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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 356 out of 6,867

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VAERS ID: 1546052 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-10
Onset:2021-07-16
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM6950 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210720; Test Name: COVID-19 PCR test; Test Result: Positive
CDC Split Type: ESPFIZER INC202100987969

Write-up: Positive PCR 20Jul2021/Vaccination failure; Positive PCR; Headache; Rhinitis; This is a spontaneous report from a contactable physician downloaded from the WEB, regulatory authority number ES-AEMPS-951206. A 46 years old non-pregnant female patient received BNT162B2 (COMIRNATY, Formulation: Solution for injection) via an unspecified route of administration on 16Jan2021 (Lot number: EM0477) as Dose 1, single and via an unspecified route of administration on 10Feb2021 (Lot number: EM6950) as Dose 2, single both doses for Covid-19 immunization. The patient was not pregnant at time of vaccination. The patient''s medical history and concomitant medications were not reported. It was unknown if the patient had Covid-19 tested passed. The reporter stated that, the patient had symptoms since 16Jul2021, headache, rhinitis. Positive PCR 20Jul2021. The patient underwent lab tests and procedures which included SARS-CoV-2 test: positive on 20Jul2021. The outcome of the events was unknown. No follow-up attempts possible. No further information expected.


VAERS ID: 1546077 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-29
Onset:2021-07-16
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER9470 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Alanine aminotransferase, Alanine aminotransferase increased, Aspartate aminotransferase, Auscultation, Base excess, Basophil count, Blood bicarbonate, Blood bilirubin, Blood chloride, Blood glucose, Blood glucose increased, Blood osmolarity, Blood pH, Blood potassium, Blood pressure measurement, Blood sodium, Blood urea, Body temperature, COVID-19, COVID-19 pneumonia, Carbon dioxide, Chest X-ray, Ejection fraction, Eosinophil count, Erythroblast count, Fibrin D dimer, Fibrin D dimer increased, Gamma-glutamyltransferase, Gamma-glutamyltransferase increased, Haematocrit, Haematocrit decreased, Haemoglobin, Haemoglobin decreased, Heart rate, International normalised ratio, Investigation, Lymphocyte count, Lymphocyte count decreased, Magnetic resonance imaging, Mean cell haemoglobin, Mean cell volume, Monocyte count, N-terminal prohormone brain natriuretic peptide, N-terminal prohormone brain natriuretic peptide increased, Neutrophil count, Oxygen saturation, PCO2, PO2, PO2 increased, Platelet count, Prothrombin level, Prothrombin time, Red blood cell count, Red cell distribution width, SARS-CoV-2 test, Vaccination failure, White blood cell count
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Lack of efficacy/effect (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OMEPRAZOLE; ENALAPRIL/HYDROCHLOROTHIAZIDE; MANIDIPINO; LIXIANA; PROPRANOLOL; ARCOXIA; METAMIZOL [METAMIZOLE]; PARACETAMOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arterial hypertension; Cholecystectomy; Chronic heart failure II. Severe dilation of the left atrium); Hiatal hernia; Hysterectomy; Low back pain; Oophorectomy; Paroxysmal atrial fibrillation (first episode. CHADS2VASc 4. HAS-BLED 2.)
Allergies:
Diagnostic Lab Data: Test Date: 20210720; Test Name: APTT (T.Cefalina); Result Unstructured Data: Test Result:1.26; Test Date: 20210720; Test Name: APTT (T.Cefalina); Result Unstructured Data: Test Result:36.8; Comments: 36.8 sec; Test Date: 20210720; Test Name: ALT (GPT); Result Unstructured Data: Test Result:44.00; Comments: 44.00 U/L; Test Date: 20210720; Test Name: AST (GOT); Result Unstructured Data: Test Result:27.00; Comments: 27.00 U/L; Test Name: Cardiac auscultation; Result Unstructured Data: Test Result:arrhythmic, no murmurs; Test Name: Lung auscultation; Result Unstructured Data: Test Result:Bibasilar crackles; Test Date: 20210720; Test Name: excess bases in blood; Result Unstructured Data: Test Result:0.100 mmol/L; Comments: (-2.0--3.0); Test Date: 20210720; Test Name: Excess bases in extracellular line; Result Unstructured Data: Test Result:-0.200 mmol/L; Comments: (-2.0--3.0); Test Date: 20210720; Test Name: Basophils; Result Unstructured Data: Test Result:0.010; Comments: 0.0 10E3/microL; Test Date: 20210720; Test Name: Bicarbonate arterial; Result Unstructured Data: Test Result:23,800 mmol/L; Test Date: 20210720; Test Name: Standard bicarbonate; Result Unstructured Data: Test Result:24,500; Comments: Standard bicarbonate; Test Date: 20210720; Test Name: total Bilirubin; Test Result: 0.30 mg/dl; Test Date: 20210720; Test Name: Chloride; Result Unstructured Data: Test Result:104.00 mmol/L; Test Date: 20210720; Test Name: Glucose; Test Result: 145.00 mg/dl; Test Date: 20210720; Test Name: Calculated Osmolality; Result Unstructured Data: Test Result:287 mosm/kg; Test Date: 20210720; Test Name: arterial pH; Result Unstructured Data: Test Result:7,447; Test Date: 20210720; Test Name: Potassium; Result Unstructured Data: Test Result:4.50 mmol/L; Test Name: blood pressure; Result Unstructured Data: Test Result:100/60; Test Date: 20210720; Test Name: Sodium; Result Unstructured Data: Test Result:136.00 mmol/L; Test Date: 20210720; Test Name: Urea; Test Result: 43.00 mg/dl; Test Name: fever; Result Unstructured Data: Test Result:38 Centigrade; Comments: fever of more than 38?C.; Test Date: 20210720; Test Name: arterial TCO2; Test Result: 55.700 %; Comments: 55.700 vol%; Test Date: 20210720; Test Name: Chest X-Ray; Result Unstructured Data: Test Result:Cardiolmegaly. Infiltrate bilateral interstitial; Test Name: left ventricular ejection fraction; Result Unstructured Data: Test Result:normal; Test Date: 20210720; Test Name: Eosinophils; Result Unstructured Data: Test Result:0.1; Comments: 0.1 10E3/microL; Test Date: 20210720; Test Name: ERYTHROBLASTS; Result Unstructured Data: Test Result:0.00; Comments: 0.00 10E3/microl; Test Date: 20210720; Test Name: D-dimer; Result Unstructured Data: Test Result:600.0 ng/ml; Test Date: 20210720; Test Name: gamma-Glutamyltransferase; Result Unstructured Data: Test Result:43.00; Comments: 43.00 U/L; Test Date: 20210720; Test Name: Hematocrit; Test Result: 34.4 %; Test Date: 20210720; Test Name: Hemoglobin; Result Unstructured Data: Test Result:11.8 g/dl; Test Name: Heart rate; Result Unstructured Data: Test Result:65; Test Date: 20210720; Test Name: international normalized ratio; Result Unstructured Data: Test Result:1.74; Test Date: 20210720; Test Name: Brescia; Result Unstructured Data: Test Result:0; Test Date: 20210720; Test Name: SEIMC; Result Unstructured Data: Test Result:17; Test Date: 20210720; Test Name: Lymphocytes; Result Unstructured Data: Test Result:0.7; Comments: 0.7 10E3/microL; Test Date: 20210720; Test Name: Lymphocytes; Test Result: 8.8 %; Test Date: 20210215; Test Name: MRI; Result Unstructured Data: Test Result:disc and facet degenerative changes with; Comments: disc and facet degenerative changes with multiple possible bilateral root space commitments; Test Date: 20210720; Test Name: Mean Corpuscular Hemoglobin; Test Result: 28.5 pg; Test Date: 20210720; Test Name: Mean corpuscular hemoglobin concentration; Result Unstructured Data: Test Result:34.3 g/dl; Test Date: 20210720; Test Name: Medium Corpuscular Volume; Result Unstructured Data: Test Result:83.0; Comments: 83.0 fL; Test Date: 20210720; Test Name: Monocytes; Result Unstructured Data: Test Result:0.3; Comments: 0.3 10E3/microL; Test Date: 20210720; Test Name: Neutrophils; Result Unstructured Data: Test Result:6.5; Comments: 6.5 10E3/microL; Test Date: 20210720; Test Name: Neutrophils; Test Result: 84.9 %; Test Date: 20210720; Test Name: NT proBNP; Result Unstructured Data: Test Result:3233.00 pg/mL; Test Date: 20210720; Test Name: arterial o2 saturation; Test Result: 96.400 %; Test Name: Oxygen saturation; Result Unstructured Data: Test Result:93; Test Date: 20210720; Test Name: arterial PCO2; Result Unstructured Data: Test Result:34,500 mmHg; Test Date: 20210720; Test Name: Platelets; Result Unstructured Data: Test Result:153; Comments: 153 10E3/microL; Test Date: 20210720; Test Name: arterial PO2; Result Unstructured Data: Test Result:117,000 mmHg; Test Date: 20210720; Test Name: Activity prothrombin; Test Result: 43.0 %; Test Date: 20210720; Test Name: Prothrombin time; Result Unstructured Data: Test Result:20.5; Comments: 20.5 sec; Test Date: 20210720; Test Name: Red blood cells; Result Unstructured Data: Test Result:4.15; Comments: 4.15 10E6/microL; Test Date: 20210720; Test Name: RDW; Result Unstructured Data: Test Result:14.90; Test Date: 20210720; Test Name: COVID-19 PCR test; Test Result: Positive ; Test Date: 20210720; Test Name: Leukocytes; Result Unstructured Data: Test Result:7.65; Comments: 7.65 x10E3/microL
CDC Split Type: ESPFIZER INC202100987821

Write-up: Drug ineffective; COVID-19 PCR test Positive; COVID-19 pneumonia; arterial PO2 117,000 mmHg (90.0 - 100.0; Glucose 145.00 mg/dl (60.0 - 100.0); NT proBNP 3233.00 pg/ml (10.0 - 125.0); ALT (GPT) 44.00 U/L (6.0 - 40.0); gamma-Glutamyltransferase 43.00 U/L (6.0 -36.0); Lymphocytes 0.7 10E3/microL (1.2 - 4.0); Hemoglobin 11.8 g/dL (12.0 - 16.0); Hematocrit 34.4 % (36.0 - 46.0; D-dimer (immunoturbidimetry) 600.0 ng/ml (0.0 - 500.0); This is a spontaneous report from a contactable physician downloaded from the WEB, regulatory authority number ES-AEMPS-958609. An 85-year-old non-pregnant female patient received first dose of bnt162b2 (COMIRNATY, Solution for injection), dose 2 intramuscularly on 29Mar2021 (Lot number: ER9470) as single dose and dose 1 intramuscularly on 05Mar2021 (Lot number: ET1831) as single dose for Covid-19 immunisation. Medical history included, non-smoker: Arterial hypertension in tto. No Diabetes Mellitus. No dyslipidemia, Paroxysmal Atrial Fibrillation, first episode. CHADS2VASc 4. HAS-BLED 2, Mild Chronic heart failure. Normal left ventricular ejection fraction (LVEF). Severe dilation of the left atrium, Low back pain to study for Rheumatology, MAP (unknown meaning) and Rehabilitation. Patient had Hiatal hernia, cholecystectomy, hysterectomy and oophorectomy. Concomitant medications included omeprazole 20 mg once daily, enalapril maleate, hydrochlorothiazide (ENALAPRIL/HYDROCHLOROTHIAZIDE, 20/12.5 mg), mandipine 10 mg once daily, edoxaban tosilate (LIXIANA) 60 mg once daily, propranolol 10 mg at 0.5DF once daily (0.5-0-0), etoricoxib (ARCOXIA) as needed, metamizole (METAMIZOL) as needed and paracetamol as needed. The patient previously took paracetamol tramadol hydrochloride (ZALDIAR) and had intolerance. On 16Jul2021, the patient experienced COVID-19 pneumonia, Drug ineffective and COVID. The patient was hospitalized. On an unknown date, had arterial PO2 117,000 mmHg, Glucose 145.00 mg/dl, NT proBNP 3233.00 pg/ml, ALT (GPT) 44.00 U/L, gamma-Glutamyltransferase 43.00 U/L, Lymphocytes 0.7 10E3/microL, Hemoglobin 11.8 g/dL, Hematocrit 34.4 % and D-dimer (immunoturbidimetry) 600.0 ng/ml. Patient underwent laboratory tests included: Lumbar Magnetic resonance imaging (MRI) on 15Feb2021 resulted disc and facet degenerative changes with multiple possible bilateral root space commitments, rehabilitation (unknown meaning) for being a candidate for facet block vs RF roots, Blood tests included: arterial pH: 7,447, arterial PCO2: 34,500 mmHg, arterial PO2: 117,000 mmHg, Bicarbonate arterial: 23,800 mmol/L (22.0 - 28.0), Arterial O2 saturation: 96,400 %, arterial TCO2: 55.700 vol% , BEb (excess bases in blood): 0.100 mmol/L, BEecf (Excess bases in extracellular line): -0.200 mmol/L, SBC (Standard bicarbonate): 24,500 mmol/L , Glucose: 145.00 mg/dl, Urea: 43.00 mg/dl, Sodium: 136.00 mmol/L, Potassium: 4.50 mmol/L, Chloride: 104.00 mmol/L, total Bilirubin: 0.30 mg/dl, NT proBNP: 3233.00 pg/ml, ALT (GPT): 44.00 U/L, AST (GOT) 27.00 U/L, gamma-Glutamyltransferase: 43.00 U/L, Calculated Osmolality 287 mOsm/kg , Blood count: Leukocytes 7.65 x10E3/microL (4.0 - 11.5), Neutrophils 6.5 10E3/microL (1.5 - 7.5), Lymphocytes: 0.7 10E3/microL, Monocytes: 0.3 10E3/microL, Eosinophils: 0.1 10E3/microL, Basophils: 0.0 10E3/microL, Neutrophils: 84.9 % , Lymphocytes: 8.8 %, Red blood cells: 4.15 10E6/microL, Hemoglobin 11.8 g/dL), Hematocrit 34.4 %, Medium Corpuscular Volume (VCM) 83.0 fL, Mean Corpuscular Hemoglobin (HCM) 28.5 pg, Mean corpuscular hemoglobin concentration (HR.C.M) 34.3 g/dL, ERYTHROBLASTS 0.00 10E3/microl, ERITROBLASTS 0.0 /100 WBC, red cell distribution width (RDW) 14.90 %, Platelets 153 10E3/microL, Prothrombin time: 20.5 sec, Activity prothrombin: 43.0 %, international normalized ratio (I.N.R.): 1.74, activated partial thromboplastin time (APTT) (T.Cephalin): 36.8 sec, APTT RATIO (T.Cephalin): 1.26, D-dimer (immunoturbidimetry): 600.0 ng/ml, ECG: pending. Blood Pressure (BP): 100/60 Heart rate (HR): 65 Oxygen saturation (Sat O2): 93% collaborator, BHP (unknown meaning), normo colored, eupneic at rest, Cardiac auscultation: arrhythmic, no murmurs, Lung auscultation: Bibasilar crackles, Chest X-ray: It is compared with previous. Cardiolmegaly. Infiltrate bilateral interstitial. On 20Jul2021 COVID-19 PCR test: Positive. Patient was hospitalized on 23Jul2021 because of fever. It was reported that "the patient was diagnosed with covid 3 days ago, begins with symptoms a week ago (+7). Refers headache, mild cough, dyspnea, nausea without vomiting, soft stools, malaise and fever of more than 38 degree C. No thoracic pain. No other symptoms of interest. Patient went to the emergency room on 20Jul2021 and was treated with prednisone 30 mg 1 cp/ 24 hours from 20Jul2021 without improvement. Conclusion was Bilateral pneumonia COVID Brescia 0 SEIMC 17. The case was considered as serious as events COVID-19 pneumonia, Drug ineffective and COVID were life threatening and caused hospitalization. The outcome of the events COVID-19 pneumonia, Drug ineffective and COVID was not recovered and other events was unknown. No follow-up attempts possible. No further information expected


VAERS ID: 1546225 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE7010 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Influenza like illness
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: FRPFIZER INC202100966984

Write-up: intense flu-like syndrome; This is a spontaneous report from a contactable physician downloaded from the regulatory authority report number is FR-AFSSAPS-MP20215475. A 53-year-old male patient received the second dose of BNT162B2 (COMIRNATY; lot number: FE7010), intramuscular on 16Jul2021 (at the age of 53-years-old) at dose 2, single in the left arm for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was reported that the patient was considered to be at risk of developing a severe form of COVID-19 disease. On 16Jul2021, 4 hours after the second dose vaccination, the patient experienced intense flu-like syndrome for 3 days. The patient stopped work due to this. The reporter assessed the event as serious due to disability. Outcome of the event was recovered on 19Jul2021. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1546275 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-13
Onset:2021-07-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF0680 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Electrocardiogram, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cessation of smoking (Stopped smoking 3 years ago); Pneumopathy
Allergies:
Diagnostic Lab Data: Test Name: blood work; Test Result: Negative ; Comments: too negative, no inflammatory syndrome; Test Name: Electrocardiography; Result Unstructured Data: Test Result:Sinus rhythm, no repolarization problems; Comments: Sinus rhythm, no repolarization problems, except in V3R V4R
CDC Split Type: FRPFIZER INC202100967076

Write-up: Pericarditis sicca; This is a spontaneous report from a contactable physician downloaded from the Regulatory Agency-WEB, regulatory authority number FR-AFSSAPS-TO20215625. A 25-year-old male patient received BNT162B2 (COMIRNATY, solution for injection), intramuscular, administered in the left arm on 13Jul2021 (Batch/Lot Number: FF0680) as dose 1, single for COVID-19 immunisation. Medical history included cessation of smoking (stopped smoking 3 years ago), and pneumopathy. There were no concomitant medications. The patient experienced pericarditis sicca (hospitalization) on 16Jul2021. The event was described as: On 18Jul2021, the patient was transferred to the Emergency Room due to intermittent precordial chest pains for 5 days after the 1st dose of the Pfizer vaccine. This pain was accentuated by inspiration. No pericardial rubbing, no signs of heart decompensation. Electrocardiography (on an unspecified date): Sinus rhythm, no repolarization problems, except in V3R V4R. Probably dry pericarditis. Bloodwork (unspecified date): too negative, no inflammatory syndrome. Treatment included aspegic intravenous then per os (as reported). The patient was discharged on an unspecified date. The outcome of the event was not recovered. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1546315 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8813 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dysmenorrhoea, Gastrointestinal pain, Headache, Irritable bowel syndrome, Myalgia, Pelvic pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (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:
Current Illness: Irritable bowel syndrome
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC202100969312

Write-up: Irritable bowel syndrome aggravated; Period pains; Intestinal spasm; Headache dull; Muscle pain; Chest pain; Pelvic pain; This is a spontaneous report from a contactable consumer received from the United Kingdom''s Medicines and Healthcare products Regulatory Agency (UK-MHRA). The regulatory authority report number is GB-MHRA-EYC 00257157, Safety Report Unique Identifier GB-MHRA-ADR 25712253. A 27-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 parenteral on 15Jul2021 (Lot Number: FD8813) as single dose for covid-19 immunisation. Medical history included ongoing irritable bowel syndrome. Had not had an IBS flare up for years. The patient''s concomitant medications were not reported. The patient experienced pelvic pain on 16Jul2021, irritable bowel syndrome aggravated on an unspecified date, period pains on an unspecified date, intestinal spasm on an unspecified date, headache dull on an unspecified date, muscle pain on an unspecified date, chest pain on an unspecified date. Patient would be calling her doctor because she had had this pain in her pelvis since getting the vaccine. It had triggered her irritable bowel syndrome (IBS) and her periods were so painful now. She had not had an IBS flare up for years, but since the vaccine she was in pain, her intestines were spasming, she had a dull headache which had not left and her muscles hurt after use quicker than before. Been getting light chest pain too. Case was reported as serious, other medically important condition. Outcome of pelvic pain and headache were not recovered and the other events were unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1546474 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD5613 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenopia, Dizziness postural, Fatigue, Head discomfort, Headache, Hypomenorrhoea, Menstruation irregular, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Corneal disorders (broad), Fertility disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased; Suspected COVID-19 (Unsure when symptoms stopped)
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Negetive
CDC Split Type: GBPFIZER INC202100969492

Write-up: Period was on/off/Very unusual pattern; Light periods; Dizzy on standing; Fever; Tiredness; Eye tired; Fullness head; Headache; This is a spontaneous report from a contactable consumer (patient) received from the Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202107281418508680-IDTHV, Safety Report Unique Identifier GB-MHRA-ADR 25720459. A 38-year-old female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on 16Jul2021 (at the age of 38 years old) (Lot Number: FD5613) as dose 2, single for COVID-19 immunisation. Patient is not pregnant at time of vaccination. Medical history included lactation decreased, suspected COVID-19 from 19Jul2021 to an unknown date (unsure when symptoms stopped). Patient is not pregnant. Patient is not currently breastfeeding. Concomitant medications were not reported. The experienced headache on 16Jul2021, fever on 19Jul2021, light periods on 23Jul2021, dizzy on standing on 19Jul2021, fullness head on 17Jul2021, eye tired on 18Jul2021, tiredness on 19Jul2021. Period was on/off for a number of days. Very light when it did come on. Very unusual pattern for her (normally bleed heavy to light for 6/7 days). The patient underwent lab tests and procedures which included COVID-19 virus test: negative. Patient has not tested positive for COVID-19 since having the vaccine. Patient is not enrolled in clinical trial. Outcome of the events headache, light periods was not recovered; of the events fever was recovered; of the events dizzy on standing, fullness head, eye tired, tiredness was recovering; of the event period was on/off/very unusual pattern was unknown. This report was serious with seriousness criteria of medically significant. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1546754 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-07-16
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FB4555 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood lactate dehydrogenase, Blood lactate dehydrogenase increased, Blood sodium, Blood sodium decreased, C-reactive protein, C-reactive protein increased, Chills, Cough, Diarrhoea, Haemoglobin, Haemoglobin increased, Heart rate increased, Hyperhidrosis, Hypertension, Productive cough, Pyrexia, Renal pain, SARS-CoV-2 test, Spinal pain, Tremor, White blood cell count, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Hypertension (narrow), Chronic kidney disease (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Kidney stone
Allergies:
Diagnostic Lab Data: Test Date: 20210716; Test Name: Lactate dehydrogenase; Result Unstructured Data: Test Result:elevated; Test Date: 20210716; Test Name: Sodium; Result Unstructured Data: Test Result:decreased; Test Date: 20210716; Test Name: CRP; Result Unstructured Data: Test Result:elevated; Test Date: 20210716; Test Name: Hemoglobin; Result Unstructured Data: Test Result:elevated; Test Date: 20210718; Test Name: PCR; Test Result: Negative ; Comments: Nasal Swab; Test Date: 20210716; Test Name: White blood cell; Result Unstructured Data: Test Result:elevated
CDC Split Type: HUPFIZER INC202100955272

Write-up: Spine pain; Renal pain; High blood pressure; Diarrhea; Cough; Sputum discharge; Chills; High heart rate; Hand shaking; Sole sweating/ Palm sweating; General weakness; Subfebrile; Decreased Sodium; elevated hemoglobin; elevated white blood cell; elevated CRP; elevated Lactate dehydrogenase,; This spontaneous report received from the contactable consumer (patient) through COVAES. A 49-year-old female patient received the second dose of BNT162B2 (COMIRNATY, solution for injection) via an unspecified route of administration, administered in Arm Left on 25Jun2021 18:45 (Lot Number: FB4555) as dose 2, single and the first dose via an unspecified route of administration, administered in Arm Left on 21May2021 18:15 (Lot Number: FC3558) as dose 1, single; (at the age of 49 years old) for COVID-19 immunisation. Medical history included kidney stone from an unknown date and unknown if ongoing. Patient had no known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient was not pregnant at the time of vaccination. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Patient did not receive any other medications within 2 weeks of vaccination. Concomitant medications were reported as none. On 16Jul2021 06:00, patient experienced spine pain, renal pain, high blood pressure, diarrhea, cough, sputum discharge, subfebrile, chills, high heart rate, hand shaking, sole sweating, palm sweating and general weakness. Laboratory on 16Jul2021 06:00 results: elevated CRP (C-reactive protein), lactate dehydrogenase, white blood cell, hemoglobin and decreased sodium. The events resulted in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. Treatment of Azithromycin Sandoz 3x1, expectorant, bisoprolol (CONCOR) was given. Since the vaccination, the patient had been tested for COVID-19. On 18Jul2021, PCR (polymerase chain reaction) Nasal swab was negative. The outcome of the events was not recovered.


VAERS ID: 1546832 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-04
Onset:2021-07-16
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP2166 / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Neoplasm
Allergies:
Diagnostic Lab Data: Test Date: 20210713; Test Name: COVID-19 molecular test; Test Result: Negative ; Test Date: 20210716; Test Name: COVID-19 molecular test; Test Result: Positive
CDC Split Type: ITPFIZER INC202100980472

Write-up: vaccination failure; PRIVACY cluster. Positive molecular swab in patient vaccinated 11Feb and 04Mar. Asymptomatic; This is a spontaneous report from a contactable other healthcare professional downloaded from the Regulatory Authority-WEB IT-MINISAL02-763044 received via regulatory authority. An 86-year-old female patient received second dose of bnt162b2 (COMIRNATY, Lot number: EP2166, Expiration date: 31May2021) intramuscularly at left arm on 04Mar2021 as dose 2, 0.3ml, single as Covid-19 immunisation and first dose of bnt162b2 (COMIRNATY, Lot number: EJ6790, Expiration date: 31May2021) intramuscularly at left arm on 11Feb2021 as dose 1, 0.3ml, single as Covid-19 immunisation. The patient medical history included Neoplasm since 30Jan2001 and unknown if ongoing. The patient concomitant medication was not reported. On 16Jul2021, patient experienced "Positive molecular swab in patient vaccinated 11Feb and 04Mar, asymptomatic" and vaccination failure. The patient underwent laboratory investigation which included COVID-19 molecular test resulted: Negative on 13Jul2021 and Positive on 16Jul2021. Outcome of the event covid-19 was not recovered and vaccination failure was unknown. The final scope was determined to be the associated lot(s) of the reported lot EJ6790 and EP2166. A complaint sample was not returned. No related quality issues were identified during the investigation. There is no impact on product quality, regulatory, validation and stability. Regulatory Authority concludes that the reported defect is not representative of the quality of the batch and the batch remains acceptable. The Regulatory Authority process determined that no regulatory notification was required. The reported defect could not be confirmed. No root cause or CAPA were identified as the complaint was not confirmed.


VAERS ID: 1547260 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-05
Onset:2021-07-16
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY4834 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cough, Drug ineffective, Nasopharyngitis, Suspected COVID-19
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: PHPFIZER INC202101007744

Write-up: cough; cold; COVID-19 positive symptomatic; COVID-19 positive symptomatic; This is a spontaneous report from a contactable other health care professional. This is a report received from the Regulatory Authority. The Regulatory authority report number PH-PHFDA-300093990. A 25-year-old female patient received second dose of BNT162B2(COMIRNATY), intramuscularly on 05Jun2021, at 25-year-old, as single dose (Lot Number: EY4834) and received first dose of BNT162B2(COMIRNATY), intramuscularly on 15May2021, at 25-year-old, as single dose (Lot Number: EY4834) for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced COVID-19 positive symptomatic on 16Jul2021 08:00. The patient had cough and cold on 18Jul2021 10:00. The outcome of all events was recovered in 2021. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1555515 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE1573 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain upper, Coma scale, Electrocardiogram, Hyperhidrosis, Hyperventilation, Investigation, Loss of consciousness, Muscle contractions involuntary, Pallor, Peripheral swelling, Physical examination, SARS-CoV-2 test, Syncope, Tachypnoea, Troponin, Vaccination complication
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), COVID-19 (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: Medical History/Concurrent Conditions: Allergy to animal; Dyspnoea; House dust mite allergy; Pollen allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210716; Test Name: glasgow; Result Unstructured Data: Test Result:15; Test Date: 20210716; Test Name: ECG; Result Unstructured Data: Test Result:regular sinus rhytm; Test Date: 20210716; Test Name: Biology; Result Unstructured Data: Test Result:no inflammatory syndrome; Test Date: 20210716; Test Name: Physical examination; Result Unstructured Data: Test Result:regular heart sounds (BDC) without murmur; Comments: regular heart sounds (BDC) without murmur, normocardial, peripheral pulses felt; no dyspnea, eupneic on room air. Bilateral and symmetrical vesicular murmur (MV) with no added noise. Glasgow 15, no rash, no pruritus, no mucosal involvement.; Test Date: 20210716; Test Name: SARS-CoV-2 test; Test Result: Negative ; Test Date: 20210716; Test Name: troponin; Result Unstructured Data: Test Result:less than 2.3 ng/L
CDC Split Type: FRPFIZER INC202100973342

Write-up: Vaccination related malaise; loss of consciousness; fainting; Pallor / pale; involuntary contraction of hands & arms; Sweating attack / hyperhidrosis; Hyperventilation; Stomach ache; Feeling swollen /feeling of swelling of hands, fingers, stomach / impression of swollen fingers and belly; Feeling swollen /feeling of swelling of hands, fingers, stomach / impression of swollen fingers and belly; Tachypneic; This is a spontaneous report from a contactable consumer (patient''s mother) downloaded from a regulatory authority, regulatory authority number FR-AFSSAPS-PB20214817. A 14-year-old male patient received the first dose of BNT162B2 (COMIRNATY, solution for injection) intramuscular on 16Jul2021 (at the age of 14 years old) (Lot Number: FE1573) as dose 1, single for COVID-19 immunisation. Medical history included dyspnoea and multiple allergies to: pollens, dust mites, cat, dog; from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. 3 minutes after injection on 16Jul2021, the patient experienced malaise (vaccination related malaise) with very short loss of consciousness (couple seconds), fainting, pallor, involuntary contraction of hands & arms (midwife''s hands), sweating attack (hyperhidrosis), hyperventilation, stomach ache, feeling of swelling of hands, fingers, stomach (impression of swollen fingers and belly). After 1 hour of care in COVID center (with anxiolytic administration and breathing in plastic bag), patient was sent to emergency room for observation. According to the emergency room chart, Tachypneic and pale initially, recovered well when reassessed. Physical examination: regular heart sounds (BDC) without murmur, normocardial, peripheral pulses felt; no dyspnea, eupneic on room air. Bilateral and symmetrical vesicular murmur (MV) with no added noise. Glasgow 15, no rash, no pruritus, no mucosal involvement. ECG regular sinus rhythm. Biology, no inflammatory syndrome. Troponin < 2.3 ng/l. Duration of effect until recovery was reported as 3 Hours (as reported). Therapeutic measures were taken as a result of the events. The events vaccination related malaise, loss of consciousness, fainting were reported as serious, medically significant. The outcome of the events was recovered on 17Jul2021. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1557897 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-07-16
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram, Polymerase chain reaction
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210720; Test Name: PCR; Result Unstructured Data: POSITIVE; Test Name: CT scan; Result Unstructured Data: 50% of lung involvement
CDC Split Type: BRJNJFOC20210809189

Write-up: COVID-19; Protocol: VAC31518COV4007: a regulatory authority. Manufacturer Receipt Date: 02-AUG-2021 A clinical investigator reported that a 48 year old male experienced severe grade 4 COVID-19, and was hospitalized. The event occurred 16 days after COVID-19 Vaccine AD26.COV2.S was administered intramusculary for prophylactic vaccination. At the time of this event was not resolved. The action taken with COVID-19 Vaccine AD26.COV2.S was not reported. The patient''s weight, height, and medical history were not reported. On 30-JUN-2021, the subject was administered COVID-19 VACCINE AD26.COV2.S (suspension for injection, intramusculary, and batch number 4381227) 0.25 ml. The vaccination injection site was not reported. On 16-JUN-2021 (16 days after vaccination), the subject started to experience COVID-19 symptoms. On 20-JUL-2021, RT-PCR test for SARS COV-2 was positive. On 26-JUL-2021, the subject was admitted to hospital, projecting fever and dyspnea. Laboratory data (dates unspecified) included: CT scan (NR: not provided) 50% of lung involvement. The subject was on supplementary high flow nasal oxygen. He was treated with a possible bacterial pneumonia. The subject had not risk factors. On 28-JUN-2021, treatment medication included: tazobactam. Additional treatment medications (dates unspecified) included: dexamethasone, acetylsalicylic acid/caffeine/homatropine terephthalate/oxycodone hydrochloride/oxycodone terephthalate/phenacetin, and enoxaparin. At the time of this report, the subject had not recovered from COVID-19. Investigator''s causality assessment: The event of COVID-19 was not related to the vaccine, and not related to any device. Company causality assessment: The event of COVID-19 was not related to the vaccine.; Sender''s Comments: V0-COVID-19 VACCINE AD26.COV2.S -COVID-19. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: NATURE OF EVENT (ongoing pandemic).


VAERS ID: 1571449 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003654 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure measurement, Body temperature, Oxygen saturation
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LEVONORGESTREL/ETHINYLESTRADIOL ACTAVIS
Current Illness: Allergic reaction; Endometriosis; Pollinosis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Blood pressure measurement; Result Unstructured Data: 130 mmhg; Test Name: Body temperature; Result Unstructured Data: 36.5 degrees Celsius; Test Name: Oxygen saturation; Result Unstructured Data: 98-100 %
CDC Split Type: JPTAKEDA2021TJP067856

Write-up: Anaphylaxis (dry cough, erythema, wheals, closed sensation of pharynx, urticaria, respiratory discomfort, decreased blood pressure); This case was received via regulatory authority (Reference number: 2021TJP067856) on 27-Jul-2021 and was forwarded to Moderna on 05-Aug-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of ANAPHYLACTIC REACTION (Anaphylaxis (dry cough, erythema, wheals, closed sensation of pharynx, urticaria, respiratory discomfort, decreased blood pressure)) in a 20-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3003654) for COVID-19 vaccination. Concurrent medical conditions included Endometriosis, Pollinosis and Allergic reaction. Concomitant products included ETHINYLESTRADIOL, LEVONORGESTREL (LEVONORGESTREL/ETHINYLESTRADIOL ACTAVIS) for an unknown indication. On 16-Jul-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 16-Jul-2021, the patient experienced ANAPHYLACTIC REACTION (Anaphylaxis (dry cough, erythema, wheals, closed sensation of pharynx, urticaria, respiratory discomfort, decreased blood pressure)) (seriousness criteria hospitalization and medically significant). The patient was treated with EPINEPHRINE BITARTRATE (ADRENALINE [EPINEPHRINE BITARTRATE]) at an unspecified dose and frequency. On 27-Jul-2021, ANAPHYLACTIC REACTION (Anaphylaxis (dry cough, erythema, wheals, closed sensation of pharynx, urticaria, respiratory discomfort, decreased blood pressure)) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood pressure measurement: 130 mmhg 130 mmhg. On an unknown date, Body temperature: 36.5 degrees celsius 36.5 degrees Celsius. On an unknown date, Oxygen saturation: 98-100 % 98-100 %. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter considered ANAPHYLACTIC REACTION (Anaphylaxis (dry cough, erythema, wheals, closed sensation of pharynx, urticaria, respiratory discomfort, decreased blood pressure)) to be possibly related. Concurrent condition included Endometriosis, Pollinosis and Allergic reaction (details unspecified.) Concomitant product included Levonorgestrel/ Ethinylestradiol for endometriosis. As for the degree of the symptoms, vital signs were relatively stable at first, and symptoms were not considered as severe. However, the symptoms tended to be exacerbated, and there was a concern that symptoms would become more severe, so the patient was raced to the hospital. Treatment was taken with Adrenaline injection for adverse event, at an unspecified dose and frequency. On an unknown date patient was admitted to hospital for the events and on 17-Jul-2021, patient was discharged from the hospital. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reporter''s Comments: The event developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1578843 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF0900 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Electrocardiogram, Myocarditis, Troponin T
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: ECG; Result Unstructured Data: Test Result:ST elevations from the deep S on the leads; Test Name: troponin T; Result Unstructured Data: Test Result:1.69 ng/ml
CDC Split Type: DEPFIZER INC202100987797

Write-up: Myocarditis; This is a spontaneous report from a non-contactable consumer, downloaded from the WEB. The regulatory authority number is DE-PEI-202100144916. A 17-year-old male patient received bnt162b2 (COMIRNATY, Solution for injection), via an unspecified route of administration on 14Jul2021 at the age of 17 years old (Batch/Lot Number: FF0900, Expiration date: unknown) as dose 2, singe for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient previously received bnt162b2 (COMIRNATY) on 26Jun2021 (Batch/Lot number and Expiration date were unknown) as dose 1, single for COVID-19 immunization. On 16Jul2021, the patient experienced myocarditis, which led to hospitalization on an unspecified date and was also considered life-threatening. It was further reported that the patient had thoracic pain, and in the electrocardiogram (ECG) on an unspecified date, it showed ST elevations from the deep S on the leads. In laboratory diagnostics, troponin T was increased at 1.69 ng/mL on an unspecified date. The outcome of the event was unknown. The result of assessment of the relatedness of drug to reaction/event "myocarditis," by the source of assessment, PEI, was reported as "B. Indeterminate." Sender Comment: Affected person had thoracic pain, in the ECG ST elevations from the deep S on the leads. In laboratory diagnostics, troponin T increased (1.69 ng / mL). First vaccination received on 26Jun2021. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1584749 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-13
Onset:2021-07-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3318 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Abortion spontaneous complete, Headache, Pyrexia, Vaginal haemorrhage, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Termination of pregnancy and risk of abortion (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: Medical History/Concurrent Conditions: Drug allergy; Penicillin allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC202100991136

Write-up: Bleeding vaginal; Vomited; Headache; Low grade fever; Abortion spontaneous complete; This is a spontaneous report from a contactable consumer (patient) downloaded from the regulatory authority-WEB, regulatory authority number ES-AEMPS-956021. A 37-year-old female patient received bnt162b2 (COMIRNATY), dose 2 intramuscular on 13Jul2021 (Batch/Lot Number: FF3318) as DOSE 2, SINGLE for COVID-19 immunisation. Medical history included penicillin allergy and macrolide allergy. The patient''s concomitant medications were not reported. Historical vaccine included COMIRNATY dose 1 (lot number: FC5436) via intramuscular route on 22Jun2021 for COVID-19 immunisation. The patient was pregnant at the time of vaccination. The patient experienced vomiting, headache, low grade fever and and abortion spontaneous complete on 16Jul2021 with outcome of recovering; bleeding vaginal on 18Jul2021 with outcome of recovering. Further ADR description stated that the patient experienced abortion spontaneous two days after the administration of the second dose of the Pfizer vaccine being 8 weeks pregnant and with a perfect check up two days before the administration of the vaccine. The same day of the vaccine (as reported) she started with descents of fever, vomiting and a very bad headache. And 36 hours later the bleeding that ended up in an abortion spontaneous complete and its corresponding curettage. The patient reported that she became pregnant while taking bnt162b2. The patient was 8 weeks pregnant at the onset of the event. The pregnancy resulted in spontaneous abortion. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1585012 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-09
Onset:2021-07-16
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3143 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Abortion spontaneous
SMQs:, Termination of pregnancy and risk of abortion (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: FRPFIZER INC202100990330

Write-up: Early miscarriage; This is a spontaneous report from a contactable physician downloaded from the regulatory authority-WEB, regulatory authority number FR-AFSSAPS-LY20218522. A 43-year-old pregnant female patient received bnt162b2 (COMIRNATY), intramuscular, administered in Arm Left on 09Jun2021 (Batch/Lot Number: FC3143) as dose 2, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient previously received the first dose of bnt162b2 (COMIRNATY, lot AX7389) on 01May2021 at Arm Left for COVID-19 immunization and experienced maternal exposure during pregnancy. The patient''s last menstrual period was on 15Apr2021. On 16Jul2021, the patient experienced early miscarriage requiring aspiration. Age of gestation at exposure was 7 weeks. The mother was 13 weeks pregnant at the onset of the event (also reported as 11 weeks of amenorrhea). The mother was due to deliver on 20Jan2022. The pregnancy resulted in spontaneous abortion. The outcome of the event was recovered with sequel.


VAERS ID: 1674487 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-06
Onset:2021-07-16
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER1742 / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Back pain, Balance disorder, Blood test, Computerised tomogram, Feeling abnormal, Insomnia, Migraine, Pain in extremity, X-ray
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradoil
Current Illness: No
Preexisting Conditions: UTI Insomnia
Allergies: None
Diagnostic Lab Data: X-ray Cat scan Blood work
CDC Split Type:

Write-up: Left arm pain Left should pain Migraines Off balanced walking Foggy brain Pain in led foot Upper pain in back on left side Insomnia


VAERS ID: 1471824 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-08
Onset:2021-07-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0151 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adverse event following immunisation, Chest pain, Dyspnoea, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Epipen
Current Illness: None
Preexisting Conditions: None
Allergies: Peanuts
Diagnostic Lab Data: Observation. Treated with Acetaminophen 500mg QD PRN and Ketoprofen 2.5% Topical gel BD PRN
CDC Split Type:

Write-up: Youth developed sensation of shortness of breath and chest pain. He was admitted to a local hospital for observation overnight and diagnosed with musculo-skeletal pain post vaccination. No other diagnoses or abnormal findings.


VAERS ID: 1474248 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: SORE RIGHT ARM, TIREDNESS


VAERS ID: 1474288 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-07-15
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A. / 009D / 2 LA / SYR

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

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

Write-up: Some Chest pain in the middle @ 2:30 AM while sleeping . 06/25/2021


VAERS ID: 1474292 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

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

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

Write-up: A different mRNA vaccine product was inadvertently used for patients 2nd dose. Patient received Moderna for 1st dose and was given Pfizer for 2nd dose by mistake. No action was taken and patient, provider consulted, and patient given information from CDC website stating that she was still considered fully vaccinated 2 weeks after 2nd dose and that no further doses were recommended


VAERS ID: 1474294 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product administration error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin 20mg, Losartan 100mg, Chlorthalidone25mg, Sildenafil100 mg
Current Illness: None
Preexisting Conditions: Heart disease
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was administered 0.5 mL of air intramuscularly, instead of 0.5 mL of vaccine. Since he did not get the dose during the first injection, had to do the vaccine again. He did not seem bothered at all, so administered the vaccine again. This time vaccine was administered correctly. He stayed around the pharmacy to be observed for 15 minutes after the 2nd injection and then went home.


VAERS ID: 1474301 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Nausea, Pallor, 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), Hypotonic-hyporesponsive episode (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Healthy 14 year old male
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt faint, hand numbness/tingling, turned pale in color, nausea 15 minutes after receiving 1st dose of Pfizer COVID vaccine. Patient put head between legs and a cold compress on neck. Took blood pressure 20 minutes, 30 minutes, and 35 minutes after vaccination. Blood pressure range 93-102/62-68. Pulse range 76-104.


VAERS ID: 1474306 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

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

Write-up: PATIENT REPORTED TODAY AS HIS FIRST DOSE. PFIZER GIVEN. LATER STATED HE RECEIVED MODERNA BACK IN FEBRUARY.


VAERS ID: 1474342 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Nausea, Neck pain, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Patient got nauseated, blurred vision, sore neck, chills that would not go away. 911 called and ambulance transported


VAERS ID: 1474353 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood pressure 125/77 Temp 97.9 07/15/2021
CDC Split Type:

Write-up: Patient mistakenly given 2 doses of Pfzier vaccine on the same day. Administration error acknowledged immediately after injections were given. Patient was observed 45 minutes and sent home with instructions to take pain/fever reducer medication in case of any pain and/or fever. Patient is to return with any problems and/or follow up as needed. Patient showed no symptoms, reactions, or signs of distress.


VAERS ID: 1474356 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

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

Write-up: Patient received first Moderna shot in left arm, and then about 5 minutes later passed out. She then started convulsing and then passed out again. This all happened over a span of about 2-3 minutes. She woke up and I gave her water, crackers, a wet towel for her head and an ice pack. She sat there for about 30 minutes and then said she was well enough to leave. Patient stated that she normally will pass out after being vaccinated, but states she has never convulsed before until now. Patient also stated she had not eaten anything that day prior to receiving the shot.


VAERS ID: 1474360 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip swelling, Pharyngeal swelling, Throat irritation
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patients started out with an itchy throat. We offered two benandryl and water. when we rechecked on pt. said her throat felt swollen. her lips felt swollen also. called 911. we waited with patient to monitor until ambulance got here. offered epi pen. pt denied epi pen. offered to call family member for patient also. EMT arrived very quickly. Patient left with ambulance. pt was still alert.


VAERS ID: 1474375 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-02
Onset:2021-07-15
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O5OC21A / 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? 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: KNDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient is only 14 years of age, he was given the Moderna vaccine at a pharmacy/store, yet it is not approved for anyone under 18 years at this time.


VAERS ID: 1474392 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Eyelid rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: PATIENT CAME TO THE PHARMACY ON 7/14/21 TO REPORT THAT HER RIGHT UPPER EYELID IS RED AND SWALLEN AND ON 7/9/21 HER PHYSICIAN TOLD HER ON VIDEO CONSULTATION THAT IS AN ALLERGIC REACTION TO THE COVID-19 VACCINE. PATIENT DID NOT SEEK ANY MEDICAL ATTENTION, SHE WAITED UNTIL 7/12/21 FOR HER PHYSICIAN TO MAIL HER EYE DROP (TOBRAMYCIN/DEXAMETHASONE). PATIENT STARTED TREATMENT ON 7/12/21. ON 7/14/21 WHEN PATIENT CAME TO THE PHARMACY TO REPORT THE INCEDENT, SHE WAS ALREADY GETTING BETTER.


VAERS ID: 1474406 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Defaecation urgency, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (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: Pt feeling light headed, nauseous, urge to empty bowel. Speaking clear sentences. Provider rec. pt to continue observation for 30 min Denies, CP, SOB, HA, palpitations


VAERS ID: 1474424 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness postural
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: N/A
Current Illness: Marfan syndrome
Preexisting Conditions: Marfan syndrome
Allergies: N/A
Diagnostic Lab Data: V/S
CDC Split Type:

Write-up: Patient refers dizziness after standing up from observation area. Approximately 25 minutes after vaccination. V/S WNL


VAERS ID: 1474432 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient reported same event occurred after he received HPV vaccine.
Other Medications: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately after IM administration of vaccine, patient lost consciousness and seemed to be seizing while seating in his chair. Patient regained consciousness within the same minute. Pharmacy manager was immediately called over. We gave the patient water and had him wait for observation for 30 minutes post vaccine administration. Patient mentioned that he had similar syncope episode after receiving HPV vaccine.


VAERS ID: 1474433 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Dizziness, Fatigue, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: estratest, multi-vits,zolpidem,tizanidine,ritalin,effexor
Current Illness: none
Preexisting Conditions: fibro,depression,post covid fatigue,cfs,back pain
Allergies: sulfa tramadol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue,dizziness, joint and muscle pain,sore arm


VAERS ID: 1474436 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-12
Onset:2021-07-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Respiratory tract congestion
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: Unknown.
Current Illness: Unknown.
Preexisting Conditions: Unknown.
Allergies: Unknown.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Client called clinic 7/15/21 complaining of congestion, headache, and fatigue. Client states he expected to have these symptoms but now his family is exhibiting the same symptoms. Client was wondering if he passed his symptoms to his family. Client was educated that he cannot pass his symptoms from his COVID shot to his family, but that his family probably picked up a cold around the same time he received his vaccine.


VAERS ID: 1474444 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-26
Onset:2021-07-15
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Bronchitis, Chest X-ray normal, Chest pain, Condition aggravated, Dyspnoea, Fatigue, Headache, Injection site mass, Muscle spasms, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, De3 Dry Eye Omega Supplements with Vitamin D, Echinacea
Current Illness: Sinusitis
Preexisting Conditions: Sinusitis Migraines Low Vitamin D Intermittent Shortness of Breath
Allergies: none Seasonal allergies
Diagnostic Lab Data: Chest Xray on 02/22/21. - Normal
CDC Split Type:

Write-up: The night of the vaccination, i developed a headache and my arm was very sore. By the next morning, my left arm was very painful and I developed a large lump, almost the size of a golf ball at the injection site. I started to feel fatigue and bronchitis coming on. By day 3, extreme fatigue, shortness of breath, headache, painful left arm. Regular albuterol inhaler was not helping at all. I made an appointment with my Dr because I was afraid of getting the second dose of the vaccine if it would make my symptoms worse. I was prescribed a stronger inhaler, which helps a bit, but still have shortness of breath and fatigue. The painful lump in my arm shrunk in size very slowly and is now (6 months later) about the size of a pea. It hurts now only if I touch or bump it. I have since developed occasional pain/cramps in my legs, chest, torso which had me worried about blood clots at first.


VAERS ID: 1474462 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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), 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, Additional Details: PATIENT FAINTED A COUPLE OF MINUTES AFTER RECIEVING PFIZER VACCINE; WHILE SITTING IN THE CHAIR, HE SLID OFF & HIT HIS HEAD ON THE OPPOSITE CHAIR. DID NOT FULLY LOSE CONSCIOUSNESS. NO EPIPEN NEEDED, EMS CALLED & NORMAL VITALS. PATIENT REFUSED TREATMENT/HOSPITALIZATION.


VAERS ID: 1474472 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1062 / 2 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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Given 4 days early.


VAERS ID: 1474475 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Fall, Head injury, Moaning, Nervousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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: none reported
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: cats/ cat hair, lactose intolerance and/or allergy
Diagnostic Lab Data: All on 07/15/2021: HR: 47 O2Sat: 97 Temperature: 97.2 F
CDC Split Type:

Write-up: Patient fainted momentarily and fell to the floor from seat. Patient was breathing and groaning before being flipped face-up. Patient was sat upright on the floor and was alert and awake within one minute. Mild impact to right forehead on fall with slight bruising. Suspected vasovagal syncope. ED called, but patient declined ambulance transport to hospital for further help/examination/treatment. Patient stayed at pharmacy for extended amount of time for observation and in order to calm nerves. Patient called friend/family for transport from pharmacy.


VAERS ID: 1474476 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Patient passed out around 5 minutes past dose. He did not have a complete loss of consciousness. Lowered him to floor, elevated legs, and slowly lowered head to ground. complained of being cold, had shivers, and complained of ringing in the ears and nausea. once resolved, sat him up and observed again. around 30 minutes past vaccine had a second fainting spell, to which called 911 for observation. Patient completely resolved and left with mom and EMS walked him to her car.


VAERS ID: 1474477 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu shot
Other Medications: Dexilant
Current Illness: chronic cough
Preexisting Conditions: chronic cough, SVT, RBBB, diverticulitis, uterine fibroids, Anemia, vocal cord polyps, acid reflux.
Allergies: codeine, sulfa,penicillin, mercury,bactrim, mushrooms
Diagnostic Lab Data: 911 called, EMT arrived. given 25mg of benadryl by nurse at covid vaccine clinic.
CDC Split Type:

Write-up: got hives within one to two minutes after getting shot on bright arm then minutes later left arm


VAERS ID: 1474480 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I gave the patient a Pfizer COVID-19 vaccine after confirming the patient had not received any previous doses of the vaccine verbally and from the consent form. After processing the vaccine, I could see that they had already gotten a Moderna COVID-19 vaccine from another pharmacy on 4/20/21. The patient denies getting the Moderna vaccine.


VAERS ID: 1474481 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Oral pruritus, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hx of Ibuprofen
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Morphine, ''Other Pain Medications'', Sulfa
Diagnostic Lab Data: Pt sent with family to nearby ER.
CDC Split Type:

Write-up: Rash to upper torso and neck, itching from rash and in mouth. Pt received vaccine at 11:55 and started having a reaction by 12:30.


VAERS ID: 1474488 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Vertigo
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit D Vit B12
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vertigo, headache


VAERS ID: 1474492 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Pt passed out for a couple seconds


VAERS ID: 1474495 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, Patient uncooperative
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: Originally tried vaccinating patient using their left arm. Patient moved arm during vaccine administration and more than half of vaccine did not enter patient''s arm. Re-dosed using right arm with new dose with no further problems.


VAERS ID: 1474497 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-01-26
Onset:2021-07-15
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: No adverse 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: Atorvastatin calcium 80 mg tab Lisinopril 5 mg tablet Fluticasone prop 0.05 mg/1 actuation spr Sodium chloride 0.65% sol (ocean) 1 spray Venlafaxine hydrochloride 75 mg tablet Aspirin 81 mg tab Plavix 75 mg tab Humalog 100 u/1 ml sus
Current Illness: Age-related physical debility Type 2 diabetes mellitus Muscle weakness (generalized) 2019 -nCov acute respiratory disease (last year)/recovered
Preexisting Conditions: Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side Encounter for palliative care Altered mental status Dysphagia Paroxysmal atrial fibrillation Acute kidney failure, unspecified Abnormal levels of other serum enzymes Acute cystitis without hematuria Chronic respiratory failure Encephalopathy, unspecified Cerebral infarction, unspecified Cardiac arrhythmia, unspecified Non-ST elevation (NSTEMI) myocardial infarction Peripheral vascular disease, unspecified Chronic ischemic heart disease, unspecified Manic episode without psychotic symptoms, unspecified
Allergies: Naproxen, Clarithromycin, Nonsteroidal anti-inflammatory drug, Macrolide, Macrobid, Metformin, Biaxin
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: No Adverse Events noted


VAERS ID: 1474500 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Individual takes medications for Multiple sclerosis, cholesterol, and for borderline DM2
Current Illness: None
Preexisting Conditions: Multiple Sclerosis, DM2, Hypercholesterolemia
Allergies: None
Diagnostic Lab Data: ---
CDC Split Type:

Write-up: 15 min after getting her vaccine, individual felt lightheaded. HR:60/min, BP 120/60. @ 13:05 pt. ate a protein bar (she didn''t have breakfast), individual also drink plenty of water. Pt states she feels better. 1310PM pt called her ride to be picked. Pt left the facility at 13:30, asymptomatic.


VAERS ID: 1474509 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH T026167 / 1 LA / IM

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

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

Write-up: Patient was here for 2 nd Covid Vaccine. She did not bring her vaccine card with her but she stated she got Pfizer vaccine. She also completed Consent Form and marked "Pfizer" vaccine to be administrated. Therefore, she received a Pfizer vaccine today. However, we found out that she received Moderna as a 1st dose 4 weeks ago. I reported and spoke with State Covid hot line and CDC hot line representative. I was told she is considered as fully vaccinated and no further vaccine needed at this time. Patient was informed about this event and verbalized understating. Patient was monitored for another 20 mins at clinic and there was no adverse reaction.


VAERS ID: 1474538 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Ageusia
SMQs:, Taste and smell disorders (narrow)

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

Write-up: Loss of taste


VAERS ID: 1474543 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / UNK LA / IM

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

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

Write-up: Patient became lightheaded, dizzy, nauseous, and she felt hot about 10 minutes after vaccine administration. Dr. was brought in the exam room to assess the patient. Dr. brought patient over to exam table and had her lying supine. Patient was given pretzels and 2 cups of water. Patient was lying supine for about 1.5 hours with no improvement. Patient was driven to Hospital Emergency Department by her father, for further evaluation and possible IV fluids.


VAERS ID: 1474547 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Erythema, Hyperhidrosis, Loss of consciousness, Malaise, Memory impairment, Musculoskeletal stiffness, Pallor, Vision blurred, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: patient received J & J vaccine at 1050 am patient was talking with nurse and suddenly stiffened his body with clenching fists curled upward to chest. He had bright red skin color, and could not speak. this lasted 10 seconds at most. Afterward the patient was sitting in chair had turned very pale and did not realize what had happened. one of the other nurses asked him if he knew where he was, he stated "In the Hospital", the nurse repeated that he was not in hospital, that he was at the health department getting a Covid shot. He stated "oh yeah.. I forgot," patient stated he was going to be sick, patient grabbed garbage can that was sitting next to him Patient was hooked up to oximetry, reading was 99% on RA, attempted Blood pressure 3 times but was unable to attain a reading, patient was holding garbage can tightly. patient had emesis 3x''s that was clear in color, cold packs were placed on the nape of the neck and under armpit, patient was sweating and white in color. patient stated he had blurred vision, and noted that he was unconscious for approx. 25-30 seconds. 911 was called at 10:57. Nursing supervisor was notified at 10:58. Patient stated that he had nothing to eat today, and his mother stated that he had been anxious about getting the vaccine and that she made her son get it. Epinephrine was available but not given. no issues with breathing. EMS came in did a quick evaluation and transported patient to the hospital. Mother was with patient during the entire incident.


VAERS ID: 1474570 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cyanosis, Injection site pain, Injection site swelling, Peripheral coldness, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (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: Internal Baclofen Pump, Zofran, Flexeril, Amlodipine, Hydrocodone Acetaminophen, Fluorouracil, CBD gummy, Albuterol. Levalbuterol, Atrovent, Fiberon, Nasacort, Folic Acid, Voltaren, Vitamin B & D, Biofreeze, Lidocaine Patch, Multivitamin
Current Illness: Pancreatitis, Bell''s Palsy
Preexisting Conditions: Cerebral Palsy, Asthma, Hypertension
Allergies: Aspirin and Shellfish (anaphylaxis), Penicillin (rash)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 50-year-old female while in observation presented with c/o localized burning and swelling on the left arm at the site of injection approximately 5-10 minutes after receiving the first dose of Pfizer. EMS was alerted and patient was then evaluated and observed. Patient''s left upper arm continued to swell to her hand and fingers which then progressed to a bluish tint and feel cold to the touch. Patient was recommended to be transported and evaluated further Hospital. Initial Vitals: HR- 74; BP- 183/105; O2 Sat- 98%; RR 22; Discharge Vitals: HR-75; BP- 142/88; O2 Sat-96%; RR-16


VAERS ID: 1474600 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest 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? 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: Approx. 10 minutes after receiving the vaccine, patient started having SOB and chest tightness. Patient has a h/o asthma when she was a child. Patient said that it felt the same as when she was a little girl when she was having an asthma attack. Dr. was brought into the room to assess the patient. Patient was given 2 puffs of a VentolinHFA with improvement.


VAERS ID: 1474602 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patients states he takes no medications.
Current Illness: none
Preexisting Conditions: Keratoconus
Allergies: NKA
Diagnostic Lab Data: Patient has yet to seek treatment, but has been advised to seek emergency treatment immediately.
CDC Split Type:

Write-up: Patient received first dose of Moderna COVID-19 vaccine on 7/15/21 at approximately 0900 by this RN. Patient reported NKA or conditions that may contraindicate receiving vaccine. After vaccine administration, patient was observed by this RN for fifteen minutes. Prior to leaving patient stated he felt fine and appeared to be in no apparent distress upon departure. At approximately 15:30, patient called stating he had been experiencing blurred vision since approximately "10:30 or 11:00 that morning" and wonders if he should seek medical attention. This RN encouraged patient to seek immediate medical attention. Patient reports a chronic medical condition called Keratoconus. Patient denies any other medical problems or allergies. Patient states he will seek immediate medical attention at the local ER or an urgent care. Patient encouraged to call back if needed by this RN.


VAERS ID: 1474604 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-03-12
Onset:2021-07-15
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood iron, Hepatitis acute, Liver function test increased, Ultrasound abdomen
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Biliary system related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor ER 25 mg, propanolol ER 60 mg, ipratropium 0.03% nasal spray
Current Illness: none
Preexisting Conditions:
Allergies: NSAIDS, Penicillin, shellfish
Diagnostic Lab Data: iron, ferritin, acute hepatitis and hepatic function panel taken June 14, 2021 US abdomens, right upper quadrant, June 14, 2021 Hepatic function panel July 12, 20201 H Pylori, IGM, IGG, IGA Labs
CDC Split Type:

Write-up: Hepatic function levels high during preventative care bloodwork, Alkaline Phosphatase 232 U/L AST 95 U/L ALT 104 U/L


VAERS ID: 1474618 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Anxiety
SMQs:, 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: "Predisone shot" (per patient)
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 30 minutes after injection, employee had an anxiety attack. States he has not had anxiety attacks for awhile and has not been on any medication for them. States he had an anxiety attack after receiving a Predisone shot. BP, pulse, respirations, and oxygen saturations were all WNL. Employee was allowed to rest and was released after approximately 30 minutes.


VAERS ID: 1474627 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Depressed level of consciousness, Dyskinesia, Hyperhidrosis, Posture abnormal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Immediately after receiving vaccine, customer appeared to slouch over and I held his head and talked to him as I was unsure if he was just joking in front of his family. He then sat up and indicated he did not remember slouching. I explained to him that his blood pressure probably just went too low and asked him to continue breathing and try to put his head between his legs. He seemed fairly alert but a few seconds later, experienced some body jerking and I asked his father to call EMS, which he did. Customer then seemed to be in a semi alert state and started sweating profusely. I continued talking to him and watched for a fall until the EMS arrived. EMS triaged him and took him from the store. EMS reported systolic blood pressure unmeasurable upon arrival and around 70 at time of taking him from location (approximate numbers)


VAERS ID: 1474628 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 LA / IM

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

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

Write-up: No adverse effects noted at time of submission. Patient received complete series of Pfizer vaccine previously, then received Moderna vaccine today (3rd dose of mRNA). Patient did not disclose previous vaccinations, was discovered after the fact. Pfizer dose #1 on 4/30/21, Pfizer dose #2 on 6/24/21, Moderna dose #1 7/15/21.


VAERS ID: 1474629 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: D.C.  
Vaccinated:1961-01-08
Onset:2021-07-15
   Days after vaccination:22103
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / UNK - / -

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

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

Write-up: 2nd dose vaccine given after 42 days


VAERS ID: 1474635 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Dry mouth, Dry throat, Erythema, Eye swelling, Malaise, Nausea, Pallor, Pruritus, Rash, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Unknown
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: One minute after vaccination patient began to develop urticaria on his upper anterior chest. Patient complained of dry mouth and throat and "not feeling well". Patient was given 50mg of PO benadryl. Rash on chest resolved but swelling began in face around eyes, and blanchable redness developed on forehead and patient complained of itching scalp and nausea. 24 mg of methylprednisolone and 8mg of Zofran was administered. Patient maintaining a normotensive state throughout events, hr in the 70s and oxygen saturation 96%. at 0910 patient had returned a normal state, no signs of swelling or difficulty breathing. Fire team was called for evaluation and patient was observed for one hour. No return of symptoms.


VAERS ID: 1474641 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling hot, Pruritus, Sensory disturbance, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 15 minutes after vaccine, patient complains of feeling ''Hot". Stated "I feel like my throat is closing and it feels like bugs are crawling on me". Patient also developed itching 30 minutes after vaccine. Patient was assessed by an MD, Benadryl 50 mg IM given in clinic and patient was reassessed again after 30 minutes. Patient reported that symptoms had resolved and patient was discharged home.


VAERS ID: 1474663 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Hives noted on face, arms, legs. No hives noted on abdomen. No respiratory or mouth involvement


VAERS ID: 1474678 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none listed
Current Illness: Nausea,
Preexisting Conditions: Diabetes, Dyslipidemia, Anemia, Lumbar disc disease with Radiculopathy, GERD, History of CVA, Asthma, Hypertension,
Allergies: Meperidine, Tramadol, Demerol, Haloperiodol, Lisinopril. Pencillins, Phenothiazines, Thorazine, Ultram, Hydroxyzine, Latex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vaccine given 14 minutes past of being diluted. No reaction, no symptoms, Pfizer contacted and instructed to fill out form and they will take under advisement


VAERS ID: 1474683 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Iodine allergy, Motor dysfunction, Nausea, Respiration abnormal, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (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: PREDNISONE
Current Illness:
Preexisting Conditions:
Allergies: SHELFISH, IODINE
Diagnostic Lab Data: BLOOD SUGAR WAS 86. PATIENT HAD STATED SHE HAD NOT EATEN ANYTHING TODAY.
CDC Split Type:

Write-up: WHILE SETTING AFTER GETTING THE SHOT, THE PATIENT STATED HER HANDS WERE NUMB AND NOT WORKING CORRECTLY, SHE FELT LIKE THROWING UP, THEN PATIENT GOT REAL SWEATY AND BEGAN WHEEZING. WE WERE CONCERNED AND CALLED 911, WE BELIEVED IT WAS A PANIC ATTACK. PATIENT WAS ASKED ABOUT PANIC ATTACKS AND PATIENT STATED SHE HAS HAD PANIC ATTACKS BEFORE NOT THIS SEVERE. WE FANNED HER, TALKED TO HER AND SHE CALLED HER BOYFRIEND AND AFTER ABOUT 15 MINUTES SHE RETURNED TO NORMAL BREATHING, NO MORE SWEATING. EMS CHECKED HER OUT AND SHE LEFT LATER WITH HER BOYFRIEND.


VAERS ID: 1474685 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM

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

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

Write-up: Pfizer vaccine was given to patient when vaccine was not indicated for the patient. Patient''s mother knowingly gave the nurse the wrong birthdate for the patient.


VAERS ID: 1474690 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-13
Onset:2021-07-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6680 / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Fatigue, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ, Amlodipine Besylate, Potassium Chloride, Rosuvastatin and Vitamin D2
Current Illness:
Preexisting Conditions: Hypertension and Hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: July 13th and 14th pain at injection site and fatigue. July 15th at 6:00am to current chest pain


VAERS ID: 1474711 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 Pfizer COVID19 vaccine for her first dose and inadvertently received the Moderna COVID19 vaccine for her second dose.


VAERS ID: 1474718 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Shortly after vaccination (~15-20 minutes) patient became very faint and nauseous. Was pale in the face and vomited. Patient was seen by several firefighters that happened to be in the store at the time. She mentioned to them having fuzzy hearing, heavy arms, and sweating. They checked vitals and gave oxygen supply. Patient was then taken via ambulance to hospital but was feeling much better.


VAERS ID: 1474724 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthma, Condition aggravated
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: Albuterol Inhaler.
Current Illness: Asthma.
Preexisting Conditions: Asthma.
Allergies: Penicillin; Nuts; Shellfish.
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received her vaccine, went to the waiting area and had an asthma attack


VAERS ID: 1474729 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

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

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

Write-up: PATIENT RECIEVED MODERNA VACCINATION BUT IS UNDER THE AGE OF 18


VAERS ID: 1474733 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 RA / ID

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

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

Write-up: Vaccine provided to patient under the approved age range.


VAERS ID: 1474740 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Face injury, Fall, Limb injury, Lip injury, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (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: Denied
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received her 2nd dose Pfizer COVID vaccine this afternoon at our offsite clinic by a LPN. Had just asked for a bandaid because there was a spot of blood where she had received the vaccine. Her sister reports she said she was feeling dizzy then her sister turned away and the client fell from standing position to the ground at 1412. Hit on her right side, shoulder and face. Lost conscious momentarily and together with family members we rolled her onto her back. I directed co-worker to call 911. Client came to and we helped her to sit up against the wall. Blood pressure 96/52, P 80 at 1415. Family and client denied history of seizures or fainting. Weather outside hot and client reported she hadn''t eaten anything all day. Water provided. Client reported pain from the right side of her face and her lower lip which had a laceration from the fall that was bleeding a small amount. Fire EMS arrived just after 1420. Reported their vitals as BP 110/68, P 97, O2 99%. Ambulance arrived around 1430 and assessed. They had her rise from sitting to standing and reported her SBP dropped to the 70s. Paramedics advised to be assessed in ER. Client left in ambulance at 1443 accompanied by mother. Family provided reassurance regarding syncopal episode and contributing factors. They had no further questions or concerns at time of departure.


VAERS ID: 1474742 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: Patient came to facility to receive their second dose of COVID-19 mRNA vaccine. After administration, the clinician realized they had administered the incorrect mRNA vaccine as the patient''s vaccine card showed their first dose was a Moderna dose. Clinician notified the patient of the error. Clinician documented on the patient''s vaccine card that the second COVID-19 dose was Pfizer


VAERS ID: 1474746 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-01
Onset:2021-07-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Cerebral haemorrhage, Computerised tomogram head, Contusion, Full blood count, Headache, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: CBC, CTH, CTangio
CDC Split Type:

Write-up: Patient presented with 1 week of headache. She had some spontaneous bruising. She is thrombocytopenic in the 50s with a large intraparenchymal hemorrhage.


VAERS ID: 1474747 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

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

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

Write-up: Was given Moderna vaccine as second dose instead of Pfizer.


VAERS ID: 1474759 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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

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

Write-up: Patient received Moderna Vaccine 04/05/2021, and left the country, he came into the clinic today and asked for a Pfizer Covid-19 vaccine. He stated that since he missed his return date for Moderna of 05/05/2021. He would like to get the Pfizer Covid-19 vaccine. He stated that he had discussed it with his PCP.


VAERS ID: 1474763 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D2 IA / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Feeling hot, Flushing
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: Finasteride 2.5MG, Vitamin D-3 5000 IU, Garlic 400MG, Niacin 500MG, Lisonopril 10MG
Current Illness: N/A
Preexisting Conditions: High Blood Pressure and possible unknown Autoimmune issues.
Allergies: None known
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: A couple hours after the vaccine I started to feel hot and my face was flush/red. The heat feeling felt particularly bad in the back of my head. Eventually my whole body started to feel hot and I noticed almost the entire length my skin was turning red as if I had been sunburnt. This continued for about an hour and slowly subsided. We were close to going to the hospital when I felt it start to subside.


VAERS ID: 1474786 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

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

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

Write-up: Client received covid vaccine @ 12:06 pm, complained of feeling lightheaded @ 12:07pm. Client placed in zero-gravity chair and vital signs taken. Client denies shortness of breath, denies allergies to anything. Client given water to drink. Symptom resolved by 12:28pm, able to stand and walk to observation area. Client left with steady gait @ 1:00pm.


VAERS ID: 1474787 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / IM

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

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

Write-up: paient got 3 rd pfizer covid vaccine with doctor orders as patient did not develope antibodies after 2 doses and patient is on transplant


VAERS ID: 1474795 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Deafness, Dizziness, Dyspnoea, Electrocardiogram normal, Hyperventilation, Hypoaesthesia, Immediate post-injection reaction, Loss of consciousness, Pallor, Paraesthesia, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 911 was called and BP, glucose and EKG were checked which were normal. Patient was cleared to go home.
CDC Split Type:

Write-up: Right after the vaccine was administered, patient complained about dizziness, temporary blurred vision & loss of hearing. Patient became pale, hyperventilating and complaining of shortness of breath. Soon after, he passed out for 20 seconds. When he gained consciousness, he felt tingling and numbing on both hands.


VAERS ID: 1474800 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-10
Onset:2021-07-15
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, Sucralfate
Current Illness: none
Preexisting Conditions: Migraine Headache, Major depression
Allergies: No allergies
Diagnostic Lab Data: Jul 15, 2021@10:11:05 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Covid 19 screening


VAERS ID: 1474806 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / -

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

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

Write-up: Pt had severe anxiety and claustrophobia prior to vaccine. Immediately following administration patient went limp/fainted, awoke seconds later was nauseous and vomited slightly. Patient was pale. Asked patients mother if he had eaten today he had not. Provided patient with a iced tea he brought with him. Upon sitting, monitoring temp, talking with patient and mom, patients color returned and patient was feeling better. Patient remained seated for approximately 30 minutes and upon leaving patient was feeling much better.


VAERS ID: 1474808 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

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

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

Write-up: Patient felt faint was sweating and pale. Her blood pressure was fine. She threw up and then immediately began to feel better. The patient never fainted.


VAERS ID: 1474815 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Oropharyngeal pain, Pain, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Losartan 10mg, metformin 500mg, zinc, b12, b3, magnesium, omega3, turmeric, ibuprofen, arthritis tylenol
Current Illness: no
Preexisting Conditions: hypertension
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: woke up with headache with evolved to fever chills sore throat runny nose and body ache all over


VAERS ID: 1474818 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Patient passed out 10 to 15 minutes after vaccine administration.


VAERS ID: 1474821 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

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

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

Write-up: Bleeding for 30 seconds followed by swelling of injection site (5mm diameters). Bleeding stopped and swelling reduced in 15 minutes.


VAERS ID: 1474825 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: PATIENT GOT VACCINE AND STARTED FEELING DIZZINESS AND VOMITING. PATIENT WAS HAVING DIFFICULTY BREATHING. CALLED 911 AND IN LESS THEN 5 MINUTES THEY ARRIVED. PATIENTS BP WAS 80/50 AND TOOK HER TO THE HOSPITAL


VAERS ID: 1474828 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Musculoskeletal chest pain
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: Client reported to EMTs pain on her left side around her ribs that she described as "pulsating." Vitals obtained at 2:08PM were as follows: BP 130/76, HR 75, and O2 98%. The client denied any SOB, chest pressure, or throat tightness. The client reports a history of a similar pain on her left side of unknown origin. The client was alert and oriented to person, place, time, and events. The client rated the pain at a 3-4 on a scale of 10. The client has a history of hypertension, which is controlled with Lisinopril. Repeat vitals obtained at 2:20PM were as follows: BP 138/76, HR 67, and O2 98%. The client stated, "I''m okay I can walk." The client stated her symptoms were unchanged. The client elected to leave the vaccination site. Client ambulated away from the observation area unassisted with a steady gait at 2:23PM.


VAERS ID: 1474830 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

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

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

Write-up: Felt very hot and sweaty about 10 minutes after immunization. Was better within the next 30 minutes.


VAERS ID: 1474970 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: PATIENT GOT VACCINE ALONG WITH HER 15 YEAR OLD DAUGHTER, DAUGHTER HAD REACTION AND AFTER 15-20 MINUTES DUE TO THE WHOLE PANIC SITUATION PATIENT STARTED FEELING DIZZINESS. WE ALREADY HAD PERAMEDIC HELPTING PATIENT''S DAUGHTER SO THEY CHECK HER BP AND TOOK PATIENT TO THE HOSPITAL


VAERS ID: 1474973 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: Patient arrived to receive first dose of the Pfizer Covid Vaccine and stated he had not received any other covid vaccines. After appropriate screening questions and signed consent obtained, Pfizer Covid vaccine was administered to this patient. While documenting this vaccine administration, it was noted that he had received the J&J vaccine in April 0f 2021. Afterwards patient admitted to receiving the J&J vaccine in April 2021 and wanted to receive the Pfizer mRNA vaccine as a booster.


VAERS ID: 1474977 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 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? 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: Mom lied about the age of her child in order to get her the covid vaccine. I received a call from the office letting us know that she received a fax from us stating we gave a covid vaccine to a patient of theirs that was only 10 y/o. The office staff stated that when she saw the fax she noticed that the date of birth did not match any of their patients. After looking up the name she saw that the DOB was different so she called the patient''s mother. The office staff member said that the mother admitted that she lied to us about her daughter''s DOB in order to vaccinate her child.


VAERS ID: 1474980 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 - / 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? 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: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt received shot in pharmacy for second covid pfizer vaccine. She sat down for 15 minutes, but then got up and felt lightheadness. However, she continued shopping in store with her family. On the way out, she was still feeling lightheadness and her vision was lessened so she sat down at the food court area. Pharmacist was alerted to come attend to her. Pharmacist suggested that she put her head between her legs and offered wet towel for her neck. After about 5 minutes, she said she was fine to go with her family.


VAERS ID: 1474985 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Ear discomfort, Head discomfort, Musculoskeletal discomfort, Pharyngeal swelling, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient was concerned she might have an adverse reaction to the covid 19 vaccine due to her long list of allergies, and patient stated that the doctor told her to only get the Pfizer vaccine. We administered the Pfizer vaccine and as patient was waiting, she started noticing that she felt a pressure in her head around 10 minutes into her waiting period. Then the patient said the pressure spread to her ears. She began to feel woozy. Finally when the pressure hit her neck area, she accepted some benadryl liquid. We administered 10ml of benadryl generic around 12:10 pm. We had offered the patient ice packs numerous times, but she declined. However, the patient did accept a snack and something to drink. Then around 12:25 pm, the patient stated that the swelling/pressure in her neck was a little worse, so we decided to administer another 10ml of liquid benadryl generic. After about another 15-20 minutes, the patient said the swelling in the throat was no longer getting worse, and that it was, in fact, getting better. The patient stayed in the pharmacy area for a little over an hour.


VAERS ID: 1474986 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oral pain, Toothache
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: Vitamins
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After 2 hours of the Johnson vaccine I started to feel my teeth give me pain and discomfort. As the day progressed the pain has gotten worse, specifically on my right side of the mouth. Top and bottom teeth are giving me sharp pain.


VAERS ID: 1474994 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Nausea, Pallor, Tinnitus
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT''S FACE LOSE COLOAR . HE WAS VERY WHITE. HE ALSO HAD COLD SWEAT. HE FELT DIZZY AND HAD RINGING IN HIS EARS HE FELT LIKE HE WANTED TO THROW UP. HIS AUNT WANTED US TO CALL AMULANCE. THE PARAMEDIC CAME . ALL THE VITALS WERE NORMAL. HIS FACE COLOR STARTED COMING BACK. PARAMEDIC ALSO CHECKED IF THERE WERE RASHES ON HIS CHEST AND ARMS. NOTHING. PARA MEDIC ASKED PT WHETHER HE WANTED TO GO HOSPITAL, HE DECLINED. HE SAT 10 MORE MINUTES FOR OBSERVATION AND HE FELT WELL ENOUGH AND LEFT.


VAERS ID: 1474996 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyschromatopsia, Hypoacusis, Laboratory test
SMQs:, Anticholinergic syndrome (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), 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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 5 minutes after giving the patient the shot, patient started feeling very dizzy, when asked if he would like an ambulance he refused. After a few more minutes, patient said he was feeling a little better. No trouble breathing or talking. After a few more minutes patient started holding his ear and said he was having trouble hearing and started seeing colors. We asked if patient would like an ambulance and patient agreed. Paramedics came and did some tests.


VAERS ID: 1475002 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: Client received Moderna (4/2021) for her first series and now received Pfizer for her second series (7/15/2021)


VAERS ID: 1475008 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blindness transient, Dizziness, Fear of injection, Pallor, Presyncope, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve 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: Mother claimed he typically has a fear of needles and sometimes passes out with vaccines or blood draws.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a vagal response caused by an anxiety attack due to fear of needles. Technician, gave the vaccine and then immediately called me in. The mother and son were worried about the needle disappearing due to the retraction mechanism. The son was loosing color in his face and becoming dizzy. I had him sit upright, talked with him for a few minutes, gave him Benadryl as a precaution, and checked his blood pressure. He was having no difficulty breathing and blood pressure was WNL. His mother said that he has passed out with needles before and that he had not eaten today. Eventually the patient claimed to lose his sight, and within 30s passed out. He was still sitting in the chair, bent over, vomited, and then immediately came back to consciousness. The patient then said that he felt fine and wanted to leave. I talked with him and his mother for around 20 minutes, had him eat a banana, and drink a full bottle of water. After the time, he felt fine and him and his mother left.


VAERS ID: 1475010 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

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

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

Write-up: Patient was erroneously administered Pfizer COVID-19 vaccine instead of Moderna COVID-19 vaccine for his 2nd dose. Patient has not had an adverse reaction or symptoms during the observation period.


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