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

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



Case Details (Reverse Sorted by Onset Date)

This is page 36 out of 4,799

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VAERS ID: 1461671 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Abortion spontaneous, Blood test, Exposure during pregnancy, Haemoglobin, Haemorrhage in pregnancy, Human chorionic gonadotropin, Ultrasound antenatal screen, Uterine spasm
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: OB US first trimester, 6-28-21 Obstetric panel, 6-28-21 SMA carrier screen, 6-28-21 Hemoglobinopathy evaluation, 6-28-21 OB US first trimester, 7-9-21 POCT hemoglobin 7-9-21 HCG quantitative panel 7-9-21
CDC Split Type:

Write-up: Pregnant at the time of vaccination, 8 weeks. Very first ever pregnancy, no history of miscarriage or abortion. Heartbeat detected via ultrasound 36 hours prior to shot on 6-28-21 at OBGYN appointment. Covid shot taken on Wednesday 7-1-21, Miscarriage occured on 7-3-21. Confirmed loss of pregnancy via ER visit due to bleeding and cramps from ultrasound. Please do more research for 1st trimester before clearing pregnant women as safe to take COVID-19 vaccination. Please add my information to any existing data regarding 1st trimester loss of pregnancy.


VAERS ID: 1461751 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-05
Onset:2021-07-02
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: C-reactive protein normal, Coagulation test normal, Full blood count normal, Metabolic function test, Petechiae, Rash, Red blood cell sedimentation rate normal
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (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: None
Current Illness: None
Preexisting Conditions: Generalized anxiety
Allergies: None
Diagnostic Lab Data: CBC, CMP, coags, ESR, and CRP were all completely normal. Hemodynamically stable, no fevers.
CDC Split Type:

Write-up: Developed petechial rash to bilateral lower extremities, scattered petechiae to bilateral upper extremities 3 weeks after vaccination. Denies all other medical complaints.


VAERS ID: 1461772 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Injection site pruritus, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pain and swelling in arm 2 days following pneumonia vaccine
Other Medications: Rituxan infusion, plaquenil, spironolactdone, restasis
Current Illness: None
Preexisting Conditions: Rheumatoid Arthritis
Allergies: neosporin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I had itching and pain at the injection site early in the day. At around 3 pm I started to having itching around my jaw line and hives started to pop up on my face. Over the next 30 mins about 5 hives arrived until I was able to talk with my doctor, read CDC guidance and take 1 benadryl (25 mg) then the itching resolved.


VAERS ID: 1461797 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Malaise, Pain, Pain in extremity, Palpitations, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Systemic: shooting pain on left arm-Severe, Systemic: Tachycardia-Severe, Additional Details: palpitation, call to pharmacy that left hospita today after being hospital since thursday, they wanted to complete a ekg and stress test and refused, will consult wqith doctor and insurance, still not feeling well.


VAERS ID: 1462084 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-25
Onset:2021-07-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Migraine, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular 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: none
Current Illness: none
Preexisting Conditions: sleep apnea
Allergies: bactrim
Diagnostic Lab Data: covid rapid test on 7/09/2020 was negative.
CDC Split Type:

Write-up: Fevers, migraines, dizziness, fatigue for over a week now.


VAERS ID: 1462111 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-25
Onset:2021-07-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Bell's palsy, Chest X-ray, Computerised tomogram head, Electrocardiogram, Full blood count, Headache, Magnetic resonance imaging head, Metabolic function test, Neurological examination, Swallow study abnormal
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hearing impairment (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CT brain MRI brain Emergendy Department evaluation Nurologist consult/ evalaution cbc, cmp, ekg, cxr Swallow study (failed)
CDC Split Type:

Write-up: Bells Palsey (right facial dysequilibrium with standing, ambulatoin Headache, cervical trigger points


VAERS ID: 1463036 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-07-02
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Lethargy, Pain in extremity
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210718975

Write-up: LETHARGY; PAIN IN ARM; HEADACHE; This spontaneous report received from a patient concerned a 53 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A expiry: 07-AUG-2021) dose was not reported, administered on 02-JUL-2021 18:30 for prophylactic vaccination. No concomitant medications were reported. On 02-JUL-2021, the subject experienced pain in arm. On 02-JUL-2021, the subject experienced headache. On 03-JUL-2021, the subject experienced lethargy. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from headache, lethargy, and pain in arm. This report was non-serious. This case, from the same reporter is linked to 20210710122.


VAERS ID: 1463407 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 0150626-17236 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 111111 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Cardiac flutter, Chest pain, Computerised tomogram normal, Dyspnoea, Electrocardiogram normal, Inflammation, Laboratory test normal, Palpitations, X-ray normal
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness: none
Preexisting Conditions: na
Allergies: no
Diagnostic Lab Data: We went to ER twice and all lab test result came out good. Test given that I remember:Heart CT scan, XRay, blood test, ticks, ekg, bp, temperature. Currently still feeling the symptoms multiple time in a day. Was adviced to consult a cardiologist, waiting for his cardiologist appointment this Wednesday.
CDC Split Type:

Write-up: ***Please ignore 2nd vaccine listed. Dont know how to delete it. Only recieved 2nd dose covid 19 vaccine on 6/30*** Heart inflamation with chest pain, a feeling of breathlessness and a pounding or fluttering heartbeat.


VAERS ID: 1463409 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-04-15
Onset:2021-07-02
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin, Cetirizine, Chlorthalidone, Genvoya, MVI, D3,
Current Illness: Well controlled HIV, HLD, HTN
Preexisting Conditions: Well controlled HIV, HLD, HTN
Allergies: Amoxicillin
Diagnostic Lab Data: CTA Chest 7/10/2021
CDC Split Type:

Write-up: Saddle PE diagnosed 7/10/21


VAERS ID: 1463427 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None, but I was two months post pardon when I had the vaccine
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles, started on back on July 2nd and grew to chest and arms.


VAERS ID: 1463774 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Blood creatinine normal, C-reactive protein increased, Chest X-ray normal, Chest discomfort, Electrocardiogram repolarisation abnormality, Full blood count, Haematocrit normal, Haemoglobin normal, International normalised ratio normal, Metabolic function test, Palpitations, Platelet count normal, Prothrombin time normal, Troponin normal, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (narrow), Conduction defects (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Wolff-Parkinson-White syndrome s/p cardiac ablation in 2014.
Allergies: None
Diagnostic Lab Data: 7/2/2021: ECG showing normal sinus rhythm with probable benign early repolarization pattern. Chest x-ray read "no discernible active lung lesion." CBC - wbc 6.5K, Hgb 12.3 g/dL, Hct 38%, platelet 341K. CRP 0.22 mg/dL. CMP - creatinine 1.04 mg/dL, all else within normal limits. PT, INR, aPTT within normal limits. Troponin-T <0.003 ng/mL. Covid-19 PCR negative.
CDC Split Type:

Write-up: Acute onset of heart palpitations and chest discomfort around 0100 the day after receiving second Moderna Covid-19 vaccine. She presented initially to the Health Clinic and was transferred to Hospital emergency department with negative workup (see below). She was treated with 1L normal saline and 30mg of ketorolac in the ED with subsequent resolution of symptoms, and discharged home without recurrence of symptoms.


VAERS ID: 1463785 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-05
Onset:2021-07-02
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute hepatic failure, Alcohol test negative, Analgesic drug level, Autoimmune hepatitis, Drug-induced liver injury, Hepatitis viral, Ischaemic hepatitis, Ultrasound Doppler normal, Vaccination complication
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Non small cell lung cancer, new diagnosis, has not started treatment yet; HTN; neuropathy
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presents in fulminant liver failure. Per GI team documentation: "We do not have an etiology for this acute liver injury. The differential diagnosis includes drug-induced liver injury, acute viral hepatitis, ischemic hepatitis, autoimmune hepatitis and indeterminate. Acetaminophen and salicylate levels are negative. Alcohol level is negative. Although patient does abuse alcohol on a daily basis, her presentation is not consistent with acute alcoholic hepatitis. Serologies have been sent to evaluate the differential diagnosis and other potential causes of acute liver injury. Liver imaging including Doppler ultrasound does not reveal any abnormality and there is no evidence of chronic liver disease." We have found four case reports of hepatitis/autoimmune hepatitis related to mRNA vaccines. We have additionally had a case of fulminant liver failure in our community a few months back of which no other etiology was identified other then mRNA vaccine. Because of such, and with no other identifiable cause, we are concerned her acute sudden liver failure was vaccine induced.


VAERS ID: 1464063 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-06
Onset:2021-07-02
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site inflammation, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: massive muscle inflammation at the site of injection (left arm)


VAERS ID: 1464100 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Haematochezia, Ocular hyperaemia, Pain, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 1 day aching & tiredness 3 days red eye (bloodshot eye) 1 week blood in stool 1 week (and ongoing) rash (itchiness)


VAERS ID: 1464161 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Gait disturbance, Joint swelling, Nausea, Pain, Rash, Rash pruritic, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rasuvo, carvedilol, tylenol #4, pilocarpine, alprazolam, escitalopram, potassium, pantoprazole, olmesartan-hctz, tizanidine, folic acid, Simponi Aria
Current Illness: n/a
Preexisting Conditions: RA, fibromyalgia, hypertension
Allergies: crawfish
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient received the first dose of the Pfizer COVID-19 vaccine on Wednesday, June 30. She reports that 2 days later, on Friday, July 2, she broke out in a rash from head to toe that lasted about a week. She reports the rash was itchy and started to blister the following day, on Saturday. She also reports she had body aches that made it difficult to walk, as well as fatigue, joint swelling, and nausea. She contacted her rheumatologist about the reaction and was instructed to take prednisone 10 mg for 2 days. She reports this helped, and the rash subsided. Her rheumatologist recommended against taking the second dose of the vaccine. Her primary care physician agreed.


VAERS ID: 1464295 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-24
Onset:2021-07-02
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Biopsy cervix, Gynaecological examination, Heavy menstrual bleeding, Laboratory test, Oligomenorrhoea, Smear cervix, Ultrasound scan
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility 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: Hydrochlorithizide .25 mg
Current Illness: none
Preexisting Conditions: High Blood pressure
Allergies:
Diagnostic Lab Data: Lab work done on 6/15/21 Ultrasound 6/30/21 Pap Smear, Pelvic exam, biopsy of cervix 7/1/21 I was told I would need a Hysteroscopy, it will be scheduled until September unless I have to go to the Emergency Department due to my bleeding then it will be done by emergency
CDC Split Type:

Write-up: I started bleeding on 06/02/21 from what i though was a regular menstrual cycle and have been bleeding ever since. I have been to the Dr. twice, for heavy, abnormal bleeding and abnormal clotting . First Dr. visit was on 06/15/21, bleeding for two weeks I was put on medication to control it, I was sent to do an ultrasound on 6/30/21, and had a biopsy done on 7/1/21. Results pending until the 20th of July 2021. To this date I am still bleeding however it is controlled by medication. If I skip my medication for a day I will start to bleed heavy. I have been bleeding for a month and ten days.


VAERS ID: 1464301 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Hypoaesthesia, Injection site pain, Nausea, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot, estimated 15yrs. similar symptoms, continued fatigued and nauseous.
Other Medications: Aderex (Allergy Medication)
Current Illness: N/A
Preexisting Conditions: Asthmatic
Allergies: Smoke, Seasonal Allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states received Phizer 1st dose 07/02/2021, Left hand/fingers going numb after 45mins. Rash over hands and feet, soreness in the left arm 2 days, vomited a little, fatigued, nauseous, fever when nauseous, loss of appetite (bland), taste buds effected. Alerted Physicians, told to just do a report. No physical physician appt. Prescribed Finnegan. ER recommended due to lack of physician''s attention to the events.


VAERS ID: 1464454 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-07-02
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Hyponatraemia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: E87.1 - Hyponatremia N17.9 - AKI (acute kidney injury)


VAERS ID: 1464512 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-03
Onset:2021-07-02
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Exposure to SARS-CoV-2, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 500 mg tablet ADVAIR HFA 230-21 mcg/actuation inhaler albuterol 2.5 mg /3 mL (0.083 %) nebulizer solution albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler benzonatate (TESSALON) 100
Current Illness:
Preexisting Conditions: Non-Hospital Asthma, moderate persistent Cardiomyopathy (CMS/HCC) Chronic joint pain Generalized osteoarthritis of multiple sites Hypertension Morbid obesity (CMS/HCC) Osteoarthritis Overweight(278.02) Vitamin D deficiency Keratosis Encounter for long-term opiate analgesic use Abscess Glenohumeral arthritis, right Controlled substance agreement signed Adenomatous polyp of colon, unspecified part of colon Benign prostatic hyperplasia with nocturia Rotator cuff arthropathy, right Hyperkalemia Pneumonia due to COVID-19 virus UTI symptoms Herpes zoster without complication
Allergies: FentanylConfusion / Delirium, Headaches Doxycycline OseltamivirRash PregabalinFatigue Tetanus ToxoidOther (document details in comments) Tetanus Toxoid, AdsorbedOther (document details in comments)
Diagnostic Lab Data: 07/06/21 1613 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 07/06/21 1459 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical 07/06/21 1613 COVID-19 PCR - Communal Living / SNF Placement (Asymptomatic) Collected: 07/06/21 1459 | Final result | Specimen: Swab from Nasopharynx
CDC Split Type:

Write-up: ASYMPTOMATIC


VAERS ID: 1464610 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-07-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Fatigue, Productive cough, Pyrexia, Respiratory tract infection, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: None
Current Illness: None
Preexisting Conditions: Hiv
Allergies: None
Diagnostic Lab Data: Covid -19 test 07/08/2021 - Negative
CDC Split Type:

Write-up: Fever, coughing up mucus, extreme fatigue, chest pain trouble breathing/respiratory infection


VAERS ID: 1465779 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: THE PT STARTED OFF WITH 2 AREAS OF ITCHY ON LEG. SHE STATED IT STARTED A COUPLE DAYS AFTER. THEN 11 DAYS LATER SHE STARTED HAVING DIFFICULTY BREATHING. SHE USED AN EPI PEN THAT SHE HAD AT HOME DUE TO HER ALLERGY WITH KEFLEX. SHE FELT MUCH BETTER BUT CALLED TODAY TO ASK IF SHE SHOULD GET HER 2ND DOSE. SHE IS GOING TO CONSULT HER PHYSICIAN AND THEY CAN MAKE THE DECISION AS TO THE 2ND DOSE. I SUGGESTED IF SHE DOES GET IT SHE SHOULD GET IT IN A CLINIC SETTING.


VAERS ID: 1465986 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Guam  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM

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

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

Write-up: COVID19 Moderna Vaccine given to 12yrs old patient. No adverse reaction/symtoms noted after vaccine given.


VAERS ID: 1466559 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Cataract, Diarrhoea, Fatigue, Headache, Impaired driving ability, Injection site pain, Myalgia, Pain, Pyrexia, Somnolence, Vision blurred, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (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), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (narrow), Eosinophilic pneumonia (broad), Retinal disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Every time I take the Flu shot I get sick with flu like symptoms
Other Medications: None
Current Illness: None
Preexisting Conditions: Hashimoto''s disease, degenerative disk disease, Migraines
Allergies: Allergic to pineapple and morphine and codeine.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Two days after the shot I started having blurred vision that kept getting worse, I was starting to have a hard time to see, especially at night driving. I went to the eye doctor that said I have fast growing cataracts, The doctor did say this is not an age related cataracts this is a fast growing cataracts. I also hade muscle and body aches and headaches and fever, and I had horrible horrible fatigue to the point I had to take naps through out the day. I also had diarrhea for 3 days. And my arm where I got the shot was sore for almost 4 days.


VAERS ID: 1466583 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

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? 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: Individual was vaccinated too early. First dose was given on 6/16/21 which means interval was only 16 days.


VAERS ID: 1466878 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-03
Onset:2021-07-02
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pharmacy don''t have data
Current Illness: pharmacy don''t have data
Preexisting Conditions: pharmacy don''t have data
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came back today 7/13/2021 and mentioned that he was having some kind of steady tingling sensation on the vaccinated arm (left) that started around July 2nd. He heard about the recently reported side effect Guillain Barre Syndrome on the news so he tried to seek out how he can report this and came back to our pharmacy. Told him we need to report thru VAERS and will reach out to him if more info is needed. He was also advised to sign up thru Vsafe for monitoring.


VAERS ID: 1467021 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 developed hives on her arms and hands within 15 minutes of vaccination. Also had itchy ears and red cheeks. Given two doses of Benedryl and symptoms improved. She was released to home.


VAERS ID: 1467042 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Conjunctival haemorrhage, Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Conjunctival 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUBCONJUNCTIVAL HEMORRHAGE(RIGHT EYE, SAME SIDE AS SHOT) BREAKTHROUGH BLEEDING


VAERS ID: 1467057 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

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

Write-up: Patient was fatigued but no other symptoms were reported.


VAERS ID: 1467071 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

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

Write-up: Fatigue


VAERS ID: 1467086 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Error: Booster Given Too Early-


VAERS ID: 1467293 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Nausea, Neck pain, Pain in extremity, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I am currently taking Levothyroxine; Potassium Chloride; Keflex; Torsemide; LINZESS; estradiol; Floranex; Gabapentin; Metformin; Sumatriptan; Rosuvastatin; Escitalopram; Omeprazole; Aspirin; Spironolactone; Vitamin B-12; Vitamin B-3; Ondans
Current Illness: I had a sinus infection.
Preexisting Conditions: Multiple Sclerosis; Sjogren''s Disease
Allergies: I am allergic to Prednisone.
Diagnostic Lab Data: Not Applicable
CDC Split Type: vsafe

Write-up: I experienced extreme headaches, neck and arm pain, nausea with pain in my stomach along with development of a rash. The headaches and nausea progressively became worst. I almost went to the walk-in-clinic but chose not to go. If I were not able to control the vomiting or had diarrhea, I would have gone to the ER. The symptoms resided on their own after a few days. I have an appointment to see my doctor on Friday to ensure that the symptoms are gone since I still have bouts of stomach cramping.


VAERS ID: 1467294 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling hot, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Pt. reported tingling in hands and then a warm feeling over body. Pt. taken to treatment room and vitals taken. Pt. placed in chair and leaned back with legs lifted. Pt. reports symptoms improving and feeling better. Pt. Dc''d home with mother.


VAERS ID: 1469671 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-07-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Haemoptysis, Muscle strain, Oxygen saturation, Pulmonary thrombosis, Suspected COVID-19
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), 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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210704; Test Name: Oxygen level; Result Unstructured Data: unable to have a good oxygen level
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Blood clots in both their lungs; though they had covid-19; Difficulty breathing; Sharp pain in chest; Though they have pulled a muscle; Spiting up blood; This spontaneous case was reported by a consumer and describes the occurrence of PULMONARY THROMBOSIS (Blood clots in both their lungs), DYSPNOEA (Difficulty breathing), CHEST PAIN (Sharp pain in chest), MUSCLE STRAIN (Though they have pulled a muscle), HAEMOPTYSIS (Spiting up blood) and SUSPECTED COVID-19 (though they had covid-19) in a 57-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 061C21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Jul-2021, the patient experienced DYSPNOEA (Difficulty breathing) (seriousness criterion hospitalization), CHEST PAIN (Sharp pain in chest) (seriousness criterion hospitalization), MUSCLE STRAIN (Though they have pulled a muscle) (seriousness criterion hospitalization) and HAEMOPTYSIS (Spiting up blood) (seriousness criterion hospitalization). On 04-Jul-2021, the patient experienced SUSPECTED COVID-19 (though they had covid-19) (seriousness criterion hospitalization). On an unknown date, the patient experienced PULMONARY THROMBOSIS (Blood clots in both their lungs) (seriousness criteria hospitalization and medically significant). The patient was hospitalized from 04-Jul-2021 to 05-Jul-2021 due to CHEST PAIN, DYSPNOEA, HAEMOPTYSIS, MUSCLE STRAIN, PULMONARY THROMBOSIS and SUSPECTED COVID-19. At the time of the report, PULMONARY THROMBOSIS (Blood clots in both their lungs), CHEST PAIN (Sharp pain in chest), MUSCLE STRAIN (Though they have pulled a muscle), HAEMOPTYSIS (Spiting up blood) and SUSPECTED COVID-19 (though they had covid-19) outcome was unknown and DYSPNOEA (Difficulty breathing) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 04-Jul-2021, Oxygen saturation: unknown (abnormal) unable to have a good oxygen level. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications included High blood pressure medication and cholesterol medication. Treatment medications included antibiotics and pain medication. Reportedly, the patient was scheduled to get the second dose on 20-Jul-2021. Company Comment: Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.


VAERS ID: 1470111 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest discomfort, Condition aggravated, Hypoaesthesia oral, Impaired work ability, Laboratory test normal, Neuropathy peripheral, Pain in extremity, Paraesthesia oral, Sensory disturbance, Visceral pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Anaphylaxis, 64 years old, 12/29/21, Moderna Covid 19 vaccination.
Other Medications: Acyclovir, estrace cream, MSM, glucosamine, chondroitin, boron.
Current Illness: Chronic idiopathic peripheral neuropathy, chronic idiopathic urticaria, IBS.
Preexisting Conditions: See above.
Allergies: Moderna covid vaccine: anaphylactic reaction.
Diagnostic Lab Data: All negative, had neurological workup which was normal. Now waiting to see if I present with Guillia-Barre. Hope I can update this later if I do.
CDC Split Type:

Write-up: J and J vaccine: 40 min. after shot, my lower lip began to tingle, then went numb, next my upper lip, next nose felt funny. chest felt tight, no wheezing. Was still at Clinic so I went to Urgent care. I used my albuterol inhaler, chest tightness resolved. Treated in UC with solumedrol, famoditine, 1 liter NaCl. My allergist had me on 2 Zytec, and 2 famoditine the day of shot. Went to urgent care 7/5 for neuropathy. Saw neurologist on 7/8/21. Today is 12 days after the vaccination. My peripheral neuropathy is so bad I can''t work. I have constant pain in my shoulder girdle, lower back thighs, calves, feet, hands, and visceral. My PCP won''t give my any pain meds, my pain is 8/10.


VAERS ID: 1470122 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-05-11
Onset:2021-07-02
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Oropharyngeal pain, Productive cough, Pyrexia, Respiratory tract congestion, Secretion discharge
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprozole, Gabapentin, Meloxicam
Current Illness: Hiatal Hernia, severe anemia, neuropathy in left leg, carpal tunnel syndrome both wrists, Gerd
Preexisting Conditions: Hiatal Hernia, Gerd
Allergies: Penicillin, sulfa drugs
Diagnostic Lab Data: Urgent care visits on 7/7/21 and 7/12/21. Received breathing treatment (steroid and Albuterol) and steroid shot on 7/12/22.
CDC Split Type:

Write-up: Developed upper respiratory infection On 7/2/2021. Low grade fever, cough, chest congestion, sore throat, yellow mucus, difficulty breathing, phlegm


VAERS ID: 1470198 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: no
CDC Split Type: 26

Write-up: 5/28/21: Dose 1 given in error was Moderna 7/2/21: Dose 2 was to be with Moderna and Pfizer was given


VAERS ID: 1470420 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-29
Onset:2021-07-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009021A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood test, Dyspnoea, Headache, Hypoaesthesia, Lumbar puncture, Magnetic resonance imaging, Musculoskeletal stiffness, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting on July 2nd my feet started tingling and going numb. On July 3rd my feet and lower legs were tingling and going numb in the evening. On the 3rd, I also got the worst headache I have ever experienced in my life. On the 4th I woke up with a lingering headache and the back of my neck was kind of stiff. My feet and legs were tingling/feeling numb on and off during the day and my left arm started to go tingly/numb as well. At about 2:30 a.m. on July 5th, I woke up with difficulty breathing and all 4 legs and arms were numb and tingly, and I was very weak. I was taken to the E.R. by my family. At the E.R. they did a lumbar puncture and blood work and sent me by ambulance to larger hospital. While there, I went through further testing including an MRI and additional blood work. The conclusion was that I was experiencing paresthesia possibly caused by a strong autoimmune reaction.


VAERS ID: 1470518 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-07-02
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone normal, Full blood count normal, Metabolic function test normal, Swelling face, X-ray normal
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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, HRT (estradial, progesterone, testosterone), Flonase Supplements: Fish oil. Omega 3 oil, vitamin C, Biotin, B12, milk thistle, astragalus, alpha lipoic acid, beta glucan, glucosomine, turmeric, bergamot, CoQ10, SamE, zinc, vitam
Current Illness: none
Preexisting Conditions: Asplenia due to trauma
Allergies: penicillan
Diagnostic Lab Data: X-ray 07/03/2021 - results normal Blood test (CBC, TSH, Comp. Metabolic Panel) 07/12/2021 - results normal
CDC Split Type:

Write-up: Left jaw swelled at throat, under ear and jaw bone area. Advil, Tylenol, ice, moist heat, Arnica cream, triple antibiotic ointment over area Swelling reduced to normal and pain-free by 07/14/2021


VAERS ID: 1470539 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dysgeusia, Pharyngeal paraesthesia, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vit
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Metallic taste and tingling in throat about 14 mins after shot. This happened with the first shot too. With the 1st shot my throat was itchy/achy for a few days but nothing serious occured with the 1st dose so I said nothing about the sensation with the 2nd dose. About 5 minutes after leaving (20 mins after receiving 2nd dose) the sensation in my throat worsened and my throat tightened. My throat was itchy. Arriving home I took my inhaler (Albuterol) since the tightening feeling somewhat reminded me of the onset of an asthma attack. But finding no relief I took Benadryl and layed down. Since July 2nd my throat has on and off bothered me. Nothing severe or painful just bothersome. It''s not constant. Its On and off sometimes I''ll experience tightness scratchiness or a odd tingling taste and sometimes I''m fine.


VAERS ID: 1470843 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dyspnoea, Injection site discomfort, Injection site pain, Palpitations
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Vestibular disorders (broad)

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

Write-up: July 2nd, 2020 - Within the hour, I had severe heart palpitations and slight chest pain which lasted about 20 minutes. An hour later, my arm was burning and felt like ants were biting me all along my arm (from the injection site to my middle finger, pointer finger, and thumb on left hand). July 3rd - I had difficult/labored breathing, while feeling like I was about to pass out (along with heart palpitations), and that continued on and off for 2 more days (July 4th and 5th). Due to this reaction, I am unsure if I will get the second dose.


VAERS ID: 1471846 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-02
   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 - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Loss of personal independence in daily activities, Mast cell activation syndrome, Migraine
SMQs:, Dementia (broad), Hypersensitivity (narrow), Arthritis (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: Lyrica, singularity, benedryl, LDN, baclofen, klonopin
Current Illness:
Preexisting Conditions: Mast Cell Activation Disorder, EDS-H,
Allergies: Gluten, lots of pain meds, non active ingredients in meds.
Diagnostic Lab Data: Multiple doctors visits
CDC Split Type:

Write-up: Severe flare of Mast Cell Activation Syndrome Symptoms and joint hypermobilty, resulting in severe joint pain in past injuries joints, and severe daily migraine. Unable to function.


VAERS ID: 1474165 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-02
Onset:2021-07-02
   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 - / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Pain, Urinary tract infection, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12 vitamin, Multi-vitamin
Current Illness: No
Preexisting Conditions: No
Allergies: No; vegan for 10 years
Diagnostic Lab Data: None yet, have set up appointment
CDC Split Type:

Write-up: throwing up the night of the vaccine and multiple times in the following two weeks of my second dose, haven''t thrown up in over a decade history of UTI''s but haven''t gotten one in months, got one the week after getting my second dose random body aches in the following two weeks after my second dose


VAERS ID: 1474307 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-07-02
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Malaise, Nasopharyngitis, Oropharyngeal pain, Pyrexia, Respiratory symptom, 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 potassium 100 mg Amlodipine 10 mg Furosamide 40 mg Acetaminophen 500 mg
Current Illness: None
Preexisting Conditions: Arterial Hypertension
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: On the second day after getting the second dose, I started having chills, general malaise like a cold, this increased to an internal fever, a lot of nasal mucus, sore throat, and now in the chest.


VAERS ID: 1474315 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 2 LA / IM

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

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

Write-up: Patient received the Janssen COVID 19 Vaccine twice.


VAERS ID: 1474321 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-02
Onset:2021-07-02
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Echocardiogram, Magnetic resonance imaging, Transient ischaemic attack, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood Pressure statin sugar
Current Illness: none
Preexisting Conditions: HTN Type IIdiabetes
Allergies: unknown
Diagnostic Lab Data: CT, MRI, Sonogram of heart 07/03/2021
CDC Split Type:

Write-up: Suspected TIA event based upon visual symptoms. Lasting less than 1/2 hour and never reoccurred.


VAERS ID: 1474420 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: Client had received 2 doses of Pfizer. Client is on immunosuppresive therapy. Privary Care physiciaian recommened getting a dose of a different type of Covid-19 vaccination, recommended Janssen. client was over the 28 days recommended between types of vaccines for Covid. No adverse reactions occured at either the time of vaccination or after vaccination


VAERS ID: 1474450 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-02
Onset:2021-07-02
   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 EW0176 / 1 LA / IM

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

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

Write-up: Error: Wrong Patient (documentation in EMR)-


VAERS ID: 1474464 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-02
   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 EW0217 / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. T036820 / 1 LA / IM

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

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

Write-up: The patient developed a low grade fever, cellulitis, and covid arm. She was concerned and sought out medical treatment at a local emergency room who diagnosed her with covid arm and cellulitis and sent her home with antipyretics, benadryl, and antibiotics.


VAERS ID: 1474669 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-07-02
   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 - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site reaction, Rash papular, Rash pustular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: papular/pustular rash at injection site.


VAERS ID: 1474673 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-05
Onset:2021-07-02
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Premature rupture of membranes, Uterine rupture
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: O42.02 - Full-term premature rupture of membranes, onset of labor within 24 hours of rupture


VAERS ID: 1474761 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-02
   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 - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Asthenia, Chills, Dyspnoea, Fear, Feeling abnormal, Feeling cold, Feeling hot, Hyperhidrosis, Hyperventilation, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: 5 mins after receiving vaccine I felt a strong sense of heat within the muscles in my back. Soon after felt anxiety and scared so I ran to the front of pharmacy to get the pharmacist?s attention for them to call 911. I began feeling weak and started hyperventilating, feeling like I was going to die. Almost felt difficult to gasp for a full breath of air. As I got on the floor due to feeling weak, I began sweating profusely in my face, while at the same time, seeing my sweat drip on the ground like I just ran a full sprint mile. I was begging the pharmacist for some water but she refused to give me water because she thought I would choke. I was able to breathe but hyperventilating made it difficult. A couple mins passed, and I began to try my best to control my breathing by taking deeper breaths. I say about 5 mins, the paramedics arrived, but by then, all the side effects went away. Lastly, I felt the chills and very cold by the time the medics came. I got up on my own accord, went outside in the sun and felt normal again.


VAERS ID: 1446530 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-11
Onset:2021-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: 3 weeks after receiving 2nd dose. Present fever of 38.8 C, headache, cut body. Take paracetamol, 2 tabs of 500mg every 8 hours. After 24 hours more, same symptoms.


VAERS ID: 1446868 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA9090 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW2245 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Diarrhoea, Fatigue, Headache, Hyperhidrosis, Injection site pain, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 6 hours after the application of the second dose there was injection site pain. 8 hours after the application of the second dose there was fever to 38.9?C intermittent for 24 hours. 8 hours after the application of the second dose there was chills and sweating -these events 1 time- 16 hours after the application of the second dose there was diarrhea 16 hours after the application of the second dose there was nausea for 4 hours. 16 hours after the application of the second dose there was headache, muscle and joint pain, tiredness that lasted 36 hours.


VAERS ID: 1473547 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, SARS-CoV-2 test, Sudden hearing loss, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (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
Allergies:
Diagnostic Lab Data: Test Date: 20210618; Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative; Comments: No - Negative COVID-19 test
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: Sudden hearing loss, unspecified; Blurred vision; Dizziness; Nauseous; Headache; This regulatory authority case was reported by a consumer and describes the occurrence of SUDDEN HEARING LOSS (Sudden hearing loss, unspecified), VISION BLURRED (Blurred vision), DIZZINESS (Dizziness), NAUSEA (Nauseous) and HEADACHE (Headache) in an 18-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Lactation decreased. On 01-Jul-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Jul-2021, the patient experienced SUDDEN HEARING LOSS (Sudden hearing loss, unspecified) (seriousness criterion medically significant), VISION BLURRED (Blurred vision) (seriousness criterion medically significant), DIZZINESS (Dizziness) (seriousness criterion medically significant), NAUSEA (Nauseous) (seriousness criterion medically significant) and HEADACHE (Headache) (seriousness criterion medically significant). On 02-Jul-2021, SUDDEN HEARING LOSS (Sudden hearing loss, unspecified) had resolved. At the time of the report, VISION BLURRED (Blurred vision) was resolving and DIZZINESS (Dizziness), NAUSEA (Nauseous) and HEADACHE (Headache) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 18-Jun-2021, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) was unknown. Concomitant products were not provided. Treatment medication were not reported. Patient reported that sometimes when standing sudden loss of hearing and blurred vision. 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.; 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: 1440427 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / IM

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

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

Write-up: AT AN OFF SITE LOCATION HE RECEIVED MODERNA BRAND VACCINE. ON 3/14/2021 HE RECIEVED PFIZER BRAND FROM ANOTHER ORGANIZATION LOT NUMBER WAS EN6202 IN MARCH. HE UNDERSTANDS THE SERIER IS COMPLETE.


VAERS ID: 1440472 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 - / IM

Administered by: Military       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Minimum interval between doses not met.


VAERS ID: 1440488 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-09
Onset:2021-07-01
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Sore arm, fever of 100.7.


VAERS ID: 1440490 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Electric shock sensation, Hypoaesthesia, Pain, Palpitations, Paraesthesia, Pyrexia, Tension, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Six hours after receiving the vaccination, I woke up with a high fever and severe, uncontrollable shaking in my whole body. Something like quivering shock waves started to radiate from the center of my chest and shuddered out through my entire body, causing every muscle to shake uncontrollably; the shaking became increasingly violent. My heart was racing. I took deep breaths and applied a cool, wet hand towel to my forehead/neck to relax, but none of it helped. After about 20 minutes, the violent shaking was only getting worse, so I took one Aleve. The shaking continued for another 20 minutes. Finally, it became less frequent and I could tell I had a little more control but was still shivering. My thumbs were also numb and tingly for the duration of the shaking (about 40 minutes) and afterwards. Eventually I completely relaxed and fell asleep, but I am now sore from being so tense. Still have slight fever and aches.


VAERS ID: 1440499 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 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 known
Current Illness: none known
Preexisting Conditions: non known
Allergies: nkda
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient given 2nd pfizer vaccine 1 week too early


VAERS ID: 1440507 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 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: non known
Current Illness: none known
Preexisting Conditions: non known
Allergies: nkda
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient given 2nd pfizer vaccine 1 week too early


VAERS ID: 1440530 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-07-01
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 9267 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 - / IM

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

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

Write-up: pt has both vaccines and tested pos for covid on 7-1-21


VAERS ID: 1440534 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-07-01
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: sore arm, sneeze, headache, running nose
Other Medications: Multi vitamins, Vitamin C, D, Calcium
Current Illness:
Preexisting Conditions: High blood pressure
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got second dose 6/4, started normal period 6/5. Period keep going for 3.5 weeks, today it finally shows sign of slowing down and stop.


VAERS ID: 1440538 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-28
Onset:2021-07-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Erythema, Feeling abnormal, Sensory disturbance, Skin wrinkling
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Dementia (broad), 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? 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 reported via phone to be experiencing a burning sensation in the neck and face, redness skin appearance that covers a significant portion of her body, something she described as "weird" and unable to explain that''s happening to her elbows, and strange "wrinkles" on her body. Pt said she did not have a PCP, she was instructed to go to her nearest walk in clinic.


VAERS ID: 1440542 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 - / IM

Administered by: Military       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Insufficient interval between doses.


VAERS ID: 1440573 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Patient began to feel lightheaded and sweating a few minutes after getting shot. Her vitals were obtained and were stable. She was placed in recumbent position and then given juice pouch, graham crackers. After 30 minute observation period she reported feeling much better. Her repeat vitals were stable, patient discharged from site.


VAERS ID: 1440574 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Magnesium taken infrequently, probably 3 to 4 times per month.
Current Illness: N/A
Preexisting Conditions: Headaches, suspected migraines bc it runs in the family but never tested.
Allergies: Cashews, Coolwhip, cranberries
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Woke up at 3:30 am from period cramps. Went to the bathroom as this was the start of my period and I didn?t have a pad on. After going to the bathroom I was washing my hands and became nauseous which I have never experienced on my period. I became lightheaded, cold sweats and vomited bile. I have good reason to believe the vomiting was not due to my period because I have never vomited due to my period. I took peptobismol for the nausea and ibuprofen for the pain and then went to sleep.


VAERS ID: 1440582 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Feeling abnormal, Headache, Throat irritation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), 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: unknown
Current Illness: unknown
Preexisting Conditions: pt answered no on vaccine administration record and informed consent form
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: 2nd dose Pfizer shot administered at 9:37am. Pt was noticed to be really out of it near the front of the store. No previous history of allergic reactions and no issues with 1st dose. Patient said head was hurting bad and throat felt weird. Her eyes were rolling back in her head and she was in and out of responsiveness. Ice pack was given at 10:07am, EMS was called, at 10:10am bp 129/101 pulse 89, ems arrived on scene at 10:15am and took patient to the hospital.


VAERS ID: 1440596 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Intern bloodwork: HIV 4th gen Ag/Ab combo, HBsAG Hep B surface antigen, HepC, HepC RNA quantitative PCR
CDC Split Type:

Write-up: Pharmacy intern went to administer the vaccine and the patient moved her arm. Intern did not notice the syringe had punctured her glove and finger until after the patient''s vaccination was completed. The intern removed her glove and realized there was blood and a puncture from the syringe in her finger. The pharmacists on duty as well as the owner of the pharmacy contacted the patient''s mother. The intern was sent for blood work.


VAERS ID: 1440603 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Feeling hot, Hyperhidrosis, Loss of consciousness, Pallor, Skin warm, 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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: nausea
Other Medications: Patient states he does not take any medications.
Current Illness: Patient states that he has not been sick in a long time, felt fine today, with no illness today, no fever, nausea, or vomiting in the last month.
Preexisting Conditions: Patient does not have any health conditions that he is aware of.
Allergies: Patient states he has no allergies to any medications, foods, or other products that he knows of.
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient received 1st dose of Moderna, then started his 15 minute wait. 11 minutes into the wait period, patient got up and came to the pharmacy counter and said he was feeling real warm and "funny" to the pharmacy technician. The technician alerted the pharmacist and when the pharmacist looked over at the patient, he looked pail and started slouching. Pharmacist ran to patient and caught him as he started to pass out. Pharmacist laid him on the floor and by the time the pharmacist had him laying down, the patient came back awake. Patient was sweaty and very warm to touch. During this process, EMS was called. When they arrived patient was already back to normal cognition and said he felt fine other than being warm. EMS check stats and cleared him to drive home after another 15 minutes wait period. The pharmacist believes this was a vasovagal syncope reaction to this patient getting the Moderna vaccine. Patient was fully recovered within 30 minutes of the adverse reaction.


VAERS ID: 1440609 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: light headnes and down to floor but was concious and speakable and mother and patient refused to call 911 eventhough pharmacist on duty offered.


VAERS ID: 1440610 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 RA / IM

Administered by: Private       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: Adderall
Current Illness: none
Preexisting Conditions: ADHD
Allergies: Penicllian
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Given at 23 days instead of 24


VAERS ID: 1440614 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 4 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Blood glucose normal, Eye movement disorder, Hyperhidrosis, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: blood sugar 116 (07/01/2021) blood pressure 132/80 mmg
CDC Split Type:

Write-up: eyes rolled to back of head sweating: could not answer questions vomited juice


VAERS ID: 1440632 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Not enough dilution in the vial causing patient to get more than one dose.


VAERS ID: 1440637 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pruritus, Headache, Nausea, Throat irritation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Pt received the vaccine 07/01/21 at 9:50. pt went home after the shot. she called the pharmacy at 11:20 stating that she was nauseous, headache, itchy eyes and scratchy throat. pe pt discussion in the past she had and allergy to benedryl (paridoxical rxn with benedryl causing anaphylaxis). due to this I instructed her to go to the ER and seek treatment.


VAERS ID: 1440661 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / UNK RA / IM

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

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

Write-up: patient was given wrong dose of vaccine. no reaction as of 12:20pm on 7/1/21.


VAERS ID: 1440685 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-08
Onset:2021-07-01
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient scheduled himself for his first dose of Moderna. On 03/08/2021 at another vaccine site. Patient did not tell the staff that he had a vaccine. Informed us this was his first vaccine.


VAERS ID: 1440686 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Crying, Dysstasia, Panic attack, Seizure, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: STOP BY AIRPORT OFFICER PT HAVING SEIZURE IN TERMINAL D WHO JUST GOT VACCINATED. I ARRIVED TO TERMINAL D PT IS TREMBLING CRYING CAN BARELY STAND FIRE RESCUSE KEEP SAYING SHES FINE JUST A LITTLE PANIC ATTACK PT CAN BARELY STAND. PT AND PT BOYFRIEND HAS NOT EATEN SINCE YESTERDAY WILL GET SOMETHING TO EAT CLOSER TO FLIGHT GATE. DOES NOT HAVE MONEY TO TAKE LATER FLIGHT. PT REFUSE ANY FURTHER MEDICAL CARE DUE TO MONEY


VAERS ID: 1440719 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, Presyncope, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Shakiness-Severe, Additional Details: Patient had vasovagal reaction 5 to 10 seconds after administration. Patient was seated and head was supported in chair by both administering RPh and Mom. Epi-pen was on hand but not given. Both APRN''s from minute clinic came into room to assist. Patient was lied down flat on the floor. Patient was slight hypotensive with 100 OSAT and pulse of 78. Patient lied down for 5 minutes, and then was able to sit up. She sat for another 20 minutes before she felt well enough to leave.


VAERS ID: 1440728 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

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

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

Write-up: Healthcare professional called to report giving an expired dose to patient.


VAERS ID: 1440732 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (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: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Additional Details: after getting second dose of vaccine pt felt dizzy, lightheaded and little faint. pt was place on floor in supine position result in improvement of symptoms. bp and pulse was normal. emt and 911 was called to be on safe side and pt ngot checked up in ambulance in case of additional issues.


VAERS ID: 1440734 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Mother assists with history that patient''s throat felt "funny" once they return to their car after post-observation 15 mins observance. States that this is similar to when she eats certain foods namely cherry which is noted as an allergy in pt chart. Patient given 12.5mg diphenhydramine oral suspension with reported resolution of symptoms ("funny feeling in throat") after additional 15 mins observation. Patient discharged with mother.


VAERS ID: 1440735 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Additional Details: pt fainted after getting second pfizer shot. was placed in supine position/water given later. bp,pulse was normal. emt/911 called and was checked in detain in ambulance.


VAERS ID: 1440750 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

Administered by: Public       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: Metformin 500mg daily Gabapentin 100mg daily Nitrostat .4 mg as needed Mucinex 600mg as needed
Current Illness: none
Preexisting Conditions: Acute and Chronic respiratory failure Hypertension Chronic heart failure Pre Diabetes Hyperlipidemia
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Health care professional gave this patient an expired dose of vaccine.


VAERS ID: 1440765 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immune system disorder
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Weakened immune system cause unknown
Allergies: Unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Health care professional administered an expired dose of vaccine in the patient.


VAERS ID: 1440773 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Interchange of vaccine products, No adverse event, SARS-CoV-2 test positive
SMQs:, Medication errors (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: patient has reported no adverse event from her COVID vaccine. We are notifying you of an inadverdant admisnitration of the Moderna Vaccine to patient who had already received one dose fo the PFizer COVID vacccine. patient received Pfizer vaccine on 3/16/2021, developed COVID and was treated with monoclonal antibodies on 3/22/2021 . She presented for COVID vaccine and reported that she was instructed by her healthcare porvider that she could receive Moderna eben though she had started series with Pfizer. She had no reaction post vaccine and was instaructed that she had completed her mRNA vaccine series now.


VAERS ID: 1440784 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C12A / 1 RA / IM

Administered by: Public       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: Silvadene cream twice a day Nicotine 21mg Flovent 110mg 2 pumps twice daily Albuterol 1-2 puffs every 4 hours as needed Lisinopril 30 mg once daily Aspirin 81mg one daily Simvastatin 40mg once daily Metformin 500mg twice daily
Current Illness: none
Preexisting Conditions: Diabetes Hypertension Hyperlipidemia COPD
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Health care professional administered an expired vaccine to this patient.


VAERS ID: 1440794 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling hot, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Noticeably swollen lymphnode under left arm; has not yet fully subsided. Noticed a couple days after the first Pfizer COVID shot
Other Medications: Famotidine Norethindrone Vitamin D Prenatal Multivitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever & chills accompanied by nausea in the middle of the night after the shot, all continuing into the next day. Did not take temperature but especially at night felt quite warm. Did not vomit, but felt very close -- nausea was intense. Taking extra strength acetaminophen every 6 hours till symptoms cease. Mild headache and body aches.


VAERS ID: 1440806 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1) METRONIDAZOLE500MG 1 TAB BY MOUTH TWICE DAILY ; 2) OLANZAPINE [ZYPREXA]2.5 MG TAKE 1 TABLET BY MOUTH EVERY NIGHT AT BEDTIME 3) hydrOXYzine PAM50MG; 1 CAP BY MOUTH TWICE DAILY 4) METFORMIN500MG 1 TAB BY MOUTH TWICE DAILY
Current Illness: None
Preexisting Conditions: Diabetes Mellitus 2; Unspecified psychotic disorder
Allergies: No Kknown Drug allergies
Diagnostic Lab Data: No medical tests. Vitals will be monitored
CDC Split Type:

Write-up: She received Pfizer dose on 5/11/2021 lot number EW0171. She received Moderna as a second dose. No adverse reaction noted at the time of the report.


VAERS ID: 1440807 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site swelling, Injection site warmth, Lymphadenitis
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, Blisovi Fe, Cylobenzaprine, Duloxetine, HCTZ, Naproxen
Current Illness: none
Preexisting Conditions: none
Allergies: no known allergies.
Diagnostic Lab Data: I advised the patient to seek medical attention due to potential risk of infection.
CDC Split Type:

Write-up: the patient came in to the pharmacy and indicated that she is having swelling at the injection site and that it is hot to the touch. The patient also noticed inflammation of local lymph nodes.


VAERS ID: 1440825 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

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

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

Write-up: Pt came into observation area at 11:04 am, after 15mins, Pt left observation area on route home. Pt came back at 11:22am with rash to b/l upper extremities and upper back. Vitals obtained and 25mg PO Benadryl administered. Pt has no compliant of shortness of breath and chest pain. Pt vitals obtained 3 more times. Pt rash spread to right breast and lower back. Benadryl 25mg PO administered again, vitals reobtained. Pt has no further complaints at this time of shortness of breath or chest pain. Pt reports that she took Buspar prior to arriving to facility for Covid vaccine and cipro antibiotic for urinary tract infection. Pt vitals reobtained at 12pm and no further interventions needed at the time. Pt reports NO shortness of breath or chest pain. Pt assessed an noted with no respiratory distress. Pt left facility at 12:05pm in route home with family at side. Last set of vitals noted to be BP 135/70 , HR 100, RR 17, temp 97.9, o2 sat 100% on room air.


VAERS ID: 1440827 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: After administering the vaccine and getting ready to enter the shot into the system, it was discovered the patient had already received a dose of Janssen COVID vaccine in March 2021. Patient had answered no to receiving any other vaccines on intake form. He waited 15 minutes after administration with no adverse effects noted. He was also informed he would not need the second Pfizer vaccine, since he was already considered to be fully vaccinated according to current health guidelines.


VAERS ID: 1440861 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: blood pressure 201/118
CDC Split Type:

Write-up: Patient immediately felt dizzy and like she was going to faint/ pass out. Checked patient''s blood pressure 5 minutes later and it was 201/118. Patient said she started having blurry vision about that same time. Called ED and patient was taken by EMS.


VAERS ID: 1440863 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Erythema, swelling, itching of upper arm surrounding administration site. Tingling to fingers of administration arm.


VAERS ID: 1440873 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Patient was feeling dizzy when walking in the parking lot to the car with his father about 15 minutes after his first Pfizer Covid19 vaccine. He sat down for a few seconds and felt ok but when he went to stand up to continue walking he passed out. They did not re-enter the store. He regained consciousness and went home. His father was with him and is observing him at home.


VAERS ID: 1440881 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Extremity contracture, Fall, Hypotension, Seizure, Unresponsive to stimuli, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin & Sulfa antibiotics
Diagnostic Lab Data: 88 BPM (heart rate) 98% O2 saturation (measured via OTC pulse ox machine)
CDC Split Type:

Write-up: Following administration of the vaccine, the patient and his wife were seated and I requested they remain seated for 15 min after because I had recently had someone with a fear of needles collapse after their shot, at which point I had already counseled on the things to expect afterward but the patient stopped responding and slumped over. I was unsure if he was breathing as his wife was cradling his head, so I shouted for a technician to call 911. I heard a sound that I perceived to be wheezing and administered an epipen at which point the patients limbs began to contract so I then suspected it was a seizure. We lowered the patient to the ground and shortly after he became responsive. He was able to state his name and date of birth and breathing was unlabored. Pulse ox was 98 and HR was 88 BPM before EMS arrived. They examined the patient and determined it was "anxiety induced response" but also noted that the bloodpressure was "very low" which is consistent with anaphylaxis, but I did not examine the patient at that time. He was sent home afterward.


VAERS ID: 1440901 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 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: NO HX
Preexisting Conditions: NO HX
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type: H219

Write-up: PATIENT UNDER AGE FOR APPROVED VACCINE. DENIES ANY SYMPTOMS AT THIS TIME. SPOKE WITH GUARDIAN . SHE WAS INFORMED AND V/U OF WHAT HAPPEN. GUARDIAN HAD NO QUESTIONS AND WAS OK WITH INCIDENT. INCIDENT REPORT FILED WITH .


VAERS ID: 1440907 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Euphoric mood, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt stated her feet felt numb and felt overall high. Doctor addressed pt and advised pt to eat crackers as well as wait 15 minutes after. Pts vitals were stable.


VAERS ID: 1440911 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-07
Onset:2021-07-01
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

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

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

Write-up: Patient had received a J&J vaccine on 3/7/2021. Patient had self scheduled in the vaccine clinic on 7/1/2021.. Patient informed staff this was his first vaccine. Moderna vaccine given to patient. When entering information on system, we noted the Janssen vaccine under patient name with same birth date and same address.


VAERS ID: 1440917 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Unknown  
Location: D.C.  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

Write-up: Due to administrative member/ electronic documenter being late, two members received their second dose of Pfizer one week earlier than the 21 Days.


VAERS ID: 1440920 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Fatigue, Neck pain, Pain, Renal pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)

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

Write-up: Chest pain, right sided kidney pain. Pain is pressure like with radiation to the left neck. Also with fatigue.


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