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From the 9/10/2021 release of VAERS data:

Found 686,636 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 340 out of 6,867

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VAERS ID: 1481371 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: PCOS
Allergies: Mushrooms
Diagnostic Lab Data:
CDC Split Type:

Write-up: Period clotting and heavy period bleeding


VAERS ID: 1481383 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-12
Onset:2021-07-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA9100 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Facial pain, Hypoaesthesia, Neck pain, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None, Fifteen days ago, Rematex
Current Illness: None apparently
Preexisting Conditions: Not sure if it is considered chronic or genetic, but I try to take care of my diet because my cholesterol and triglyceride levels rise easily.
Allergies: Dairy food, animals, cats, dogs, dust, abrupt weather change, sunflower plant, epazote.
Diagnostic Lab Data: Not yet.
CDC Split Type:

Write-up: At 3am I had a horrible pain, I had never felt on the left side, as if went through my chest. A sharp pain that went all over my left arm, neck and face and after, a sharp cramp pain in the abdomen like colic. I took aspirin and had pain for half and hour, later it decreased but I still have mild pain, like when I exercise. Numbness in the face neck shoulder, arm and hand. Today I have an electrocardiogram and Monday with my doctor since being the weekend they do not have consultations.


VAERS ID: 1481388 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK AR / ID

Administered by: Other       Purchased by: ?
Symptoms: Oropharyngeal discomfort
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Calcium, Vit D Klonopin, Toprol, MVI, Crestor, Prozac, Coenzyme
Current Illness: none
Preexisting Conditions:
Allergies: PCN and Thimerasol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was in observation area after receiving Pfizer EW0185 7/17/21 Reaction reported by nurse at 9:19am after 4 minutes in observation area. Stated that her throat felt funny. Denies SOB denies need for EPI. Stated to Nurse that I only notice something when I swallow. Patient requested Allegra Vitals 9:19: 124/72 85 97% pulse ox room air 9:45: 116/63 75 97% pulse ox Had patient stay for 30 minutes after Allegra. Feeling better Nurse discussed with patient if symptoms increase- she will go to the ER. Patient is also sending her PCP a note in MYChart. Know allergies PCN Thimerasol, also allergic to Latex Also stated "allergic" to flu at 14 years of age. No other illness at time of vaccination Note: she conferred with her pcp about taking vaccine and her PCP had her see allergist who advised taking an antihistamine 5 days prior to vaccination which she did follow this protocol. Note: 4 weeks ago she received the Shingrex - which she had chills and low grade fever for 3 days. Scribed incident reported by Nurse


VAERS ID: 1481390 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-23
Onset:2021-07-17
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (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: Vertigo. Lasted 4 days.


VAERS ID: 1481395 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Gastrooesophageal reflux disease, Paraesthesia, Post-acute COVID-19 syndrome
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma Arthritis COVID-19 in April 2021 with diagnosis of COVID Longhauler
Allergies:
Diagnostic Lab Data: BP 138/82 manually Pulse 62 and regular RR 16
CDC Split Type:

Write-up: Patient described "bubbling in chest" relative to her GERD experiences as well as some tingling in bilateral arms. No dyspnea, diaphoresis, dizziness or chest pain reported.


VAERS ID: 1481405 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

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

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

Write-up: 17 year old given Moderna, not approved for that age group


VAERS ID: 1481410 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-01
Onset:2021-07-17
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO173 / N/A AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received first dose Moderna 5/24/21. Error received Pfizer in error


VAERS ID: 1481424 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Deafness, Dizziness, Heart rate irregular
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Hearing impairment (narrow), Vestibular disorders (broad)

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

Write-up: Patient felt light-headed, said she lost some sense of hearing, stomach was upset. Her blood pressure was 88/60, HR read irregular when measured manually. When EMTs arrived at 10:40 A.M., her BP was around 117/89, HR 91.


VAERS ID: 1481435 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immediate post-injection reaction, Pharyngeal swelling, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient with swelling of face, throat, Immediately after getting Johnson and Johnson COVID vaccine, improved with epinephrine.


VAERS ID: 1481442 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: When administering a pfizer shot using a vanish point syringe, the syringe retracted and the liquid ran down the patient''s arm instead of going into muscle. More than half the 0.3ml dose ran down the arm, so the shot was administered again with the 0.3ml dose with a new syringe in the same arm per patient''s request.


VAERS ID: 1481460 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Nausea, Retching, Syncope, Tremor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Nausea-Medium, Systemic: Vomiting-Mild, Additional Details: After injection was administered spoke with patient and mother about waiting the 15 minutes. Returned to pharmacist station, heard mother call out, patient was laying face first in floor, went to grab epi-pen. Mother said patient fainted, she said she thought it possibly could have been a seizure because her whole body shook before she fainted. Patient said she felt like she was going to vomit, grab a trash can and the patient dry heaved a few times. While this was going on tech called 911.


VAERS ID: 1481467 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hyperhidrosis, Loss of consciousness, Vision blurred
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), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: customer asked how felt was ok, gave covid-10 im sat for 2-3 minutes, fell off chair. pharmacist picked up patient patient woke(said not aware of falling out of chair and on floor) no injuries reported, noticed excessive sweating/said vision blurred/ bp normal(taken by rph). 911 called by front store. rph stayed with patient until emt arrival gave info as to events prior to theier arrival. emt came in and reported patient was ok and on there way home.


VAERS ID: 1481470 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 11D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LASIX 80, BUPRONORPHINE, ZOLOFT 50MG, MAG OXIDE, NYSTATIN POWDER, CLOTRIMAZOLE CREAM, CYCLBENAPRINE, MIRAPEX
Current Illness: ON DIAYSIS
Preexisting Conditions: SUFFERS FROM SPASMS, KIDNEY DISEASE
Allergies: ULTRAM, LATEX, STATINS, BENADRYL, HYDROCORTISONE, AMOXICILLIN, DILAUDID,
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT RECEIVED 1 COVID SHOT IN EARLY JANUARY FROM A DIFFERNT LOCATION. PHARMACIST UNAWARE OF THIS GAVE PATIENT OUR FIRST SHOT ON 6/16/21 AND 7/17/21 SO PATIENT RECEIVED TOTAL 3 DOSES. PASTIENT SIAD SHE WAS TOLD BY DOCTOR TO RESTART THE SERIES. NO ADVERSE REACTIONS NOTED


VAERS ID: 1481472 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1481489 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Blood pressure fluctuation, Feeling hot, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Patient stated he gets anxiety when getting any vaccinations or at the dentist office. Patient states he feels hot. He looked flushed and sweaty. His blood pressure at 12:48pm was 159/84. Two ice packs were used. One was placed on his neck while other one was used on his forehead. He was given couple of water bottle. Blood pressure was taken at 12:58pm 132/82. He stated ?I feel much better and this always happens to me when I get vaccinated? He was observed for additional 10 minutes.


VAERS ID: 1481491 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Hot, sweaty, and dizziness


VAERS ID: 1481498 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-07-17
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram, Condition aggravated, Haemorrhagic disorder, Surgery
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin, Symbicort, Albuterol, Escitalopram, Loratadine, Metoprolol, Pantoprazole
Current Illness: N/A
Preexisting Conditions: CAD, asthma, hemorrhagic CVA,
Allergies: NKA
Diagnostic Lab Data: CT
CDC Split Type:

Write-up: Second hemorrhagic CVA in 3 months since vaccine. Given KCentra and vitamin K. Going to surgery now.


VAERS ID: 1481505 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyskinesia, Dyspnoea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient felt faint a few minutes after injection. Patient fainted in chair, after 15 to 20 seconds he had some jerky movements and regained consciousness with a gasp. He lay on the ground for a few minutes and drank water I provided when he felt better. He ate a granola bar and left after 15 minute observation. Counseled mom on vasovagal syncope and prevention.


VAERS ID: 1481509 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / 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: no
Preexisting Conditions: no
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fainted at doorway. Got her into a chair and a few minutes later fainted again. Never lost consciousness.


VAERS ID: 1481513 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

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

Write-up: Pt experienced vasovagal syncope 5 minutes after receiving the Janssen Covid 19 vaccine. Pt became cool, pale, and clammy, and lost consciousness briefly. During this time, pt was breathing (moving adequate tidal volume) and maintained a radial pulse. Pt regained consciousness about 1 minute later, and vital signs were obtained. Pt had a heart rate of 56, breathing at 16 times a minute, moving adequate tidal volume with clear lung sounds. Pt was satting at 96% on room air, and when asked questions appeared fully oriented to person, place, time, and event. Pt had a blood pressure if 124/82, and pupils were 2 (L) and 3 (R) mm, and fully reactive to light. Pt states his pupils are irregular in size


VAERS ID: 1481515 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, 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: None
Current Illness: None
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient arrived at the pharmacy today, 7/17/2021, stated she received the second dose of Moderna yesterday morning, and this afternoon, has noticed red-spots/hives on arms and torso. Patient advised to take Benadryl and follow up with a Physician if worsens or continues.


VAERS ID: 1481518 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol HFA Fexofenadine 60mg
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt developed slight dizziness/light-headedness after receiving vaccine dose. This resolved on its own in 5 minutes. Pt did not complain of any other adverse reactions.


VAERS ID: 1481519 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on right side of face Low-grade fever


VAERS ID: 1481524 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypotonia, Pallor
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Syncope following flu vaccine approximately 2 years prior
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Manual Blood pressure, left arm 95/60, manual pulse 74 bpm.
CDC Split Type:

Write-up: Approximately 10 minutes following the injection, patient was in observation area when she became pale and slumped over in her chair. The vaccinating nurse, along with the help of her parents, lowered the patient to a supine position on the floor and I elevated her legs. . We applied ice packs to her neck and forehead and within 10 seconds, was able to respond appropriately to verbal stimuli. Approximately 10 minutes later, the patient felt well enough to sit up and drink water . We continued to monitor the patient for another 25 minutes until she felt well enough to stand. The patient was stable and discharged from the facility at 11:48 am in custody of her parents. The patient ambulated without difficulty. No further complaints of dizziness. Skin pink, warm and dry.


VAERS ID: 1481531 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Dizziness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Patient felt dizzy and stomach upset in 8 to 10 minutes after vaccination. Patient''s mother helped her to lie down on back on floor safely as she was vomiting. EMS summoned right away. Patient was conscious. EMS came on 11 minutes , checked patient vitals. Patient was feeling well and family decided to go home and follow up with PCP.


VAERS ID: 1481535 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Somnolence, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT WAS WAITING AFTER VACCINE AND PHARMACIST NOTICED HIM DROP HIS CELL PHONE ON THE GROUND AND HIS EYES CLOSE. PHARMACIST WENT OVER TO HIM TO SEE IF HE WAS RESPONSIVE. TOOK A LITTLE NUDGING AND THE PATIENT RESPONDED AND SAID "I JUST FELL ASLEEP." IT LOOKED LIKE MORE OF A FAINTING SITUATION THAN JUST NODDING OFF. PT DENIED FEELING DIZZY AND SAID HE WAS JUST TIRED. UNKNOWN IF IT WAS VACCINE RELATED OR NOT. PT MONITORED FOR ABOUT 40 MINUTES AND WAS FINE.


VAERS ID: 1481536 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 began complaining of dizziness after receiving Pfizer vaccine, while sitting in recovery area. Pt was pale and clammy to touch. Pt''s father stated that Pt did not eat anything today prior to coming in for vaccination. Pt was evaluated by staff, and given a bottle of water and a granola bar. Pt ate and drank what was provided, stated he felt better, and left clinic in care of his parents without further incident.


VAERS ID: 1481548 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 RA / IM

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

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

Write-up: Patient stated he received AstraZeneca back in February


VAERS ID: 1481550 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: psoriasis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: itching on left arm , pt taking Benadryl


VAERS ID: 1481553 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

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

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

Write-up: Patient revealed she received the AstraZeneca Vaccine back in February


VAERS ID: 1481556 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Feeling jittery, Heart rate increased, Pharyngeal swelling, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), 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: 33-year-old female who complained of throat tightness and shortness of breath about 15 minutes after receiving her first dose of pfizer Covid-19 vaccine. Patient was given one dose 0.3 ml epinephrine to the right thigh at 12:42PM on scene and EMS was called and arrived at 12:50 PM. Patient stated that her throat swelling felt moderately improved after administration of epinephrine, but that she felt jittery with a fast heart rate after administration of the epinephrine. Vital signs remained stable throughout the event. The patient was able to speak throughout the event. No loss of consciousness. No hives or angioedema noted. The patient was evaluated by EMS and was transferred to the ED.


VAERS ID: 1481560 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip swelling, Pharyngeal swelling, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Epilepsy, anemia, insomnia, Raynaud''s phenomenon, sleep apnea
Allergies: Latex, amoxicillin, propranolol, Naproxen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itching all over body. Swelling of the lips and throat.


VAERS ID: 1481565 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18020095 / 1 LA / IM

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

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

Write-up: Patient received the Janssen COVID-19 vaccine on 7/17/21 at roughly 4:35 pm and shortly after felt hot, sweaty, and faint. Patient was given apple juice and laid on the floor for several minutes before feeling much better. She was then able to leave on her own.


VAERS ID: 1481566 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NAUSEA/VOMITING
Other Medications: NOT KNOWN
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO KNOW ALLERGIES
Diagnostic Lab Data: NO
CDC Split Type:

Write-up: NAUSEA/VOMITING


VAERS ID: 1481568 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 1 LA / IM

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

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

Write-up: Patient received his first Moderna COVID vaccination and went and sat down in front of the pharmacy. About 5 minutes after his shot, a woman walking by heard him say he felt like he was going to pass out and caught him as he was falling out of his chair. Staff member heard the commotion and immediately got my attention. I instructed him to call 911 and went out to the patient. As I got to the patient he was beginning to regain consciousness. The woman said the patient had hit his head on the shelving that was behind the chair. I gave him some water and had him stay seated until EMS arrived. EMS checked him out and released him into the care of his family.


VAERS ID: 1481570 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dysphagia, Heart rate increased, Nausea, Palpitations, Presyncope
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: History of Present Illness: 13y/o male with no significant past medical history or allergies reports nausea following receipt of first dose Pfizer vaccine today. He reports associated pre-syncopal sensation, palpitations and minimal difficulty with swallowing. He denies shortness of breath, chest pain, swelling/numbness of the lips and tongue, vomiting, injection site pain/redness or rash. Physical Exam: VS- HR ~110 VS #2: taken by paramedic reportedly within normal limits and normal sinus rhythm Inspection: no redness, swelling or pain at injection site; no rashes. No tongue/lip swelling. Heart: increased rate, regular rhythm; radial pulse strong with increased rate Lungs: clear to auscultation bilaterally without adventitious sounds Plan: Patient was also evaluated by paramedics. After ~30min, the patient reported cessation of symptoms and was feeling much better. Paramedic informed patient and mother that he can be transported by ambulance to hospital or decline services. The mother and patient elected to decline transportation via ambulance to hospital as he was feeling much better. Patient and family left the site after his symptoms resolved.


VAERS ID: 1481577 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-17
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Libido decreased, Menstruation delayed, Non-consummation, Premenstrual syndrome
SMQs:, Fertility disorders (broad), Sexual dysfunction (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: Escilatopram 20mg daily
Current Illness:
Preexisting Conditions:
Allergies: Dairy, almond sensitivity
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have not had my period, should have come on the 11th-13th. I?m always regular, and not sexuality active. I have some mild pms symptoms . Also reduced sex drive.


VAERS ID: 1481580 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: pt felt light headed, dizzy,nausea, headache


VAERS ID: 1481582 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip pruritus, Oral pruritus
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: 10:11 about 25 minutes after 2nd Moderna shot patient stated mouth, tongue, lips feel itchy, breathing is fine, no swelling, no other symptoms , gave 50mg dose of Benadryl at 10:13am , pt stated feeling better after about 15 minutes, continued to watch/monitor for an hour , pt stated feelilng fine and appeared to be fine, boyfriend was with her , so she did not leave alone.


VAERS ID: 1481583 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Pain
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: Pravastatin 40 mg, CoQ10 200 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Excruciating headache, chills, body aches for 10 hours.


VAERS ID: 1481594 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 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: not known
Current Illness: none reproted
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was faint a few minutes after receiving the vaccine. She was lowered to the ground and regained consciousness almost immediately. airway was stable--no other adverse events. Patient was able to sit up and drink water. When she was comfortable, she was moved to a chair to recover. She continued to drink water as needed and was monitored by staff. No medication/other interventions were needed. When patient was comfortable and feeling better she was able to leave with her father without incident.


VAERS ID: 1481596 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Nausea, vomiting, dizziness, light headed


VAERS ID: 1481597 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PT STATED AFTER THE INCIDENT THAT SHE HAD FELT DIZZY BEFORE BUT NEVER PASSED OUT BEFORE, HOWEVER, SHE ANSWERED NO TO THE QUESTIO
Other Medications: VYVANSE, AVIANE
Current Illness: NONE LISTED
Preexisting Conditions: NONE LISTED
Allergies: NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PT WAS SEATED IN CHAIR WAITING FOR 15 MINS AFTER THE VACCINE AND HER MOM CAME TO GET ME JUST A FEW MINS AFTER SHE SAT DOWN AND SAID SHE PASSED OUT FOR A FEW SECONDS AND WOKE BACK UP. I PUT HER BACK IN THE IMZ ROOM, ASSESED HER AND ASKED FOR 911. SHE STATED SHE WAS FEELING BETTER AND DIDNT WANT 911 CALLED. I GAVE HER SOME WATER AND A COLD RAG AND FAN AND CALLED MANAGEMENT. SHE SAT IN THE ROOM FOR AN ADDITIONAL 30 MINS AND SAID SHE FELT FINE BEFORE SHE LEFT. I WILL FOLLOW UP WITH PT TOMORROW TO MAKE SURE SHE IS STILL DOING WELL.


VAERS ID: 1481599 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Flushing, Headache, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: non
Preexisting Conditions: asthma, mitral valve prolapse
Allergies: Tetracycline
Diagnostic Lab Data: about 10 minutes after her immunization , I noticed her face was flushed. I went to check on her and she said she was hot. I gave her an icepack and a bottle of water. Her symptoms continued to progress. She felt dizzy, got a headache and lips began to tingle. The ambulance was called. The EMT took her to the ambulance to assess her. Her husband then arrived and after 10 minutes they opted not to go to the ER in the ambulance but drove to the parking lot and monitored for symptoms for 20 more minutes
CDC Split Type:

Write-up: None stated.


VAERS ID: 1481601 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Crying, Headache, Limb injury, Myalgia, Nausea, Pain in extremity, Pyrexia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Left arm extremely sore (interfered with sleep, feels like a significant shoulder/arm injury). Extreme headache. General muscle soreness and joint aches and pains. Significant nausea. Pain going down left leg. Fever/chills. Curled up on couch sobbing from pain.


VAERS ID: 1481602 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Hyperhidrosis, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (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: vomiting
Other Medications:
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Less than 5 minutes after receiving the vaccine the patient began vomiting and sweating. After vomiting, sitting down with a cold compress on the forehead and a few sips of water the patient felt perfectly fine. Patient''s mother stated that this has happened with previous vaccinations and even doctors appointments. She believes it was more nerves than an actual reaction to the vaccine.


VAERS ID: 1481604 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site swelling, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Swelling on injection site 1 day after vaccine. Major pain when moving arm, almost unable to move in some directions due to pain.


VAERS ID: 1481609 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT SAID SHE FELT LIGHT HEADED THEN PASSED OUT ALMOST 2 TO 3 MINUTES AFTER RECEIVING THE VACCINE.


VAERS ID: 1481611 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate decreased, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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? No
Office Visit? No
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: pt slightly collapsed, paramedics called low heart rate and blood pressure


VAERS ID: 1481613 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 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: None
Current Illness: None
Preexisting Conditions: None that I know of.
Allergies: PCN
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderna COVID vaccine was administered to a 12 y/o child


VAERS ID: 1481615 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Patient received dose 1 of the Pfizer COVID vaccine (lot EW0191) at 1400. At 1425, patient and her mother approached RN reporting visible tremors in her left thumb, the same side that she received the vaccine. The Paramedic approached to assess and take vital signs. PHN brought over juice and goldfish. Vital signs: blood pressure 126/88, pulse 88, respirations 16, O2 96%. Patient reported she ate a meal before arrival at the vaccine site but only drank approximately 8oz of water at breakfast in the morning. Patient denied swelling, pain, numbness. PHN noted no swelling in the face. Patient maintained full range of motion of left arm and hand. PHN encouraged patient to follow up with provider and when to call 911. PHN offered Benadryl but patient declined. Patient reported an allergy to amoxicillin, medical condition includes PCOS, and medications include vitamin D and birth control pill. PHN encouraged patient to stay for 30 minutes from onset of symptoms. Patient drank juice and ate goldfish. At 1440, vital signs: respirations 16, blood pressure 132/84, pulse 84. Patient reported a decrease in symptoms. At 1445, patient left walking with steady gait, against medical advice.


VAERS ID: 1481619 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 - / IM

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

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

Write-up: Patient was given Pfizer for first dose and Moderna for second dose


VAERS ID: 1481622 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Hypoaesthesia oral
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Patient administered First Dose Covid Vaccine. 10 minutes into observation period, patient states she is having shortness of breath, increased heart rate, tongue numbness, and lip and mouth numbness. RPH Administered 25mg of liquid bendaryl to patient and called 911 for EMS/Paramedics. Patient was taken on stretcher to ER with father. Patient was alert and able to respond/talk to staff/paramedics at time of departure


VAERS ID: 1481623 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Contusion, Fall, Loss of consciousness, Pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No known
Current Illness: no
Preexisting Conditions: no known
Allergies: No known allergies
Diagnostic Lab Data: Recommended to be seen but they states he has no insurance and did not want to take him into the doctor.
CDC Split Type:

Write-up: approximately 24 hours post vaccine fainted. pt''s partner describes he was walking toward her and then suddenly fell to the ground "passed out cold" She tried to talk to him and at first he did not make sense but after few minutes was able to converse. Call to pharmacy was made about 3 hours after event and pt has recovered, main complaints were weakness and sore (bruised himself when falling).


VAERS ID: 1481626 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Following vaccination patient was dizzy and seeing stars. Moved patient to floor and checked blood pressure 118/68 heart rate 70. Patient did not faint and felt better. Observed patient and patient left with family member feeling fine and did not want further intervention.


VAERS ID: 1481629 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hyperhidrosis, Syncope, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (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: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced dizziness, fainting, sweatiness, and blurry vision 10 minutes after receiving the vaccine. Pharmacist asked patient to sit down and remove facial covering. Pharmacist took blood pressure, first reading was 104/56. Pharmacist offered patient water to drink and continued to monitor patient''s symptoms for 40 minutes. Pharmacist took another blood pressure reading and the results were 129/73. Patient stated he no longer feel dizzy or feel fainting. Patient''s father took patient home. Pharmacist called patient 2 hours after he left pharmacy. Patient stated he has severe headache. Pharmacist advised patient to take one Tylenol and eat some snack.


VAERS ID: 1481633 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

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

Write-up: Pt received first dose of Pfizer COVID-19 vaccine after already having completed vaccine series with Moderna COVID-19 vaccines on May 7, 2021 and 6/04/2021. Pt waited in observation area for fifteen minutes with no immediate adverse reactions observed or reported by patient while patient was in clinic. Dr. notified of incident by phone call.


VAERS ID: 1481636 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions: ASTHMA
Allergies: NONE
Diagnostic Lab Data: na
CDC Split Type:

Write-up: 14 year old received Moderna Covid-19 vaccine


VAERS ID: 1481643 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, Headache, Loss of consciousness, Moaning, Pallor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient received the Covid-19 vaccine (Moderna) at 1:05 PM. The patient had no history of any seizures or incidents post vaccination. About 7 minutes after receiving, while going to help a customer, my tech witnessed the patient get up from their seat, pass out, and hit their head on the concrete floor. My tech immediately called me over. The patient was moaning and not initially responding, but breathing. My tech turned the patient on their side and we removed the mask because we thought the patient was having a seizure. My tech held the patient''s head to prevent it from hitting anything else. I rushed to get the emergency kit and when I returned the patient was slowly starting to respond. I folded my white coat to place under the patient''s head. I asked the patient questions and made sure they could breath. I asked the patient how they were feeling and described what happened. With consent from the patient and wife we called 911. While waiting, we stayed with the patient who then requested to sit up. We had the patient stay laying down but the wanted to rotate to their back. We provided a cold compress to the patient as they stated their head was hurting. The patient was very pale and we provided water to the patient. The patient kept asking what happened and could not remember falling and hitting their head. We relayed this to the EMTs taking patient to the Emergency Room when they arrived who then took over care providing the patient a neck brace and taking patient out on a stretcher.


VAERS ID: 1481645 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oropharyngeal pain, Pruritus, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (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: Flu vaccine many years ago but no anaphylaxis just some itching. Discussed risks with patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After about 15 min of administration patient had tightening and soreness of the throat and itching all over her body. Patient was given oral Benadryl and stable after about 10 min with no worsening of symptoms but little improvement. Patient advised to see medical attention.


VAERS ID: 1481649 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (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: none
Current Illness:
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the Pfizer COVID vaccine (lot EW0191) at approximately 1625 in the Collaboration Room, to provide more privacy at patient''s request. Pharmacist vaccinated patient and remained with the patient for observation period. At 1630, the patient vomited and PHN approached to assess. Patient reported feeling hot and sweaty before vomiting, and relief after emesis. At 1632, vital signs: blood pressure 134/88, pulse 70, O2 97%, respirations 18. Patient reported having a similar reaction after receiving the 1st Pfizer dose and after the meningococcal vaccine. PHN noted no swelling or work of breathing. Patient reported a fear of needles. Patient did not follow up with his provider after the 1st dose of Pfizer COVID vaccine. Patient reported eating a full meal and drinking water throughout the day. PHN encouraged patient to follow up with provider and symptoms in which to call 911. Patient reported no allergies, medical conditions, nor medications. PHN offered patient Benadryl but patient declined. AT 1650, vital signs: blood pressure 122/80, O2 98%, pulse 80, respirations 16. Patient reported symptoms had resolved. Patient drank water offered by Pharmacist. Patient left walking with steady gait at 1703.


VAERS ID: 1481654 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 7590665385 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb discomfort, Muscle discomfort, Musculoskeletal discomfort
SMQs:, Rhabdomyolysis/myopathy (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: Thorne Basic Prenatal, Thorne Phosphatidyl Choline, Nordic Naturals DHA XTRA
Current Illness: common cold, root canal, sinus infection
Preexisting Conditions: None
Allergies: Iodine
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Heaviness in both calves that moved up to back of leg (specifically right leg and included slight localized discomfort in area of leg with prominent varicose veins), and now also feeling heaviness in the muscle along either side of the spine /back. Progression occurred over the course of about 45 minutes to one hour.


VAERS ID: 1481655 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Oropharyngeal pain, Palpitations, Pyrexia, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Fever for approximately 8 consecutive hours. Sweating, shivering, headache, sore throat, palpatations, and tachycardia. Fever ended, still have headache, sore throat.


VAERS ID: 1481666 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-09
Onset:2021-07-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: bio identical hormone cream daily per cycly (Willey Protocol)--estradial and protesgrone for menopause, citaplahgm 5 mg daily for aniexty. Vitamins d, c, b12- immune support multi and coQ10.
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Allergic to Sulfa based drugs. Previous reaction to a sulfa drug was extensive rash all over body.
Diagnostic Lab Data:
CDC Split Type:

Write-up: large red slightly swollen circle about 2.5 inches round appeared on arm. A bit tender to the touch. Not itchy at time of this report.


VAERS ID: 1481683 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / 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: Unknown
Current Illness: No known health conditions
Preexisting Conditions: None reported
Allergies: No Known Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s parents potentially lied about age stating it is 6/17/2009 instead of 9/17/2009 as reported by insurance. Therefore patient is age 11 not 12, which made them ineligible for Pfizer. This was known after the injection was provided.


VAERS ID: 1482060 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Myalgia, Pain in extremity, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Magnesium, Vitamin D, Vitamin B complex
Current Illness: Long term COVID
Preexisting Conditions: N/A
Allergies: Rocephin, Latex,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Some soreness on the left arm day of and the next day after the shot. 7/16 some muscle aches and really fatigued around 3:00p.m. On 7/17 fatigued, hand tremors and joint pain.


VAERS ID: 1482061 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Loss of consciousness, Malaise
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), Ocular motility disorders (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:
Other Medications: none
Current Illness: no
Preexisting Conditions: no
Allergies: no known allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient came up to rx counter stated he wasn''t feeling well his eyes rolled into the back of his head and he passed out we called 911 he was assessed and they recommended to not transport him since vitals were okay


VAERS ID: 1483714 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

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

Write-up: Systemic: blood on toilet paper after bowel movement-Mild


VAERS ID: 1483715 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 2 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: pt prone to fainting due to vagal-vasal response. she expected it, her mom was with her. she did faint for about 30-40 seconds and then came to.


VAERS ID: 1483716 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1483717 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Site: Redness at Injection Site-Medium, Systemic: Allergic: Rash Generalized-Medium


VAERS ID: 1483719 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache, Impaired work ability, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Light headedness, fever, muscle aches, headache. Began approximately 12 hours after dose was administered. Prevented returning to work or any strenuous physical activity?have not waned noticeably now 34 hours after vaccination.


VAERS ID: 1483721 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1483722 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1483723 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1483724 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 LA / IM

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

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

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


VAERS ID: 1483729 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Flushing, Hyperhidrosis, Injection site pain, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Weakness-Medium


VAERS ID: 1483730 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Immediate post-injection reaction
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Sexual dysfunction (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: left hand felt numb-Mild, Additional Details: light headed right after vaccine. offered and accepted water. observed her for 20minutes. left arm numb. mother was here. offered to call emergency services. pt said no. mother took her home for further observation. checked on her at 8pm. she was back to normal


VAERS ID: 1483737 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: not know
Allergies: not know
Diagnostic Lab Data:
CDC Split Type:

Write-up: When I lay down myself, I feel uncomfortable in lung, and feel a little bit of difficulty to breath.


VAERS ID: 1483738 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Vaccination of underage member (17 years 11 months old when the indications were for those age 18 and over). Immunization was well tolerated and permission was given by parent for administration.


VAERS ID: 1483756 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-07
Onset:2021-07-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Headache, Injection site pain, Muscle spasms, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 2nd vaccination on 7/6/2021@7pm On 7/7/2021 at 10am I began to feel achy, fevered and nauseous. By 12:00pm I was completely incapacitated with pain throughout my body, back and joints and injection sight arm. Extreme headache and both chills and fevered with vomiting . These symptoms subsided 8-10hrs later and had no symptoms the following morning 7/8/2021 and resumed normal work and activities. On 7/17/2021 @8:00am I felt some muscle spasms and pain in my left arm (injection site) by 10:00am I was completely incapacitated again with all of the listed symptoms above lasting through 11:00pm at which time they began to subside somewhat. Today 7/18/2021 I woke up to chills/fever, lower back pain, headache and general body aches and soreness. This continues at this time.


VAERS ID: 1483762 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Oral herpes, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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: PCOS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, body aches, fatigue, headache, cold sore


VAERS ID: 1483764 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: At 2:00 am following the shot I started having severe body aches. At approx 3:15 am I started having severe chills and my body couldn?t stop shaking


VAERS ID: 1483769 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Deafness, Dizziness, Feeling hot, Hyperhidrosis, Loss of consciousness, Muscular weakness, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (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), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Extreme heat, sweating, light-headedness, black spots/sight going, buckled knees, hearing gone in left ear and then both ears, unconsciousness-- told husband when I began sweating and getting light-headedness, he held my body weight and helped me to the ground safely, friend held my head, husband lifted legs until I regained consciousness, help escort me to a place I could sit down, EMT provided cold water bottle to wrists, cold cloth was provided, sat with legs elevated until feeling stable


VAERS ID: 1483779 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: NONE SPOKE WITH MOM, NOTHING REPORTED


VAERS ID: 1483792 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Feeling hot, Gait disturbance, Hyperhidrosis, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: After the shot was administered, patient was asked to sit for 15 minutes for monitoring. Within 5 min after administration, patient said she was feeling hot and sweaty. We provided patient with a cold bottle of water and ask her to take small sips. Also gave her ice pack to apply to get her to cool down. After few more minutes, patient stated that she was itchy and having burning feeling thru her body. We asked the mother to see if she would like us to call 911 but the child told the mother she will let us know if that was necessary. We asked her to sit longer at this point because of how she was feeling. Few more minutes passed by and patient was starting to feel a little better but the burning didn''t go away. She tried to take a walk with her mom in the store to see if she can shake it off, but returned after about 10 min stating that when she walks, the burning feeling is getting to be excessive in her feet. So I asked her to sit for few more min and said they are ok to leave when they feel comfortable but if condition worsens, they should go to ER. I told mom to keep very close eye on her and that she should lay down when she gets home. Next morning, I followed up with a phone call. Spoke to patient and she said everything seems fine now and that it started going away after few hours of administration.


VAERS ID: 1483804 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial paralysis, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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: Adderall, zolpidem, lexapro
Current Illness:
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Partial paralysis of face, tingling in cheek of face


VAERS ID: 1483830 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Extremely heavy menstrual flow - super absorbent leaking after 2 hours - Ongoing - currently day 2


VAERS ID: 1483870 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: Patient seemed fine at the time of injection, upon leaving his seat and walking into the store he became light headed, pupils dilated, and fainted on the floor. This was approximately 3 to 4 minutes after injection. He seemed almost immediately fine, vision fine, and was able to talk and drink water. Monitored for 30 minutes after and no other signs / symptoms during this time.


VAERS ID: 1483894 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: She got her 2nd Moderna vaccine at about 1515, then waited in the store for at least 15 minutes before leaving. Prior to getting her 2nd shot she expressed that she was worried about the side effects of the 2nd dose--especially the 24 hours of flu-like symptoms that are common. At about 1608 she called the pharmacy--shortly after getting home--saying she had tingling in the lips. I told her that could be a sign of an impending serious reaction. She took some Benadryl and called her daughter to come over to her house. I told her if it got any worse, or if she had difficulty breathing to call 911, or to even do that now to be extra safe. When we closed the pharmacy at 1900, I called her back. She said she had called and they came to check on her, take her BP, etc. She was feeling much better as of that call.


VAERS ID: 1483904 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Pt felt dizziness and fell on the ground but did not lose consciousness. Symptoms went away after 2 minutes. Pt was assisted to stand up, seated and observed for 45 minutes. Pt felt fine and he was sent home. Father declined going to emergency room.


VAERS ID: 1483906 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Insomnia, Muscle spasms, Myalgia, Neck pain, Palpitations
SMQs:, Rhabdomyolysis/myopathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pain Swelling at site Redness Warm to touch Headache Muscle pain Neck pain Anxiety Insomnia Heart palpitations Fatigue Cramping (foot)


VAERS ID: 1483943 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Ampicilin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: On the next day of the second shot of vaccination, a swollen spot appeared about a half inch from the injected spot. The swollen part was prominent and slightly pink. It was painful. The swollen part was about 1.25 inch in diameter in the afternoon, and 1.5 in the evening. The next day (today and the 2 days from the inoculation), the swollen part was not so prominent anymore, but it was spread out to 2 inches in diameter. And it had become itchier. I didn''t have this kind of adverse reaction when and after I got my first shot on May 22nd.


VAERS ID: 1483962 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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: FLECAINIDE
Current Illness: NONE
Preexisting Conditions: NOT DISCLOSED BY PATIENT
Allergies: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient felt dizzy right after the administration of the vaccine. She was asked to sit down and BP taken at that time was 139/99. Patient sat and drank some water and about 5 minutes later, BP was 135/95, and she said the dizziness improved a little. About 10 minutes later, patient said her hands were tingling and she felt nauseous. Patient was offered to drink and after a few sips, the nausea subsided. BP was retaken and it dropped to 125/94. Patient said she does not take any BP med but forgot to take her Flecainide dose for the evening. Patient claimed she felt much better after another 10 minutes and preferred to go home to lie in bed. Her husband accompanied her and said he would continue monitor her BP at home.


VAERS ID: 1483981 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: trazodone 100 mg, benztropine 1 mg, haloperidol 10 mg, mirtazapine 15 mg ,
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the covid Moderna vaccine on 05/14/2021 but was accidently/incorrectly given Pfizer covid vaccine on 07/17/2021 as her second dose. no reported adverse reaction occurred.


VAERS ID: 1483994 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratadine, pseudo ephedrine, saw palmetto, magnesium, potassium, vitamin C, vitamin B 12, multivitamin.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site pain, tiredness, headache, muscle pain, chills, joint pain, fever, injection side swelling, feeling unwell, hot flashes.


VAERS ID: 1484017 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: Fever, Chills, Body aches, Fatigue


VAERS ID: 1484046 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Dizziness, Warm sensation @ Injection Site


VAERS ID: 1484068 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Erythema, Headache, Menstruation irregular, Nausea, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Fertility disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: ? fever for about 24 hours, up to 38.5 ? chills ? headache/pain back of the head ? nausea ? menstruation started 8 days earlier (about 30 hours after the shot) ? swollen left upper arm, redness


VAERS ID: 1484085 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-17
Onset:2021-07-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (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: Vyvanse 10mg daily
Current Illness: No
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Metal taste in mouth that lasted for about 6 hours.


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