National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

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



Case Details (Reverse Sorted by Onset Date)

This is page 336 out of 7,116

Result pages: prev   237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435   next


VAERS ID: 1512955 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Blood pressure increased, Dizziness, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: At 1145, patient reported dizziness to EMT. Patient reported the dizziness started "about ten minutes after I sat down". Patient stated the dizziness "feels the same when I sat down". Patient denied itchiness, rashes, hives, difficulty swallowing, and difficulty breathing. At 1145, EMT assessed patient vital signs: blood pressure 156/102 mmHg and pulse 76 beats/minute. Patient reported history of hypertension and took her unspecified blood pressure medication in the morning. Patient offered EMS. Patient denied EMS. At 1150, EMT reassessed patient vital signs: blood pressure 170/114 mmHg and pulse 79 beats/minute. Patient reported she felt less dizzy. Patient reported this blood pressure is "normal" for her. Patient reported feeling anxious. At 1200, EMT reassessed patient vital signs: blood pressure 172/112 mmHg and pulse 79 beats/minute. Patient reported she feels "all better". Patient denied dizziness. RN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider and to sign up on v-safe. At 1210, patient left facility with unlabored respirations and steady gait.


VAERS ID: 1512964 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / UNK LA / IM

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

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

Write-up: Pt mother intentionally identified patient as being 12 years old and documented pt DOB (redacted) when actual pt DOB was (redacted) and pt is 11 years old. When I went to d/c him I confirmed his DOB and the mother spoke up to say he was only 11 y/o. I asked if she was told he needed to be 12 and she yes, she was aware and deliberately lied. Her son than spoke up and said, "I told you we shouldn''t of lied mom." Her reason was, " he''s starting school soon and they are not going to require masks. He is 11.5 and never had an issue with vaccine so I considered this an emergency. I made the decision to bring him in and if 1 dose is all he gets than thats better than nothing at all." "You have my name and my phone number if you need to reach me." I explained that we had a call into Pfizer in order to know if it will be recommended for him to get his 2nd dose and I also notified her that it will be reported to the CDC because it is out of the guidelines for emergency use at this time. She understood.


VAERS ID: 1512965 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: pt received 1st dose pfizer. pt was extremely anxious and nervous. After receiving dose patient waited/monitored for 15 minutes. After 15 minutes patient asked to use the restroom and on the way to the restroom vomited. Phoned patients mom later in the day to check on child and she was doing well


VAERS ID: 1512971 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 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:
Current Illness:
Preexisting Conditions:
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: the dose was given 14 hours after it was diluted, there was no any reaction or adverse effect reported by the customer.


VAERS ID: 1512994 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dysphonia, Dyspnoea, Oropharyngeal discomfort, Swelling face, Throat clearing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Age 25 on 11/10/2005 Influenza Flumist Anaphylaxis
Other Medications: Lexapro 10mg, Celebrex 400mg
Current Illness: denies
Preexisting Conditions: denies
Allergies: Formaldehyde, Metronidazole, Permethrin, and Influenza vaccine that contains preservatives
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 1104 -Vaccine administer IM in L arm. 1110- PT states to complain of having something in her throat. Denies having any SOB, chest tightness, itching, and no hoarseness. 1115- PT is clearing her throat more and states that she feels like she has to keep clearing her throat more and started to have Hoarseness denies having SOB but states that she is having a harder time breathing when positioning her head in certain ways. 1118- Minimal facial swelling noted clearing throat more often pt continues to talk to staff. Denies having SOB or chest tightness. Doctor notified of pt''s symptoms and instructed to give Epi-Pen NOW. Epi-PEn(Lot #0FM407 exp: 02/2022) administered to Left Thigh by LPN. Pt tolerated and continues to talk to staff. 1120- Doctor in Room evaluating patient. Doctor instructed to continue monitoring in room for the remainder of 30 minute wait and advised patient that she could return back to work since pt works in the hospital. PT voiced understanding. Pt continues to deny SOB and chest tightness. 1125- PT states that she can tell her throat is starting to feel better states that she doesn''t feel like she has to continue clearing throat. Continues to communicate with staff and continues denying any SOB. 1130- PT continues to states that feels like she is improving. Facial swelling has gone down. Continues to communicate and denies having and SOB and chest tightness. 1135- PT''s 30 minute wait is up and Pt continues communicating with staff. Denies SOB states that she feels somewhat better. Informed patient that she could continue to be monitored by immunizations RN but pt denies and verbalized that ''''Dr. said I could go back to work''''. Informed patient that if symptoms do not improve and if she starts to have SOB, difficulty swallowing, swelling in throat or tongue to seek immediate attention at the ER. Pt verbalized understanding and ambulated out of area.


VAERS ID: 1512998 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: Patient came in for her second dose of vaccine as per the recommendation of her OBGYN . Pt had received her first vaccine on 04/07/21. On 07/29/21, pt came to Urgent Care for her second dose of the Moderna vaccine. Pt is currently 6 months pregnant. During 15 minute period that pt was waiting after the administration of the vaccine, patient went to the bathroom and vomited. Patient reported feeling dizzy. Patient did not LOC or feel faint. Emergency was called immediately. Pt started to feel better. Pt denied any injuries or head injuries at the time she was vomiting . pt left with ambulance to go to the hospital walking out with EMT assistance.


VAERS ID: 1513000 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, 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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s guardian informed staff of the incorrect birthday leading to the patient getting vaccinated a day before she turned 12. Guardian did not inform staff of the misinformation until after the vaccination. Patient sustained no adverse reactions and needed no further treatment.


VAERS ID: 1513018 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 RA / IM

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

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

Write-up: Moderna given to a 15 year old.


VAERS ID: 1513031 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 1816027 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Computerised tomogram normal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient''s mother called the day after vaccination, mentioned daughter (who received Janssen COVID-19 vaccine) reported severe back pain and stomach pain the morning after. Patient went to hospital, got CT scan, no results found. Patient was given pain medications.


VAERS ID: 1513033 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Disturbance in attention, Headache, Insomnia, Pain, Pain in extremity, Pyrexia, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: On same day of #1 vaccine experienced sore arm, headache, body aches, fever, decreased energy. Symptoms lasted 2 days. On same day of #2 vaccine experienced same symptoms as above, but lasted 5 days. Early May 2021 developed "ringing in ears" and has continued until today 7/29/21. Complains of HA, difficulty sleeping, difficulty focusing. Has seen GYN, PCP and Chiropractor. No relief. Employer sent to Urgent care on 7/29/21.


VAERS ID: 1513034 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / IM

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

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

Write-up: Patient received dose of vaccine at age 14. Not realized by provider until vaccination was given. Patient stayed at pharmacy for 15 min and no adverse reactions occured. Phone call to patient''s home approximately 1 hour later and spoke with grandmother who is the patient''s guardian. She states that the patient still does not present with any signs of additional adverse event(s).


VAERS ID: 1513043 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation error
SMQs:, Medication errors (narrow)

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

Write-up: Vaccine was drawn up by another nurse inadvertently without diluting first. Patient received .3mL of undiluted Pfizer vaccine. Patient''s father was notified as soon as error was discovered. Patient to return to clinic on 7/30/21 to be evaluated.


VAERS ID: 1513048 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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: DM, Hypertension, dyslipidemia, GERD
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None. Patient received a dose from an expired vial


VAERS ID: 1513051 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: FEMALE STRESS INCONTINENCE LEIOMYOMA ADVERSE EFFECT OF TETRACYCLINE ANTIBIOTIC OBESITY, BMI 30-30.9, ADULT GERD (GASTROESOPHAGEAL REFLUX DISEASE) ANDROGENIC ALOPECIA ABNL BREAST IMAGING ABNL UTERINE BLEEDING
Allergies: minocycline hydrochloride
Diagnostic Lab Data:
CDC Split Type:

Write-up: Not an adverse event, but med error. pt requested Pfizer vaccine, but given J&J inadvertantly


VAERS ID: 1513052 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure increased, Dyspnoea, Erythema, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin with fluoride 1mg Naproxen 250mg Sertraline 25 mg
Current Illness: none.
Preexisting Conditions: sz disorder - diagnosed 1/15. Being followed by neurology at U of U in SLC. CONSTIPATION NOS scoliosis: convex left orientation along T6-L1 measured at 11 Major depressive disorder in partial remission, unspecified whether recurrent Current severe episode of major depressive disorder without psychotic features without prior episode
Allergies: none known.
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient experienced what appeared to be an anaphylactic reaction immediately after receiving the vaccine. Patient''s chest became extremely red and splotchy. Patient''s blood pressure was slightly elevated. Patient reported no difficulty breathing and no wheezing was witnessed. The doctor remained in the room with this patient and monitored her until emergency services arrived. Patient refused hospital transfer. Patient was alert and vocal during entire incident. Patients mother was shown how to enroll herself and her daughter in V-safe. Patient will remain in clinic for monitoring and will be followed-up with later this evening and tomorrow morning.


VAERS ID: 1513054 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Dizziness, Fall, Pallor, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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: No report
Current Illness: No report
Preexisting Conditions: No report
Allergies: No known drug allergy
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: After receiving a 1st dose of Pfizer vaccine, patient fell to the ground within a minute. A pharmacist rushed back to check her heart rate and consciousness. She was quickly alert and breathing normal. She did not recall what happened. Her face was still pale and she felt dizzy. 911 was called. After 5 minutes, she had new seizure episode last for 10 seconds then stopped. 911 came and checked her blood pressure, heart rate and oxygen level. They were all normal. Patient was advised to see doctor for follow up. Her mother took her to seek medical care.


VAERS ID: 1513055 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient is 16. Provider ordered Moderna vaccine to be given. Nurse did not follow proper protocols and administered vaccine. Patient family notified of error.


VAERS ID: 1513061 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Seizure like phenomena, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (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? No
Hospitalized? No
Previous Vaccinations: Slight Dizziness
Other Medications: Not available
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergy
Diagnostic Lab Data: none available
CDC Split Type:

Write-up: Patient completed 2nd dose of Moderna 07/29/2021, first dose was given 07/01/2021. After completed dose, patient was advised to sit and wait (MINUTES). After the timed interval was completed he would be free to leave. A few minutes after vaccination, the patient started experiencing dizziness and fainting. Objectively, the patient displayed fainting and minor seizure like activities. In addition, the patient was sweating all over the body. This happened over a period of 15-30minutes before EMT arrived to provide additional support.


VAERS ID: 1513066 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-22
Onset:2021-07-29
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site reaction, Muscle spasms, Muscle tightness
SMQs:, Dystonia (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: Eosinophilic Asthma
Allergies: Sulfa, Amoxicillin, Clindamycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle tightness cramping at injection site a week later


VAERS ID: 1513068 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Condition aggravated, Fatigue, Headache, Hypertension, Hypoaesthesia, Impaired work ability, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: per patient, has headaches frequently and undocumented high blood pressure (reported after adverse reactions commenced)
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: A few minutes after patient received the Moderna vaccine in his left shoulder, he reported that his left arm was numb down through his ''pinky'' finger (although he was able to move it). He subsequently reported that he felt tired, he developed a headache, he had some stomach cramps and began to get nauseous. He did not ever vomit during this period. His blood pressure was monitored and found to be elevated initially at 173/121 (with a pulse of 69). His blood pressure was monitored over the course of just over an hour. It varied over this period but was elevated. The pharmacist in charge determined that patient was not able to go back to work. Patent stated that his girlfriend with whom he lives was off work today and could stay with him. He was advised to call 911 if he started feeling worse. Patient was driven to his home by a co-worker. Through the course of the day, contact was made with Patient and his girlfriend (per his authorization). He ate and then slept for some time. Upon awakening, he vomited for awhile - but "not alot". The numbness in his arm started subsiding. The headache maintained. They had no way to check his blood pressure. At 3:36pm he indicated he was "doing somewhat better" but the nausea was not any better.


VAERS ID: 1513072 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect 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: none reported
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: none
CDC Split Type: na

Write-up: Patient was administered 2.0ml of Pfizer COVID-19 Vaccine, noted after the patient left the clinic, unable to reach patient at this time, unknown signs or symptoms, was in good health on leaving the clinic. Patient did report breastfeeding her 9 month old daughter.


VAERS ID: 1513074 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / 1 RA / IM

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

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

Write-up: Pt said her arm was not able to move and was painful ; this was about an hour after the vaccine was given. EMT was called to evaluate. Contacted patient about 6 hours after vaccine and pt stated she was doing fine and feeling much better.


VAERS ID: 1513075 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Basophil count decreased, Chest X-ray normal, Chest discomfort, Chest pain, Differential white blood cell count, Dyspnoea, Electrocardiogram ST segment elevation, Eosinophil count decreased, Fatigue, Full blood count, Haematocrit normal, Haemoglobin normal, Lymphocyte count, Mean cell haemoglobin concentration increased, Mean cell volume normal, Monocyte count decreased, Myalgia, Neutrophil count, Oropharyngeal pain, Pain, Pain in jaw, Painful respiration, Platelet count normal, Red blood cell count normal, Red cell distribution width normal, Troponin I increased, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Myocardial infarction (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: NKMA
Diagnostic Lab Data: Labs Reviewed POCT TROPONIN - Abnormal Result Value Troponin I POCT 7.14 (*) CBC AND DIFFERENTIAL COMPLETE BLOOD COUNT COMPONENT White Blood Cell Count 6.3 RBC Count 4.92 Hemoglobin 14.3 Hematocrit 41.8 MCV 85 MCHC 34.3 Platelet Count 180 RDW 12.9 AUTO 5 PART DIFF Neutrophils Absolute 3.5 Lymphocytes Absolute 1.8 Monocytes Absolute 0.8 Eosinophils Absolute 0.3 Basophil Absolute 0.0
CDC Split Type:

Write-up: Patient is a 16-year-old boy with no significant past medical history presents to the emergency department with concerns for chest pain and shortness of breath. Patient had his second dose of the Pfizer Covid vaccine 3 days ago. Initially after the dose he did experience some myalgias, fatigue, and a sore throat. The symptoms lasted overnight and into the following day. They then remitted. Yesterday, patient was feeling well in the morning, however, in the evening he began to experience significant shortness of breath. This shortness of breath along with some anterior throat and upper chest discomfort with deep respirations. He denied any associated nausea, vomiting, or sweating. With these symptoms he went to hospital. There he was evaluated and a chest x-ray was performed. Patient''s chest x-ray did not show any concerning findings. Patient was discharged in stable condition with albuterol and encouraged to follow-up with his primary care physician. Today, patient''s shortness of breath and chest pain returned. He states that it is in the center of her chest with occasional radiation to his jaw. He denies any associated nausea, vomiting, or diaphoresis. His pain was initially severe in route to the emergency department, however, it has lessened and is now 4 out of 10 in severity. Patient otherwise denies any other fevers, lightheadedness, change in vision, abdominal pain, constipation, diarrhea, or dysuria. Medical Decision Making: Pt presented for chest pain. EKG was given to me shortly after obtaining it. This showed ST elevation inferiorly and laterally with possible reciprocal change in I, aVL & V1. Troponin was markedly elevated. I discussed case with our interventional cardiologist initially who wanted to take pt to the cath lab. However, pt is a minor and he noted that he couldn''t cath a minor. This decision was made after the patient was already in the cath lab. Therefore, I contacted Hospital and discussed this case with the on call cardiologist. He recommended pt be tranferred to the ED where they will evaluate him and possibly do an echo of his heart. I discussed this with the ED physician at hospital who agreed to see pt. He was then tranferred via ambulance for further care.


VAERS ID: 1513076 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-07-29
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head abnormal, Diarrhoea, Feeling abnormal, Generalised tonic-clonic seizure, Impaired work ability, Magnetic resonance imaging head abnormal, Vision blurred, Vomiting, White matter lesion
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Alprazolam, Ortho-Cyclen, Amphetamines, Buspirone
Current Illness: ADHD
Preexisting Conditions: ADHD, a seizure in 2019, prior alcohol abuse
Allergies: Amoxicillin, penicillins
Diagnostic Lab Data: Head CT was abnormal "1 cm focus of hypoattenuation in the posterior aspect of the LEFT centrum semiovale is of uncertain etiology and: Vascular, infectious, inflammatory, neoplastic, and toxic/metabolic etiologies are in the differential diagnosis. This finding was not definitively present previously. Further evaluation of this finding with MRI is recommended. No other abnormal findings." Led to MRI. MRI which showed: "Nonspecific cerebral hemisphere T2 and T2 FLAIR white matter hyperintensities. These are atypical for a patient of this age. Considerations include sequela of remote trauma, migraine, smoking, diabetes mellitus, collagen vascular disease, Lyme disease, neurosarcoidosis and demyelination." Neurology has been consulted.
CDC Split Type:

Write-up: Patient came in after having two tonic-clonic seizures at work. Had been vomiting, having diarrhea, and feeling off. Vision was blurry on the way to work. BG was less than 20. Had seizure in 2019. So far Ativan has been ordered PRN for seizures and neurology to see pt for full workup.


VAERS ID: 1513082 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 RA / IM

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

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

Write-up: Patient received the second dose of Moderna after only 13 days from Moderna dose 1. Less than 28 days between doses.


VAERS ID: 1513086 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypoglycaemia (broad)

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

Write-up: Patient complained of feeling dizzy and blurry vision 10 minutes after receiving the vaccination shot. Patient found out she was pregnant yesterday that gestation was about 5 weeks ago. She mentioned she had a granola bar for breakfast and nothing else before receiving the vaccination. Water initially provided, vital signs taken with no improvement, gave juice and snacks and patient consumed it. Patient with vitals taken multiple times after initials vitals taken. Patent stated she felt improvement, not feeling dizzy and blurry vision subsided, final vitals taken and ambulation closely supervised with no issues to gait. Patient left with boyfriend in a private car.


VAERS ID: 1513091 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK - / SYR

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

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

Write-up: None stated.


VAERS ID: 1513098 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-29
Onset:2021-07-29
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: breakthrough covid19 infection symptomatic


VAERS ID: 1513100 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Pallor, 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: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient experience a brief moment lightheadedness while waiting in the waiting area after the shot was administered. He appeared to faint briefly dropping his phone, and almost immediately regained coherence. Patient sad he felt fine. 2 or 3 minutes later he asked for a cup of water. He appeared pale at the time but a few minutes later looked normal. He was anxious about the vaccine. We were about to call the ambulance and he refused to let us saying he was fine. He expressed that he didn''t want any medical attention. He also reported after the event, that he hadn''t slept the night before or eaten anything that day. We would not let him drive himself home. He had his brother pick him up. We explained what had happened, and will follow up with him to see how the patient is.


VAERS ID: 1513104 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-07-29
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation delayed
SMQs:, Fertility disorders (broad)

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

Write-up: since receiving second dose of COVID vaccine in JUNE, my daughter has not had her menstrual cycle since MAY 2021


VAERS ID: 1513111 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient had Moderna covid-19 vaccine as first dose but was given pfizer mistakenly at appointment for second dose.


VAERS ID: 1513115 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Eye swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (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: none
Current Illness: no
Preexisting Conditions: high blood pressure & diabetes
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient said her right under arm is tender and her right eye is tender and swollen


VAERS ID: 1513118 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 RA / IM

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

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

Write-up: Administered vaccine to patient in right deltoid. When injecting the vaccine, the hub of the syringe was loose and greater than 50% of dose was lost. Checked with clinical coordinator. Per CDC guidance, another vaccine is recommended and was administered to the patient to make sure there is a sufficient dose given.


VAERS ID: 1513122 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (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: fainting or feeling dizzy
Other Medications: NO
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient seemed nervous at time of vaccination and afraid of vaccine. Shortly after vaccination patient fainted for 5 to 10 seconds, once patient regained consciousness patient became panicky and started crying. We promptly called 911, patient attempted to leave store, we advised her to stay for paramedics. Paramedics arrived and took over patient care.


VAERS ID: 1513123 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Loss of consciousness, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: N/A
Current Illness: No
Preexisting Conditions: N/A
Allergies: No known drug allergies
Diagnostic Lab Data: Blood pressure reading.
CDC Split Type:

Write-up: Patient felt very warm and tingle for about 10 minutes. This feel causes him to lose consciousness for approximately 10 seconds. He return to state of full consciousness. He stated he was okay, "just fell asleep for a second." Blood pressure reading was 115 / 55 about 3 minutes after event occurred. Monitored patient for full 30 minutes. He stated he felt fine after 30 minutes were up.


VAERS ID: 1513130 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Immediate post-injection reaction, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Injection was given at 1215pm. Immediately after vaccine injection patient became clammy and was lowered to the floor. BP 110/60 P 67. Alert and oriented x3. Nausea with small amount of emesis. Patient felt better. Patient left at 1247 pm.


VAERS ID: 1513143 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 RA / IM

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

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

Write-up: This vaccine has not been approved for persons under 18 years of age. This was given in error to a 14 year old.


VAERS ID: 1513147 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-06-15
Onset:2021-07-29
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: 0.5ML DOSE GIVEN INSTEAD OF 0.3ML DOSE


VAERS ID: 1513152 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / UNK RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Disorientation, General physical condition abnormal, Presyncope, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: pt had shot and went to sit for observation period. when period was almost over mom noticed pt looked asleep and just not right. she tried shaking him and he seemed groggy and unoriented. called for nurse and we checked him then took him to ER. symptoms seemed most consistent with vagal syncope so epinephrine was not administered.


VAERS ID: 1513154 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Interchange of vaccine products, Wrong product administered
SMQs:, Medication errors (narrow)

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

Write-up: pt rcvd Pfizer as her first dose and was mistakenly given Moderna as her 2nd dose


VAERS ID: 1513171 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Mother informed us that pt. passed out at the dentist office when the dentist gave him a shot. Mother was unaware of what shot
Other Medications: None per mother''s response. She was present at time of event
Current Illness:
Preexisting Conditions: Anxiety and ADHD
Allergies: NKDA
Diagnostic Lab Data: Blood pressure and O2 stats (7/29/2021 @ 1:40pm) Blood pressure re-check, EKG, IV line started (7/29/2021 @ 1:55pm)
CDC Split Type:

Write-up: Patient came in for his first dose of the Pfizer Covid vaccine. He received his shot in his left arm (given @ 1:20pm on 07/29/2021). He went to our waiting area for his 15 minutes of observation. As soon as he sat down he start to have a reaction (1:22pm 07/29/2021). He became unconscious. His mother was with him and alerted the vaccinator (pharmacy technician) immediately. Technician alerted the pharmacist/pharmacy manager. Pharmacist ran out to check on patient. I yelled and shook the patient. He became alert. He was no longer unconscious at this point. He began sweating, his eyes kept closing. He complained of feeling nauseated and having a headache. Pharmacist immediately called 911. Paramedics arrived (@ 1:40pm). They check his vitals. BP was 80/59. Patient then alerted the paramedics that he had to use the restroom. He has been having diarrhea for at least the past 3 days. Paramedics took him to the restroom. He then was asked to have a seat outside of the restroom where his vitals were done again. They started an IV and ran an EKG (@ 1:55pm). Paramedics brought in stretcher and were taking him to the hospital for further observation (@2:10pm).


VAERS ID: 1513172 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-23
Onset:2021-07-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Tenderness
SMQs:

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

Write-up: On 7th day, woke up with tenderness in axilla on same side of. injection.


VAERS ID: 1513175 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Loss of consciousness, Seizure like phenomena, 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), Convulsions (narrow), 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: none
Current Illness: none
Preexisting Conditions: unknown
Allergies: None
Diagnostic Lab Data: EMT and Ambulance called.
CDC Split Type:

Write-up: Patient experienced syncope, pale and clammy skin. Possible short small seizure. Patient was on empty stomach did not eat breakfast and or lunch. Patient passed out from the chair and possibly hit his head on the floor


VAERS ID: 1513177 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Nausea, Peripheral coldness, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: Approximately 10 minutes after being vaccinated with Moderna vaccine for his 2nd dose, the patient said his throat was closing up a little and itching and he felt nauseous. The patient was told to sit down and wait for 20 minutes after administration. The patient was walking around the pharmacy and talking. The covid ambassador reinteriated to the patient to sit back down. A few minutes after sitting down, he admitted he should have listened and proceeded to tell the pharmacist of his symptoms. The pharmacist clarified if his throat was closing up or was it itchy. The patient said it was a little itchy and a little difficult to breathe. The pharmacist gave the patient 25mg of liquid benadryl. The pharmacist continued to monitor the patient. The patient said he felt chills in his hands a few minutes later but he was no longer feeling nauseous. The patient did not claim to have any allergies on his form or any previous allergies he was aware of. The pharmacist followed up with the patient 5 minutes after his claim of chills. He said he can breathe better but still had the chills. The patient sat in the chair for approximately one hour while the pharmacist monitored him. He called a relative to come pick him up. He told the pharmacist his ride was there and he felt much better before leaving. The pharmacist told him to rest and monitor his symptoms. If the symptoms came back or got worse he needs to call 911 or go to the emergency room.


VAERS ID: 1513182 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoaesthesia, Paraesthesia, Respiratory rate increased, Tachycardia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: 10 MINUTES POST VACCINATION PATIENT BECAME DIAPHORETIC, RAPID BREATHING, TACHCARDIA, PROGRESSED TO NUMBNESS AND TINGLING IN DISTAL EXTREMITIES. EVALUATED IN THE HOSPITAL ED FOR OBSERVATION


VAERS ID: 1513183 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event, Product preparation error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: Allergic rhinitis Anaphylaxis due to allergen immunotherapy Cervical radiculopathy Hematuria Intermittent low back pain Lumbar radiculopathy Multiple allergies Urticaria Vitamin D deficiency
Allergies: Fish Allergy, Sulfa Antibiotics, Dexamethasone, Ibuprofen, Tape
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given the pfizer vaccine without the diluent being mixed in the vaccine. Patient waited in office for 30 min with no reactions or symptoms. CDC was called and was told that no patient harm was done. Patient notified.


VAERS ID: 1513186 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MMR, fever
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: Rash and hives across chest about 10 mins after vaccination.


VAERS ID: 1513190 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A221A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Fatigue, Headache, Sleep disorder
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Allergic reaction to flu vaccine
Other Medications: Bupropion, zyrtec, baby aspirin
Current Illness: None
Preexisting Conditions: None
Allergies: Flu vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain behind sternum that woke me from sleep-ongoing Upper abdominal pain-ongoing Headache-3 days Fatigue-3 days


VAERS ID: 1513199 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / IM

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

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

Write-up: PATIENT CAME INTO PHARMACY AND WANTED THE PFIZER VACCINE , SHE FILLED OUT THE ONLINE FORM AND THEN WAS ASKED ON THE INTAKE SCREENING AND CONSENT FORM IF THIS WAS HER FIRST DOSE TO WHICH SHE ANSWERED YES THIS WAS HER FIRST DOSE AND HAD NEVER HAD A DOSE BEFORE. SHE WAS GIVEN THE DOSE STYED THE REQUIRED TIME AND LEFT THE STORE. UPON RECORDING THE FIRST DOSE I HAD FOUND THAT SHE HAD GOTTEN THE FIRST AND SECOND DOSE 1/22/21 PFIZER LOT #EL3246 AND PFIZER LOT#EL3246 ON 2/12/2021 . WE TRIED REACHING OUT TO HER BUT SHE STILL CLAIMS THAT SHE HAD NEVER GOTTEN THE DOSES.


VAERS ID: 1513200 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Do not have the information at this time.
Current Illness: Heart Disease
Preexisting Conditions: Heart Disease
Allergies: No
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Diarrhea and heart palpitation


VAERS ID: 1513380 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Hyperhidrosis, Nausea, Vaccination complication
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had Adverse reaction to vaccine. Felt light headed- seems to have been brought on my anxiety. Had some sweating and nausea. Gave patient water and Benadryl and told him to sit and relax. Patient started feeling much better and left within the hour.


VAERS ID: 1513384 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0817 / 2 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site nodule, 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 she woke up a knot on her arm near the injection site. Arm is harm to move if she moves her neck to the right she gets a sharp pain.


VAERS ID: 1513387 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FW7485 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Vertigo
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (narrow)

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

Write-up: On and off all day today I have been getting extreme dizziness and vertigo. It feels like the room is spinning and that I am off balance. It hits out of nowhere and has been lasting for about half an hour to an hour at a time.


VAERS ID: 1513389 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA165969 / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Incorrect 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: Sertraline 1.5 tabs daily Gabapentin 800mg daily Methadone 135mg liquid daily
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given 0.3 ml undiluted covid-19 vaccine. Patient declined to wait 15 minutes for possible side effects.


VAERS ID: 1513396 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Headache, Paraesthesia oral
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypertension (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: Migraine
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient to clinic 07/29/21 to receive first dose Pfizer vaccine. Later c/o tingling of tongue and headache. No c/o swelling or indication of anaphylaxis. Airway unobstructed. No apparent swelling of tongue. Vital signs: BP 186/98 HR 99 RR 20 Temp 99 O2 s sat 98%. Onsite paramedic offered ibuprofen for headache, patient received 400mg of ibuprofen at 5:09 P.M.. Patient advised to seek emergency care due to elevated BP. Patient refused.


VAERS ID: 1513399 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Feeling hot, Hyperhidrosis, Muscular weakness, Pallor
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fainting, patient did not provide specifics, said history as she dislikes needles.
Other Medications: unknown, patient does not fill with our pharmacy
Current Illness: None listed
Preexisting Conditions: None listed
Allergies: None listed on questionnaire
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Within 15 minutes or less of vaccine patient reported started to become dizzy, and hot. She put her head between her legs to get it to pass, but started to fall to the ground. Husband was nearby and able to break her fall. She was pale, sweaty, and reported dizzy. We checked pulse. She quickly came to and within minutes color returned to her lips/face. She was talking the entire time and answering questions, no signs of anaphylaxis. Her legs were elevated, remained lying on floor, provided cold pack for her to place on her neck. After almost 15 minutes she slowly got up, and stated that she was feeling better, legs a little wobbly. She was able to leave on scooter.


VAERS ID: 1513402 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, 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), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: she let me know after the event she had a similiar one at the gyn office
Other Medications: no
Current Illness: none. pt had 2 seizures when she was 11 but none since then
Preexisting Conditions: n/a
Allergies: none
Diagnostic Lab Data: none..
CDC Split Type:

Write-up: pt passed out and fell off the chair. pt was unconscious for about a minute. we called 911 and place pt on a mat. she regained consciousness very quickly and very alert and aware she passed out


VAERS ID: 1513407 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: none, took blood pressure twice first slightly low around 110 and 15 min later blood pressure normalized to 120
CDC Split Type:

Write-up: slightly fainted, recovered within 5 min


VAERS ID: 1513414 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

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

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

Write-up: PATIENT WANTED MODERNA,. INSTEAD PT RECEIVED jANSSEN


VAERS ID: 1513428 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

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

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

Write-up: Pt c/o bodyache,headache and feeling lowe grade fever but did not check temp. Pt concerned its due to possible s/e of covid 19 vaccine Pfizer that she got on 07/27/21. Pt speech clear, comfortable. AO X3. Also denies emergency sx at this time. Advised to monitor her sx but pt requested f/u MD appt for these mentioned concerns .


VAERS ID: 1513437 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-20
Onset:2021-07-29
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Injection site warmth
SMQs:, Hypersensitivity (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 received shot on 7/20 on 7/29 patient reported rash and heat coming from injection site


VAERS ID: 1513440 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 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? 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: MINUTES AFTER RECEIVING COVID VACCINE PATIENT FAINTED. HE DID NOT HIT HIS HEAD. RESCUE WAS CALLED AND HE REGAINED CONSCIUOUSNESS MOMENTS AFTER FAINTING. WHEN RESCUE CAME PATIENT DENIED ANY FURTHER SERVIES AND STATED HE WAS FEELING BETTER AND LEFT THE PHARMACY.


VAERS ID: 1513618 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Nausea, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal 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: no
Allergies: no
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: After about 13 minutes, patient stated that he started to have blurry vision about 80% of it was gone, he felt nauseous, and starting to sweat a lot. Then patient threw up a little bit. After that we gave gave him some water and glucose tablets. Patient hasn''t eaten all day either.


VAERS ID: 1513620 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood pressure decreased, Dizziness, Nausea, Neuropathy peripheral
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unkown
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: took blood pressure 93/57 pulse 81 7/29/21 3:45 pm
CDC Split Type:

Write-up: nausea, weakness, dizziness, neuropathy


VAERS ID: 1513622 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7489 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Vision blurred
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3; Divalaproex 500mg; Divalaproex 250mg ER; TraZODone 100 mg (1/2 tab) last night ; Potassium CL 10 mEq SR Tab (2 daily); CertaVite with Antioxidants multivit/Min/FA FeFum 0.4/18 mg Tab Ruab; Vitamin B-12 Cyanocobaiamin 1,000 mcq
Current Illness: Swelling in lower extremity and foot
Preexisting Conditions: High blood pressure; Seizure; Vitamin deficiency; Low Iron; PTSD; Anxiety; Depressive disorder
Allergies: Tuberculosis skin test
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seizure; Blurry vision


VAERS ID: 1513627 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 requesting a COVID vaccine, Pfizer, Moderna, whatever we had. Patient was given Moderna. Hours later daughter calls and states that father had received Pfizer when the vaccine was first available to the public back in January and had received both doses. Stated that father suffers from memory problems.


VAERS ID: 1513629 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Patient fainted after about 5 to 10 minutes never stopped breathing emt checked patient out and he left of his own accord stating he was fine now


VAERS ID: 1513636 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Oropharyngeal pain, Skin warm
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt received first dose on Monday 7/26/21 and returned to pharmacy on Thursday 7/29/21 reporting she had a sore throat the night she got her vaccine. She now has redness/red-like and warm-to-the-touch circular appearance about 3 inches below her injection site (may be cellulitis). Pt denied she did not have other symptoms like throat swelling, itching, lip swelling, etc. She will take benadryl and ibuprofen to reduce the redness/inflammation. She will also keep the area clean by washing with warm water and soap. She was advised to contact MD if she does not see it going away or symptoms persist or new symptoms occur.


VAERS ID: 1513642 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / UNK LA / IM

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

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

Write-up: Patient stated that they did not receive any previous COVID-19 vaccinations. Moderna vaccine was administered. Patient''s insurance kicked back because they did receive both doses before.


VAERS ID: 1513643 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, Vaccination site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: Ambien 10mg daily at bedtime, Benadryl for bug bite on face OTC
Current Illness: Patient had a bug bite on her face
Preexisting Conditions:
Allergies: NKA per the administration form
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called and asked if we had the Pfizer vaccine in stock, and my tech confirmed that we do. She explained if they are the first of the day, they will need to wait 30 minutes for it to come to room temperature. Patient showed up around 6PM and asked for the Pfizer vaccine. We told her we had it in stock and it was ready to go from previous vaccines in the day. We gave her the form to fill out and asked if she has filled her prior. She has filled a prescription recently so we didn''t need to get her license or insurance card. As she was filling out her administration form, she asked about a bug bite on her face and wondered if she can get the vaccine today. I told her it would be fine. The gentleman that was with her (I am assuming the husband) asked if I could look at it and make a recommendation on her to treat it. She stated she took a dose of Benadryl already. I told her to use the Benadryl and to contact the MD for a steroid. She agreed to call in the morning since it is after hours and probably no one is in the office at this time. She completed her paperwork and we sent her into the vaccination room. When I walked in to the consultation room, I asked verbally if she had any other of the vaccines and if this is in fact her first COVID vaccine. She verbally stated yes this is the first and she didn''t have one anywhere else. I proceed to ask if she has any questions about this vaccine and to inform her on the procedure about seeing her back in 3 weeks. I vaccinate her and she bleeds. As I am stopping her arm from bleeding and cleaning up the area, she states something along the lines of "I hope I don''t have any issues like I did with the J and J shot." I said what, you already had a vaccine and she said ?Yes I had the J and J back in March or April and since the delta variant is out, I am afraid of getting it so I came to get the Pfizer today?. I said you told me you didn''t have any other vaccines and now you are saying you did. She confirmed again. I told her I needed to fill out an incident report for my corporate and she said "It''s okay don''t fill out the report." I stated no I like my job and I am going to fill out the report. I also told her that corporate may be contacting her about this. I stated that I''m not sure what she will experience with getting this after the J and J vaccine, and that we will not be giving her another dose. I put on note on her file here.


VAERS ID: 1513650 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Dizziness, Fall, Hypoacusis, Nausea, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: BLOOD PRESSURE, BLOOD SUGAR, VISION, HEART RATE, BREATHING RATE, AND PULSE OXYGEN LEVEL .
CDC Split Type:

Write-up: PATIENT WAS NERVOUS ABOUT THE SHOT. AFTER THE VACCINE WAS ADMINISTERED, SHE WAS TOLD TO WAIT AROUND FOR 15 MINUTES. APPROXIMATELY 2-5 MINUTES AFTER, THE PHARMACY STAFF HEARD A THUD AND SAW SHE SLUMPED DOWN ON OUR CHAIR. THE PATIENT CLAIMED SHE IS DIZZY, NAUSEOUS, BLURRY VISION, AND MUFFLED SOUNDS. PARAMEDICS WERE CALLED AND CAME TO CHECK HER VITALS. THE PARAMEDICS CONCLUDE THAT SHE IS FINE TO GO HOME AND REST. PHARMACIST FOLLOW UP WITH THE PATIENT''S MOTHER 4 HOURS LATER AND WAS TOLD PATIENT IS FINE.


VAERS ID: 1513653 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypotension, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Pt fainted on mother''s arm after a few minutes of receiving vaccine. She fainted approximately 30 seconds - 1 minute. When she woke up, she was pale and weak. BP was taken, and it was below normal. She drank water and ate skittles to boost her sugar and get BP back up. She was informed to sit for another 30 mins with her mother to make sure she was okay. She also had a fan blowing cool air on her to help her feel better. After waiting over 30 mins and retaking her BP, pt felt better enough to leave with her mother. Mother was advised to watch her daughter for the remainder of the day, and for the pt to eat a hearty meal before returning for her second covid imz.


VAERS ID: 1513657 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-01
Onset:2021-07-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

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

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

Write-up: Per immunization and confirmed by patient today, she had received J&J vaccine on 4/1/21 and should not have received the first shot of Moderna on 7/1/21. Pt was given 1st Moderna vaccine in error. Pt was told today that she could not receive 2nd dose without further clarification by CDC guidelines.


VAERS ID: 1513659 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Disorientation, Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NO MEDICATIONS BEING TAKEN
Current Illness: NO KNOWN ILLNESSES AT TIME OF VACCINATION
Preexisting Conditions: NO KNOWN CHRONIC/LONG STANDING HEALTH CONDITION
Allergies: NO KNOWN DRUG ALLERGIES, FOOD ALLERGIES OR OTHER PRODUCT
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was alert but disoriented, difficulty breathing, speaking in between breathes, chest tightness, dizziness, and nausea 5 minutes after receiving the Pfizer Covid 19 Vaccine. 911 was called & paramedics arrived at the scene about 10 minutes from onset of patients symptoms. Patient was taken into Paramedics care and transported to the hospital.


VAERS ID: 1513663 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH C417319 / 1 - / SYR

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

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

Write-up: Allergic reaction broke out in hives on my back then hours later had a swollen lip reaction this has never happened to me before prior to the vaccination


VAERS ID: 1513667 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Patient reported to clinic 1+ hour post vaccination with complaints of itchiness and swelling to face. Patient denied any discomfort of the throat or tongue. Vital signs were within normal limits. Consulted with Pediatric Dr. who consented the administration of a 25 mg oral capsule of Benadryl. Patient began to feel slight discomfort swallowing. Oxygen levels remained within normal limits. Consulted with Dr. and per his assessment patient stable and no need for further intervention. Patient was observed for a total of 30 minutes following administration of medication. After 30 minutes patient reported that her symptoms were resolved.


VAERS ID: 1513669 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Public       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:
Current Illness:
Preexisting Conditions: asthma
Allergies: allergic to lentil
Diagnostic Lab Data:
CDC Split Type:

Write-up: 14 year old patient refers to EMT feeling dizzy 20 minutes after second Pfizer dose. The EMT proceed by taking him to observation area to measure his vital signs: 70/40 mmHg b/P, P-59 beats/minute Oxygen98% and DXT 135mg/DL. Patient is instructed to lay down on table with feet elevated (trendelenburg position) for the return of the volume in his blood. He is in observation for 15 minutes. At 4:57 his vitals are taken again: 80/50 mmHg B/P, P-70 beats/minute and Oxygen 99%. At 5:15pm he is discharge with stable condition by Doctor.


VAERS ID: 1513677 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: I got the vaccine at 10:30 am and began to notice side effects at 7:30. My symptoms are fever, malaise, and migraine.


VAERS ID: 1513682 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: Pt mentioned she did not eat dinner previous night and breakfast the morning of vaccination and right after the vaccine shot she fainted a few seconds and we watched her longer than 15mins and she said she was fine and left with her ride.


VAERS ID: 1513882 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: 14 year old male patient refers to EMT feeling dizzy 20 minutes after the second Pfizer dose. The EMT proceed by taking him to the observation area to measure his vital signs: 70/40 mmHg B/P, P-59 beats/minute, oxygen 98% and DXT 135mg/DL. Patient is instructed to lay down on table with feet elevated (Trendelenburg position) for the return of the volume in the blood. He is in observation for 15 minutes. At 4:57 his vital are taken again: 80/50 mmHg B/P, P-70 beats/minute and oxygen 99%. At 5:15pm he is discharge with stable condition by Dr.


VAERS ID: 1513889 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-25
Onset:2021-07-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OO6D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient reported Tiredness, headache, and nausea on day of vaccine (7-25-21). On 7-29-21 pt woke up with body rash.


VAERS ID: 1513896 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 - / IM

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

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

Write-up: Patient became dizzy after receiving vaccine and started to become unresponsive. Patient was helped to ground and the legs were elevated, within 10 seconds patient was responding to verbal ques and was back to 100% within 30 seconds. Patient was observed in a chair and given some water and saltine crackers for an additional 20 minutes. Patient stated he was ready to go at the end of the 20 minute wait period and left the pharmacy


VAERS ID: 1513899 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Immediate post-injection reaction, Loss of consciousness, Seizure like phenomena, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Immediately upon administering the vaccine, the patient loss consciousness. I was able to catch him. He was unresponsive for approximately 5 minutes. His eyes rolled back in his head and he made seizure like motions. By the time EMS arrived he was responsive.


VAERS ID: 1513900 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: PATIENT PRESENTED FOR IMMUNIZATION AND REVIEWED ALLERGY LISTS. INQUIRED AND PATIENT STATED SHE HAD NO PREVIOUS REACTION TO VACCINATIONS. NO ALLERGY EXCEPT TO HAND SANITIZER (LATER SAID COULD EAT ORANGES BUT NOT DRINK ORANGE JUICE). ADMINISTERED VACCINE (AND ALSO WAS PRESENT FOR A FRIENDS VACCINE SO I OBSERVED HER FOR 15 MINUTES IN PERSON WITH NO REACTION AND ASKEDAFTER 15 MINUTES IF SHE WAS STILL OK AND ANSWERED YES WAS OK). SHE WAITED FOR ABOUT ANOTHER 10 TO 15 MINUTES AND REPORTED THAT WAS ITCHING ACROSS BACK AND LEGS. NO SWELLING IN FACE WAS EVIDENT AND CONFIRMED BY FRIEND. NO SHORTNESS OF BREATH OR DIZZINESS. TECH WERE NOTIFIED OF ALLERGIC REACTION AND GIVEN REQUESTS: THEY CALLED PHARMACY MANAGER. I OFFERED AND GAVE 50MG DIPHENHYDRAMINE LIQUID (12.5MG/5ML=20ML). i OFFERED TO CALL FOR AMBULANCE AND PATIENT DECLINED. NO EPINEPHRINE WAS ADMINISTERED OR APPROPRIATE BASED WITH PRESENT SYMPTOMS. I RECOMMENDED TO THE PATIENT TO BE EVALUATED AT HOSPITAL EMERGENCY DEPARTMENT BUT PATIENT DECLINED. PATIENT WAITED AND PRESENTED TO ME AT 8:25 TO 8:30PM AND RELAYED WAS FEELING OK ( TWO THUMBS UP) AND LEFT STORE WITH FRIEND.


VAERS ID: 1513903 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Immediate post-injection reaction, Lethargy, Loss of consciousness, Skin laceration, Skin warm, Somnolence
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: couldn''t remember which vaccine
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient immediately felt dizzy after receiving vaccination. Gave her a cold pack. That seemed to help. She moved to a different chair. Within 2 minutes she passed out and fell out of the chair which resulted in a gash on her forehead. Patient was unconscious and warm to the touch. Paramedics were called. She came to and knew who she was, where she was, but was very lethargic and groggy. Paramedics took her to the hospital for evaluation.


VAERS ID: 1513905 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 RA / IM

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

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

Write-up: No actual adverse event - patient received his first dose of moderna at a clinic when he shouldn''t have because he was underage. We completed series because no one would give him Pfizer since he had Moderna already and no where else would give him his Moderna 2nd dose because he was underage. His primary care provider is aware and we decided it was the best course of action to take for the patient so he could complete his COVID vaccine series.


VAERS ID: 1514044 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Nausea, Peripheral swelling, Swelling, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None at the time but is taking Oxycodone 15mg, methocarbamol 750mg, cimetidine 30mg, diclofenac gel 1%, losartan 100mg
Current Illness:
Preexisting Conditions: Lupus, other immune disorders
Allergies: Azathioprine, cefdinir, leflunomide, Elavil, Iodine contrast dye, vancomycin, Bactrim, duloxetine, belimumab, lactose, mycophenolate, rituximab, sulfas
Diagnostic Lab Data: BP taken by pharmacist when first started to feel chest tightness: 160/110mmHg, HR: 65bpm
CDC Split Type:

Write-up: After about 5-10 minutes after receiving the vaccine, patient stated that her arm started to feel like it was becoming swollen. Patient was monitored and Benadryl and EpiPens were prepared. Patient wanted to take the Benadryl and took 2 25mg caps. Patient had not eaten or drank anything prior to shot and water was provided. Pt became nauseas and described chest tightness and threw up both Benadryl caps as well as the small amount of water that she drank. BP ~160/110, HR: 65 after vomiting. EMS services arrived, and the patient was brought to the hospital for further evaluation


VAERS ID: 1514049 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

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

Write-up: The first dose of Covid 19 vaccine was Moderna on 1/7/2021 I attended my sencond dose on 7/29/2021 at facility but they gave me Pfizer vaccine, they gave me two different vaccines. I did not get the necessary information about which vaccine they gave me, although I showed them my previous vaccination card that said the first dose of Moderna vaccine, they did not check my information good and I got the Pfizer vaccine. I realized that until I got the paper of my second vaccination and asked them why I got different vaccine. They told me I could take another vaccine from Pfizer in 21 days, I took information from another pharmacy and they told me this was not possible since facility had given me the necessary information and they did not.


VAERS ID: 1514051 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Testicular pain, Testicular swelling
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Sexual dysfunction (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: Omega-3, red yeast rice, vitamin D
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: PCN
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Swelling and pain in left testicle''s vas deferens and epididymis. The swelling lasted approximately 6-10 hours.


VAERS ID: 1514053 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Patient made an appointment to received 1st COVID-19 vaccine, requested Pfizer. Upon processing the Pfizer vaccine later, received a third party block that patient already received other vaccine. Per online patient received Janssen vaccine on 3/22/21. PT VERIFIED VERBALLY AND IN WRITING THAT HAD NEVER RECEIVED A COVID-19 VACCINE prior to being administered the Pfizer vaccine. Pharmacist attempted to contact patient to discuss but kept being forwarded to voice mail. Canceled return vaccine appointment that patient made for 2nd Pfizer vaccine via email in scheduling system since additional vaccination does not meet current protocol guidelines.


VAERS ID: 1514055 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Eye movement disorder, Muscle rigidity, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), 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: sister-in-law told us he had a history of "fainting" with shots, but when questioned by EMT, she told them he had a history of
Other Medications: unknown
Current Illness:
Preexisting Conditions: History of seizures per sister-in-law
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had what appeared to be a seizure within 5 minutes of receiving vaccination. Per sister-in-law: he has a history of "fainting" with shots, but to me, it did not appear as a "fainting" episode since he became rigid and his eyes rolled back while he remained seated. 9-1-1 emergency services was called and patient was taken to the local E.R.


VAERS ID: 1514060 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / SYR

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

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

Write-up: The first dose of Covid 19 vaccine was Moderna on 1/7/2021 I attended my sencond dose on 7/29/2021 at facility but they gave me Pfizer vaccine, they gave me two different vaccines. I did not get the necessary information about which vaccine they gave me, although I showed them my previous vaccination card that said the first dose of Moderna vaccine, they did not check my information good and I got the Pfizer vaccine. I realized that until I got the paper of my second vaccination and asked them why I got different vaccine. They told me I could take another vaccine from Pfizer in 21 days, I took information from another pharmacy and they told me this was not possible since facility had given me the necessary information and they did not.


VAERS ID: 1514218 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

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

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

Write-up: Patient was vaccinated with dose 1 of COVID19 Pfizer shot. Stated non know reactions after other vaccinations. Patient left vaccination room, and walked back to pharmacy waiting area where his significant other was waiting for him. Upon sitting down he lost consciousness. I was in the vaccination room at the time, completing paperwork, when my technician, tech came to get me to come out to the patient. When I got out to the waiting room, patient was pale, but conscious and responding to me. Tech called paramedics. I had him lay on the ground until he felt ok to sit up. My technician got him some water to drink. He said this has happened once before on an ear piercing. Paramedics showed up within 5 minutes. I recounted what happened to one of the paramedics while the other took the patient''s vitals. Paramedics took him out to their truck for further evaluation.


VAERS ID: 1514234 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088DRR1A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Crying, Dizziness, Dyspnoea, Hypoaesthesia, Mobility decreased, Movement disorder, Nasopharyngitis
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Twenty minutes after I received the vaccine, I was home and started to feel dizzy, light headed, and numb. My body felt extremely cold and I had to sit in the car with the doors closed to feel hotter under the weather. I probably stayed in the car close to 10 minutes. Then, I went into the house and I started feeling waves of cold so I immediately went and sat in the yard for another 15 minutes. This was one of the worst times. I could not move my face, arms, fingers, or legs and I was literally crying and trying to breathe. There was a numbing sensation that stretched from my finger tips to my arms, legs, toes, and across the chest (like a "u" shape). I told my dad at the time to get the phone ready to dial 911 just in case. This was very similar but slightly worse reaction when compared to the first vaccine I got 28 days earlier. I moved back into the house and had to be under blankets for the next 10 minutes. It was very difficult because my entire body was numb, like it was locked up in one posture. After another 15 minutes, it started getting better but it felt like my heart had taken a pounding. Later this evening, I started feeling chills again with my teeth clattering. I had to go under blankets. I had my watch on and it said my HR was 80. I used my dad''s oxygen device and it said 97%. My heart felt heavy again, as if it had done a lot of work.


VAERS ID: 1514240 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Asthenia, Erythema, Oropharyngeal pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12 shot. Lisinopril.
Current Illness: N/A
Preexisting Conditions: HTN
Allergies: Pork
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives, anxiety, sore throat, redness, weakness,


VAERS ID: 1514548 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mono-linyah
Current Illness:
Preexisting Conditions:
Allergies: B. cephalosporins, and pre-med suggested for vancomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seemingly extreme pain in arm, where functionally lifting arm becomes impaired at certain angles and directions.


VAERS ID: 1514829 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Dyspnoea, Feeling hot, Musculoskeletal stiffness, Neck pain, Respiratory tract irritation
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Albuteral inhaler
Current Illness:
Preexisting Conditions: Asthma Thyroid condition Severe central cervical spinal stenosis & severe foraminal cervical stenosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 3-4 hours after receiving the shot I had stiffness and pain in neck , shoulders, upper back and chest. Also started feeling very hot but did not show fever on thermometer. Approximately 4 1/2 hrs after shot I started having a bit of difficulty breathing, and my lungs feel itchy like they do when I?m about to go into an asthma attack. It?s now approximately 7 1/2 hrs since shot and I still feel the same. Have taken albuteral inhaler one time when breathing started to feel difficult but the feeling in my lungs did not and still have not changed.


VAERS ID: 1514831 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Diarrhoea, Dyspnoea, Headache, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Dehydration (broad)

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

Write-up: Diarrhea, chest pain, fast heartbeat, shortness of breath, severe headache


VAERS ID: 1514835 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-14
Onset:2021-07-29
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood culture, Blood gases, Blood lactic acid, Cough, Dyspnoea, Exposure to SARS-CoV-2, Fibrin D dimer, Full blood count, Metabolic function test, Respiratory viral panel, Serum ferritin, Sick relative, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol inhaler PRN, Dulera 200mcg/formoterol 5mcg inhaler 2 puffs BID, fluticasone nasal spray, gabapentin 800mg tid, indomethacin 25mg TID, losartan 100mg daily, simvastatin 40mg daily, CBD+THC 3 drops per night
Current Illness:
Preexisting Conditions: HTN, COPD, seasonal allergy, hypothyroidism, hyperlipidemia,
Allergies: codeine - burning sensation
Diagnostic Lab Data: blood gas, D-Dimer, ferritin, Lactate, cbc, cmp, blood culture, resp panel upper, UA
CDC Split Type:

Write-up: 72yo female presenting to the ER complaining of sob and cough. ss x 1 day. +hx copd. patient states her family member was dx with covid 1 week ago. Chief Complaint: Visit CC: COVID, SOB SPO2 39% (SON positive covid at home)


VAERS ID: 1514839 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Additional Details: she is scared of needles and has history of dizziness after a blood withdrawl or after administration of a shot and didnt inform about it before administration of covid vaccine.she was little dizzy,laid her head over the chair for few seconds, but didnt loose consciousness-she is alert,blood pressure was normal-15/80mm Hg.we reached out to emergency services but we never used them as she is alright by then. called the pharmacy back after reaching home.


Result pages: prev   237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=336&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


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