split Type:

Write-up: 24 hours after getting the vaccine I started feeling sleepy and groggy. 48 hours after the vaccine I felt very groggy and off balance, like I was half asleep or had been drugged with a sedative. I also had low energy and exerting myself (with long walks, etc) made me feel wiped out and exhausted . After one week I started to feel better, but still felt slightly groggy and off balance, like I was drugged with a mild sedative. Now on July 1 -- one full month since getting the vaccine -- I still feel slightly groggy and off balance, no matter how much sleep or rest I get. I also still have lower than normal energy and muscle soreness. The grogginess and off balance is most noticeable when walking or moving my head quickly.


VAERS ID: 1443605 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

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

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

Write-up: Patient was administered first dose of Moderna vaccine on 5/6/21 and returned for second dose on 7/2/21. This is beyond the recommended range of 28 to 42 days between doses. No adverse event


VAERS ID: 1443611 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM

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

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

Write-up: Patient was experiencing blurry vision approximately 15 minutes after receiving the 2nd dose of the moderna COVID-19 vaccine


VAERS ID: 1443614 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fall, Flushing, Nystagmus, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: 30y M w/no PMH s/p COVID-19 J&J vaccine <5min exhibited syncopal episode while seated, resulting in ground level fall from chair witnessed by relative associated w/prodrome of mild flushing and upward nystagmus, but w/no significant head trauma. On exam noted to be contracted in extension, nonverbal and with fixed gaze which resolved w/in 1-2min with nl return of mental status. Pt''s knees were slowly bent and the spine lightly placed in flexion, with slow transition to chair and finally legs elevated; no further complaints/events encountered.


VAERS ID: 1443616 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

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

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

Write-up: About 5 minutes after the immunization the patient started complaining of a headache and dizziness. No difficulty in breathing. After couple of minutes the symptoms did not subside and she asked us to call 911. The paramedics took her vitals and her blood pressure was normal and oxygen stats were fine. But the headache and dizziness did not resolve so the patient was taken to the hospital. I called the patient later and she was at home and doing much better.


VAERS ID: 1443620 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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: she hates needles and has felt faint and passed out getting blood drawn
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: she started to feel nauseated and dizzy and faint. she said she really hates needles and has passed out from getting blood drawn in the past. she feels like this situation was anxiety. she sat in a reclining chair at our Clinic for awhile and felt better.


VAERS ID: 1443638 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Immunisation, Injection site extravasation, No adverse event, Syringe issue, Underdose
SMQs:, Extravasation events (injections, infusions and implants) (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: PNC
Diagnostic Lab Data:
CDC Split Type:

Write-up: During injection into right deltoid, needle detached from syringe and greater than half the vaccine squirted out of syringe onto the floor and patient''s arm. Cleaned patient, monitored for reaction, and read through CDC site about partial doses given. Discussed CDC recommendation of given vaccine again to patient in left deltoid. Patient agreeable and second attempt of first dose of vaccine given immediately. monitored for 15 minutes. No signs or symptoms of reaction.


VAERS ID: 1443641 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bradycardia, Cold sweat, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: No
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Bradycardia, Pale Skin Color, Clammy, Dizziness.


VAERS ID: 1443642 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / IM

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

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

Write-up: Moderna mistakenly administered to 16 year old employee of nursing home.


VAERS ID: 1443648 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: celiac
Preexisting Conditions: long standing
Allergies: wheat
Diagnostic Lab Data: ER all ok per mother
CDC Split Type:

Write-up: At the injection the patient started to faint his mother was there and knew what was needed patient came back around and stayed seated for 45 minutes Mother took him to ER for observations


VAERS ID: 1443651 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: 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: N/A
Current Illness: None reported
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Per testing center- patient?s rapid COVID test completed AFTER vaccination resulted positive.
CDC Split Type:

Write-up: Notified by COVID testing unit at same church location that patient went to get rapid testing done AFTER vaccination at the Color vaccination site same day and rapid report came back positive. Patient answered ?no? to pre-vaccination questions regarding having any symptoms or exposure to COVID. Patient notified by testing center of her positive result and will be contacted by local health department per protocol.


VAERS ID: 1443652 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

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

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

Write-up: Patient experienced a black out for a few seconds approx 5 minutes after Covid vaccine administered while seated and talking on phone with friend. Patients friend called us to check on her and she was conscious but very nauseous. She seemed unable to calm down but was breathing fine and no signs of hive/allergy. Called 911 and EMT gave patient an exam of BP, HR and breathing and said she was fine. Offered patient water and soda and she left approx 30 minutes later with friend to drive her home.


VAERS ID: 1443653 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: The patient was given the Pfizer COVID vaccine. The patient immediately felt nausea and dizzy. The patient''s wife asked up to call for help and we called 9-1-1. The patient then fainted and had some seizure like activity. The patient woke up immediately after. The patient had no previous history of fainting or seizures but has almost fainted after blood tests. The EMT''s came and checked his vitals which were all normal. Then the patient was taken to the hospital.


VAERS ID: 1443667 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Brain tumor in remission for 7 years
Allergies: Contrast dye
Diagnostic Lab Data: Blood pressure and heart rate were all within normal limits after the event.
CDC Split Type:

Write-up: Patient received vaccine and seemed fine. Had a seat in the waiting area. About 5 minutes later the patient stood up to tell the staff that she felt dizzy. She then collapsed. A by-standing patient protected her head from the floor. Patient laid down on the floor and remained there until she felt better. She had some water and crackers and slowly felt better. Patients dad picked her up from the pharmacy and no other events were reported.


VAERS ID: 1443670 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Cold sweat, Dizziness, Ear discomfort, Pallor, Peripheral coldness
SMQs:, Anaphylactic reaction (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: Levothyroxine, atenolol, hydroxychloroquine
Current Illness: None
Preexisting Conditions: Deafness, Lupus, High blood pressure
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client stated she was feeling pressure in her right ear and lightheaded. Lead RN made contact with the client at approximately 1305 to assess the client. Client stated that approximately 15 minutes after her vaccination she felt dizzy and had pressure in her right ear and in her chest. She denied any shortness of breath, difficulty breathing, chest pain or swelling of her lips, throat or mouth. Client reported having a history of deafness, Lupus, high blood pressure and an allergy to penicillin which gives her hives. She denied any other allergies to medication/food/environment. Client stated she takes Levothyroxine, Hydroxychloroquine, and atenolol daily otherwise denies any other medication use. A first set of vitals were taken at 1310, blood pressure (BP): 140/80, Heart rate (HR) 72, Respiratory Rate (RR) 14, client''s skin was pale and clammy. Client stated her last oral intake was at 0830 and she had a small cup of tea and toast with butter. Client was given a water bottle which she drank and a sugarfree lollipop as she declined the other snacks offered due to avoiding sugars and gluten in her diet. Client stated her BP was normal level for her and that she had been having pressure behind her eyes and in the middle of forehead for a few days due to having elevated BP but denied having the ear pressure prior to vaccination. Client was advised by Lead RN to stay in the zero gravity chair and in observation for an additional 30 minutes for monitoring. At 1320 a second set of vitals were taken: BP 138/78, HR 72, RR 14, skins: normal for ethnicity, slightly clammy with cool fingertips. Client stated the pressure in her ear and chest were persisting but the dizziness/lightheadndess resolved when she laid down in the zero gravity chair. Client stayed in observation an additional 20 minutes and at 1340 stated she was feeling much better and her symptoms of dizzinesss, pressure in ears and pressure in chest had resolved. Lead RN advised client to follow up with PCP regarding ear and chest pressure and gave client ED precautions. Client verbalized understanding and left the observation site on her own accord with a steady gait.


VAERS ID: 1443673 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

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

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

Write-up: Vaccine leaked out from syringe at time of administration. Proportion leaked out estimated as more than half. Another dose was prepared and given in the opposite (right) arm.


VAERS ID: 1443675 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: technician administered vaccine, within minutes pt developed stinging/burning in left arm, stated that they could not relax it. pharmacists were notified at this time. Pt skin and face appeared red and pt was in distress. Pt was given cold compress for arm, and advised by pharmacists to wait additional 30 minutes. Pt and mother (a nurse) agreed and agreed to have pt take diphenhydramine. pt was then checked on every ~5 minutes by technician and pharmacist. after ~45 minutes total, pt still complains of burning/arm pain but is able to move arm and denies any signs/symptoms of anaphylaxis. I assessed pt at this time and stated they could stay as long as they wanted, but that they may leave if comfortable to do so. Upon leaving, I counseled pt and mother to watch for signs/symptoms of anaphylaxis and if they develop to go to ER immediately. Also counseled to see a doctor if pain/burning does not resolve within 24 hours. Also counseled could take APAP/IBU for pain in short-term. This was all documented on back of pt''s VAR


VAERS ID: 1443688 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Erythema, Hot flush, Lip erythema
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (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 got Pfizer vaccine at 2:00 pm and she had reaction to the vaccine at 3:30 pm from the vaccine. Patient had difficulty breathing, light headed, her lips and nose turn blue to deep red color. Patient''s blood pressure was 179/ 100 then second reading was 180/ 115 mmHg with Heart beat of 96. Patient felt chest tightness and hot flashes, she stated that she is going through menopause as well. Administered three ammonia, ice pack, and later on had patient to drink. Called 911 and they came in the mean time. Patient started coming back to normal status and her blood pressure was 130/ 89 with heart beat of 84. Patient agree to go with Ambulance to do full body check up. We will follow up with patient and her PCP to make sure she will be ok.


VAERS ID: 1443694 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN EW0179 / 1 OT / IM

Administered by: Unknown       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? 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: Dizziness, nausea. Evaluated by EMS-Cleared


VAERS ID: 1443702 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Administered vaccine at 1:48 pm. Prior to administration patient''s mother stated she had previously fainted after vaccine administration. Advised patient to wait in vaccine area for 30 minutes. Approx. 10 minutes after receiving the vaccination, the patient''s mother called for help from the waiting area I went outside to waiting area. Had patient sit back and grabbed patient water and returned to waiting area. Patient began to faint and upon awakening she started to vomit continuously. Patient''s mother and I decided to call EMS. EMS arrived and assessed patient. It was determined that her vitals were okay and since she was feeling better she would not go to the hospital and would follow up with her pediatrician about the incident.


VAERS ID: 1443705 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Pain, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported
Current Illness: none reported
Preexisting Conditions: diabetes
Allergies: none reported
Diagnostic Lab Data: none
CDC Split Type:

Write-up: throwing up, nausea, body aches


VAERS ID: 1443710 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / N/A LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 UN / IM

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

Write-up: No adverse effects noted following vaccination. Individual requested and received a different COVID-19 vaccine. The individual received 1st COVID vax dose on 4/23/21 (Pfizer, Lot Number ER8734). The individual requested and received a 2nd dose of Moderna (Lot Number 027C21A) on 7/2/21 at 0812. No reactions noted or reported and the report filed per protocol.


VAERS ID: 1443713 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Sore, puffy underarm, same side that was vaccinated. Swollen lymph node.


VAERS ID: 1443714 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-22
Onset:2021-07-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: topiramate, omeprazole, gabapentin, percocet, diclofenac, methocarbamol, sumatriptan, ondansetron, pramipexole, l-methylfolate, midodrine, freestyle libre
Current Illness: no
Preexisting Conditions: progressive small fiber neuropathy with autonomic neuropathy, gastroparesis, EDS
Allergies: sorbaview adhesive
Diagnostic Lab Data: no
CDC Split Type:

Write-up: red, not itchy, swollen, tender, no treatments tried other than daily pain medication


VAERS ID: 1443718 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: nonce
Preexisting Conditions: nonce
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient''s mother handed the technician her own ID to register for a walk-in covid shot for her son. The prescription was put through for the mother instead of the 15 year old son. The pharmacist checked MIIC for the mother and verified the shot. The technician gave the immunization without verifying DOB or who the VAR was filled out for. The tech realized the mistake when filling out the CDC vaccine card. The patient had received Pfizer in the past and was expecting a second shot of Pfizer. Instead, he received one dose of Pfizer and one dose of moderna. The patient was counseled to watch for any side effects. The patients primary care doctor was contacted an a report was filed at the store level.


VAERS ID: 1443720 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: Patient had immunization at 5:40pm on left arm. Patient returned back at 6:40pm showing she had a bleeding (stopped at the time)and swelling at injection site. She complained that she did not have reaction on first dose. RPH cleaned up the blood on injection site and applied another bandage for for her, then informed the patient that she still can have reaction to second dose even she did not have reaction to first dose. Her swelling was localized at the injection site. She was advised to watch for any potential allergic reaction like rash, SOB or unusual swelling (anaphylaxis), call MD or 911 if severe allergic reaction occurred. Meanwhile she may use ice pack and ibuprofen to bring down the swelling.


VAERS ID: 1443910 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Muscle twitching, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nothing
Current Illness: no other illnesses
Preexisting Conditions: no
Allergies: no allergies
Diagnostic Lab Data: No results related to the adverse event.
CDC Split Type:

Write-up: After waiting 10 minutes patient completely tilts to her right side and is awakened by an employee. Patient states that she feels dizzy, very warm, whole body was twitching and was sweating profusely. Patient also felt the urge to vomit.


VAERS ID: 1443911 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / UNK RA / IM

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

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

Write-up: patient came to pharmacy reporting nausea post vaccination


VAERS ID: 1443912 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Hypoaesthesia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (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: Sintrocid (levotinoxina Sodica) 100mcg Losartan 50mg
Current Illness:
Preexisting Conditions: HTN, Patient stated having half her thyroid gland removed a few years ago.
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient stated being ok after 15 min observation time. She came back a few minutes later to the clinic stating she felt a burning, numbing and swelling sensation near on her right neck/throat area. Her vitals were taken at 10:25am and read BP-140/84, HR-75, RR-18, O2 sat-98% at room air. She was given water and observed. she was talking and had no difficulty in drinking water, she had no complaint of having difficulty drinking. she stated it was feeling a bit better than when she first felt it. vitals were taken again in 10:45 and read BP-128/82, HR-70, RR-20, and O2 sat-97% at room air. Provider came in to exam patient and informed patient to monitor symptoms and if they got worse to return to clinic or go to hospital. Patient stated feeling better after being observed by the provider and was released home. Pt was contacted by phone at 4:17pm she stated the sensation and numbness had gone away and felt better.


VAERS ID: 1443918 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

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

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

Write-up: so adverse events, pt received first dose underaged (16yo)


VAERS ID: 1443920 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Patient had received vaccine on 03/16/2021 (LOT 1805025), but didn''t notify provider giving vaccine today; spoke with patient and husband to let them know to monitor for any adverse effects and go to ER for anything life threatening. There was no reactions noted after patient left clinic. Called and spoke with patient two and a half hours later.


VAERS ID: 1443923 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-21
Onset:2021-07-02
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Abdominal rash. hydrocortisone not relieving. recommended follow up with pcp


VAERS ID: 1443926 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

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

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

Write-up: We administered 2nd dose of Moderna early in the day at 10 am. Patient called at 5:15 pm to report leg and feet swelling and pain in her legs, otherwise she felt fine. We told her to keep her feet elevated and to call her doctor if she felt worse. Since it''s a holiday weekend, told her to be aware of signs of myocarditis and blood clots and if she felt worse, to seek emergency care. Also told her to report to vsafe.


VAERS ID: 1443927 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast feeding, Interchange of vaccine products, No adverse event, Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: Nurse administering vaccine reported error in administration. Patient was administered Janssen vaccine instead of Pfizer covid-19 vaccine 2nd dose. Patient has not presented adverse effects thus far, but counseled on going to the nearest emergency room in case of serious adverse event. She was told to document any symptoms should they happen. She was concerned as she is a lactating mother and was getting the Pfizer vaccine recommended by her doctor so that her child could develop antibodies.


VAERS ID: 1443934 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy, Fatigue, Feeling hot, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, 10mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 15 weeks pregnancy, is my second pregnancy (first was miscarriage), due date is December 22nd. The instant I got the shot I became dizzy, nauseous and overheated. I felt better after laying down. Since then I am having muscle aches, nausea, and fatigue.


VAERS ID: 1443937 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ, levothyroxine, famotidine, Flonase
Current Illness: Allergic rhinitis flares
Preexisting Conditions: Hypothyroidism, GERD, prediabetes, allergic rhinitis
Allergies: Diphenhydramine
Diagnostic Lab Data: COVID + test 7/1
CDC Split Type:

Write-up: Positive COVID test after full vaccination, symptoms started 6/28


VAERS ID: 1443945 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: The patient received the vaccine, walked around the store after receiving it and started having an allergic reaction. We then gave her 2 tablets of 25mg Benadryl and contacted 911. Paramedics came and checked her out, suggested she go to the hospital but she declined.


VAERS ID: 1444141 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Passed out after receiving COVID vaccine, brief loss of consciousness then regained consciousness and was able to speak quickly after, PAGED code white (store management) to the pharmacy, and called paramedics, no reason to feel that epipherine or benadryl was necessary.


VAERS ID: 1444143 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Other Medications: No
Current Illness: No
Preexisting Conditions: Anxiety
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient communicated that he has anxiety. Patient received the first moderna vaccine and about a minute after stated that he was feeling light headed. He then felt very nauseous but did not vomit. He said he felt very hot inside and was sweating very profusely. We got cold water for the patient to drink and placed some cold water on a towel on the back of his head. We then checked his blood pressure 117/68 his pulse was 65. We kept an eye on him for the next 30 minutes and he opted to leave because he said he was feeling a lot better and lived very close by. Patient ate lunch by 1 pm. We took his information to follow up and counseled him to lay down and get something to eat. He was instructed to call the pharmacy if he had any concerns or questions.


VAERS ID: 1444162 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Gait disturbance, Grunting, Hyperhidrosis, Memory impairment, Muscle rigidity, Visual impairment
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Customer did not feel right within 7-10 mins after receving the Janssen vaccine. He complained of vision changes, "seeing dots". When he tried to walk, his legs buckled, but customer was slowly assisted to the floor. While on the floor, my technician heard grunting noises coming from him and his left arm was rigid and bent at the elbow. But within 5-10 seconds, he slowly sat up and said that he "doesn''t remember being on the fall" and complained of being sweaty and "seeing dots". Paramedics were contacted and took him the hospital. Contacted the customer later in the evening and was informed that he was resting at home after spending half of the day in the hospital. He mentioned that the paramedics treated him with Epipen and bendadryl and then he felt better. He was treated "other things" but don''t recall.


VAERS ID: 1444164 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-01
Onset:2021-07-02
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Fatigue, Injection site rash, Injection site swelling, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (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: Over the counter antihistamine generic Zyrtec
Current Illness: NA
Preexisting Conditions: NA NOTE: This report refers to THE SECOND Moderns COVID-19 VACCINE.
Allergies: Zulfa
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Approximately five and a half hours after the moderna vaccine number two, taken on July 2nd 2021, this patient (self) experience a red, swollen rash on the left arm below the injection site north of hand. Dizziness, joint pain, extreme fatigue.


VAERS ID: 1444166 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-07-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049CZ1A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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: Zyrtec (apx 12 hours before); Complex B supplement, probiotic, Vitamin D supplement (all OTC), and Arnica montana "pellets" taken apx 1 hour before vaccination.
Current Illness: None
Preexisting Conditions: Seasonal allergies/chronic rhinitis.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itchy arm with red circular rash around injection site, about 1-inch in diameter.


VAERS ID: 1444167 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Inappropriate schedule of product administration, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: denies
Current Illness: Pt states informed RN felt dizzy upon entering clinic & prior to vaccine. Also states informed RN received TDAP vaccine on 6/14/21.
Preexisting Conditions: HLD w/o meds
Allergies: Shrimp, Peanuts
Diagnostic Lab Data: TDAP 06/14/21
CDC Split Type:

Write-up: Pt states immediately post vaccine "throat began to feel tighter" & states dizziness p/t arrival & @ time of arrival, & informed RN of experiencing dizziness p/t & at time of vaccination & received TDAP 6/14/21. Pt states only dizziness & tightened throat at this time 1635. Pt vitals: 122/62 HR 78, 98% RA, RR 16, No swelling, inflammation, redness to throat & inside mouth, appeared WNL. No dysphagia, no dysphasia. Pt & family informed medical professional of vaccine & what to expect over post vaccine & when to call DR, EMS, & go to ER. Pt & family verbalized understanding & states no needs at time at 1720 &


VAERS ID: 1444169 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

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

Write-up: Before pt got her 2nd Covid injection, she did warn me that she might faint. She said that she is afraid of needles. I advised to stay seated after the vaccine was given. After the injection, less than a few minutes, patient did have an episode of syncope. Mom and brother were there. I immediately got the EpiPen and told my technician to call 911. When I got to her, it looked as if she was seizuring for a few seconds, then she came out of it. I told her that I would give her the epinephrine injection and put she pushed it away and said that she was fine and not needing it. I asked mom on what they wanted me to do. She said that she wasn''t quite sure. Patient then slowly became more conscious and was able to talk to me. I asked her whether she had any difficulty breathing but she said no. She said that she was just really dizzy. She was sweating a bit. She didn''t eat or drink anything before coming to the pharmacy. The injection was given around 12:48pm. I kept on talking to her to make sure that she was still conscious and not passing out. Then the EMT came. They took her blood pressure. First, it was 90s/60s, then 105/70s (if I am not mistaken). Per patient, she almost passed out before at Dr. office but ever did. She didn''t with her first Covid vaccine. Eventually, patient agreed to go to the ER. I called my coordinator, and informed her of what happened. I did ask mom whether I could call her to check on her and mom was okay. However, when I called around 7:20p, and I couldn''t reach her. I left a VM and told them that I will checked back with her on Monday.


VAERS ID: 1444170 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received an unnecessary dose of Pfizer Covid19 vaccine due to his apparently not knowing or remembering that he had previously received the Janssen Covid19 vaccine several months ago. He presented requesting a first dose of the Covid19 vaccine and pharmacy was initially unable to look up his vaccine history. After double-checking with the patient that he had not received a previous Covid19 vaccine, vaccine was administered. Afterward, when we located the patient''s vaccine history, we noticed that he had previously received the Janssen Covid19 vaccine in March. After questioning the patient about this discrepancy, he maintained that he did not remember ever getting the Covid19 vaccine, but stated that his English was not very good, so he may have gotten it without realizing it. Patient was not given an additional immunization record card, and 2nd dose appointment was cancelled. No adverse effects occurred during the 15 minute waiting period in the pharmacy.


VAERS ID: 1444172 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 540205009 / 1 LA / IM

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

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

Write-up: Dx: Angioedema, pruritus Tx: Prednizone, Clairitin, ice Results: Swelling not going down with treatment, itching is now gone.


VAERS ID: 1444173 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-23
Onset:2021-07-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Hair/skin/nail vitamins and Women?s Multivitamins
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: When I use my arm muscles of the arm where I got the vaccine, I get really weird nerve like(?) pain all along my arm. It hurts more so when I pull my arm to the back and when I flex my muscles/grab something tight. It goes away in a few minutes but comes back when I flex my muscles again.


VAERS ID: 1444578 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Face injury, Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (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: None Known
Current Illness: not known
Preexisting Conditions: none known
Allergies: NKA
Diagnostic Lab Data: Checked by paramedics vital signs and cognitive signs.
CDC Split Type:

Write-up: Patient became light headed and fainted from a seated position and fell on floor within one minute of receiving vaccination. Patient checked by pharmacist on site as well as Nurse practitioner and paramedics and was deemed well and fit to go home. There was a facial injury from the fall.


VAERS ID: 1444579 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01A0 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
Hospitalized? No
Previous Vaccinations: fainting, unsure of when or what vaccine
Other Medications: COVID-19 Pfizer vaccine
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient Vomited about 10 minutes after the Pfizer COVID-19 vaccine. We gave the mother a water bottle, asked how he was and he said he felt better. About 10 minutes later they left without checking back in with the staff. The RPh on duty was watching him for other reactions and he seemed fine.


VAERS ID: 1444580 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (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: Same dizziness and throat tightness
Other Medications: Albuterol inhalant PRN
Current Illness: Asthma
Preexisting Conditions: Asthma
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: C/o throat closing up, dizziness, headache soon after 2nd dose Moderna. Pt took a puff of her inhalant & felt relieve. All vitals wnl.


VAERS ID: 1444581 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Fall, Feeling hot, Glassy eyes, Syncope
SMQs:, Torsade de pointes/QT prolongation (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: Lexapro 20mg, Tri-Sprintec
Current Illness: NA
Preexisting Conditions: anxiety
Allergies: NKA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: On 7/2/2021, 28y.o. female patient presented to the pharmacy with her husband to receive their COVID-19 vaccines. Patient was checked in, screened and requested Janssen vaccine. RPh stepped outside to speak with patient about the potential side effect risks with Janssen due to her age group but told patient ultimate decision of which vaccine to receive was her choice. Patient stated she wanted to stick with Janssen and RPh then proceeded to review the questionnaire with patient that she had filled out online. Patient answered no to all questions including the question about ever having a reaction, fainting or feeling dizzy after a vaccine. She was counseled by the pharmacist of potential side effects and how to treat at home or seek medical attention , v-safe program reporting, vaccine card, waiting 15 mins in pharmacy area to be monitored, etc. Her vaccine was administered at approximately 10:12 by rx tech and a wait time of 10:27 given to pt. Work continued in the pharmacy and the patient and her husband were in the waiting area chairs in front of the pharmacy talking (per him, they were joking about side effects when she started to slump over and he thought she was playing around until she started falling backwards and he tried to catch her by her shirt). At approximately, 10:19, the pharmacist and techs heard a loud noise as patient experienced syncope falling backwards hitting the back of her head on the cement floor and the chair fell out from under her and crashing against the floor. Husband was by her side as RPh ran out to assist asking techs to close the pharmacy down for the medical emergency and to call 911 ASAP, call in around 10:19. Code white was called as well. Assessment following Adv Events protocol: Patient was breathing and awake with dazed/glazed eyes as pharmacist started trying to ask questions to assess her conscious level. After about 30-45 seconds pt came back around and answered name and DOB for pharmacist who was talking back and forth with 911 operator. Patient answered that she felt hot, dizzy and anxious to rph who immediately had cold compresses (cool, wet paper towels) for patient''s face and neck. Patient also stated that she had not had anything to eat since 7/1 PM as they had planned to grab breakfast after their vaccines. Store managers arrived as well. Local firefighters from the station just down the street were in the store doing their daily meal shopping and heard the call come across to EMS so they came back to the pharmacy to help. They already had equipment in hand and recorded vitals while RPh was still attending to pt and 911 operator. at 10:24; bp:124/92, pulse 70, O2 sat: 98. Patient stated she felt well enough to try to sit up in the chair again and get off the hard floor and was assisted up by firemen and husband. One of the firemen and RPh assessed the back of the patient''s head and no blood or knot was located, patient able to ambulate head and neck and no blood was found on the floor. Patient still able to answer questions, knew where she was, what she had done except in the moment of fainting and knew who her husband was. Patient refused to be transported to the hospital and EMS was cancelled by firemen to 911. Firemen left scene. Rph, rx tech and Assest Protection completed initial questioning for VAERS/SCRT, Incident and EOC contacted while patient and husband still present. Patient asked for some water and was provided her wishes. Rph continued to ask patient questions about how she was feeling as reports were being gathered. Patient stated she thought not eating and her anxiety got to her causing her to faint and still reported no previous issues with receiving vaccines. Also counseled on signs/symptoms of a concussion, soreness to be expected over the next few days and to seek help immediately if any conditions worsened. Patient was given RPh''s card and told that she would be followed up with Friday PM at COB and Monday, but if anything changed between then to call RPh at the number on the business card. Upon finishing reporting and standing, patient stated back of right knee was hurting from tangle with chair upon fall; otherwise felt fine just a little tired and laughing. A wheelchair or electric cart was offered to patient upon leaving but she asked to walk out assisted by husband and was released. Reporting: Pt meds tri-sprintec and lexapro 20mg, no allergies, only medical condition is anxiety, no PCP


VAERS ID: 1444582 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 RA / IM

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

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

Write-up: PATIENT BROUGHT IN COVID VACCINATION CARD WITH A FIRST DOSE OF MODERNA FROM 6/4/21 RECEIVED FROM ANOTHER SITE. I GAVE THE PATIENT HIS SECOND DOSE OF MODERNA AND WHEN I WENT TO PROCESS THE VACCINE OUR SYSTEM ALERTED ME THAT HE HAD ALREADY RECIEVED 2 DOSES OF PFIZER FROM ANOTHER PHARMACY. UPON FURTHER INVESTIGATION IN THE IMMUNIZATION REGISTRY, I SAW HE HAS RECIEVED BOTH PFIZER DOSES AND NOW BOTH MODERNA DOSES. PATIENT DID NOT DISCLOSE THIS INFORMATION AT TIME OF VACCINATION.


VAERS ID: 1444584 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-01
Onset:2021-07-02
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Feeling drunk, Feeling hot, Injection site erythema, Pruritus, Vaccination site reaction
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: After 2nd shot- Covid arm- large red spot by injection spot. Hot to touch. A little itchy. Appeared 3 days after injection. First day after injection felt drunk- woozy- foggy. Today is first day of Covid arm. No treatment yet. After first shot - felt dizzy and waves of nausea off and on for 4 days.


VAERS ID: 1444590 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: PT HAD APPOINTMENT FOR 1ST DOSE VACCINE AND HAD FILLED OUT THE SCREENING QUESTIONAIRE AND CONSENT FORM FOR PFIZER COVID-19 DOSE #1 INDICATING THAT THEY HAD NOT RECIEVED ANY OTHER VACCINES IN THE LAST 4 WEEKS AND DID NOT INDICATE THAT SHE HAD ALREADY RECIEVED A DOSE OF J & J JANSSEN COVID-19 ON OR ABOUT 04/08/2021 AT PHARMACY. VACCINE WAS ADMINISTERED AND WHEN BILLED IT WAS NOTICED THAT SHE HAD POTENTIALLY RECIEVED A DIFFERENT COVID-19 VACCINE. UPON CALLING THE PATIENT SHE ADMITTED SHE HAD PREVIOUSLY BEEN GIVEN J&J AT PHARMACY AND HAD "INDEPENDENTLY AND KNOWINGLY DECIDED UPON HER OWN TO GET THE PFIZER VACCINE ALSO WITH FULL KNOWLEDGE THAT THE J&J VACCINE WAS A ONE TIME DOSE. PT STATED SHE IS A BIOSTATISTICIAN HANDLING CLINICAL TRIALS AND CLAIMED TO HAVE KNOWLEDGE ABOUT THESE VACCINES. NO REACTION OR ADVERSE EVENTS TO REPORT AT THIS TIME. PATIENT ADVISED TO REPORT THIS INCIDENT TO VAERS ALSO AND TO REPORT ANY ADVERSE EVENTS TO US OR PRIMARY DOCTOR.


VAERS ID: 1444724 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Shellfish, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: After administration and counseling when the patient went to stand up to get out of the room, about 2-3 minutes after injection, she felt lightheaded and dizzy. She sat back down and started visibly shaking. She was not having any breathing distress or closure of passage ways. Her blood pressure was 140/89 and HR was 88. She stayed sitting with her feet up on another chair and we had an epi-pen ready to administer. I offered to call EMS, but she was hesitant as she wasn''t experience her normal allergic reaction symptoms. We got her some water and Benadryl. After about 10 minutes the shaking had stopped and she only felt a little bit of lightheadedness. Her BP was down to 118/78 and HR was 66. At that point she was able to stand and start making her way home with her husband. They bought some Benadryl on the way out and were counseled that if she started to develop any further symptoms to alert EMS.


VAERS ID: 1444734 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: Patient was given Janssen covid 19 vaccine. Patient fainted during her 15 minutes post vaccine observation period. Patient regained consciousness and refused emergency medical help. Patient did not get inquired and felt better after after resting in the pharmacy area for over 30 minutes. She was feeling better and left the pharmacy with her father.


VAERS ID: 1444737 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Malaise, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: fainting after vaccination
Other Medications:
Current Illness:
Preexisting Conditions: Diabetic
Allergies: None reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has a history of fainting after receiving vaccines. About 15 seconds after receiving the vaccine, the patient stated that he felt dizzy and then the patient fainted, caught by his wife. He came to after about 10 seconds. He then started throwing up and felt dizzy and did not feel good. Paramedics were called and came to the pharmacy to evaluate vitals etc. Pt remained conscious. He declined transport to hospital and paramedics left. The patient then drank orange juice and water. He started to feel dizzy again and started throwing up. Paramedics were called again and they were able to help him into the bathroom and evaluate the patient. Paramedics walked him to the car and the patient and his wife were going to drive to the hospital for further evaluation.


VAERS ID: 1444739 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

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

Write-up: PATIENT STATED WHILE WAITING IN PHRMACY WAITING SEATED IN ROOM HE WAS FEELING SWEATY /CLAMMY , LIGHT HEADED ABOUT 10 MINUTES AFTER 2ND DOSE OF PFIZER COVID 19 VACCINATION GIVIN AT APPROX 3PM .PATIENT THEN SAID HE STOOD UP TO GET ATTENTION FROM PHARMACY PERSONNELL AND FEINTED . BOTH PHARMACIST AND CLERK SAW PATIENT PASSING OUT AND LOWERED PATIENT TO THE FLOOR. A FEW MINUTES LATER PATIENT REGAINED CONCIOUSNESS. PARAMEDICS WERE CALLED AND WAS TAKEN TO HOSPITAL FOR CHECK UP


VAERS ID: 1444745 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1800980 / 1 RA / IM

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

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

Write-up: PT vaccinated outside of age range. No adverse reactions noted.


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