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

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



Case Details (Reverse Sorted by Onset Date)

This is page 365 out of 6,867

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VAERS ID: 1470158 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Disorientation, Hyperhidrosis, Tinnitus, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza vaccine on 11/11/2016 Lot # 53T43 IM left arm during office visit. immediately after diaphoresis, felt dizzy and unawa
Other Medications: Took Lorazepam 0.5 mg 2 hours prior to vaccination to prevent vasovagal reaction
Current Illness: none noted
Preexisting Conditions: HX of vasovagal episode following influenza vaccine at age 9
Allergies: Dexamethasone (causes diaphoresis and hallucinations)
Diagnostic Lab Data: none
CDC Split Type:

Write-up: ~10 mins post vaccine became diaphoretic, described a buzzing in his ears, and was not aware of where he was, talking throughout, no LOC, BP stable 100''s/60''s, sats 98-99%, no respiratory distress, vomited a moderate amount and immediately felt better. Seen by PCP on site immediately following episode.


VAERS ID: 1470162 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-01
Onset:2021-07-14
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Dyspnoea, Headache, Pain, Pneumonia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcistrate 315mg/vit D 200 units PO BID celecoxib 200mg PO BID cholecalciferol 1250 units PO weekly gabapentin 600mg PO qHS hydroxychloroquine 200mg PO BID lidocaine 5% ointment AA BID prednisone 10mg PO daily lisinopril 40mg PO qAM cetir
Current Illness:
Preexisting Conditions: HTN vit D deficiency systemic lupus erythematous Sjogren''s syndrome recurrent UTI
Allergies: Mango, bee sting
Diagnostic Lab Data: COVID(+) 7/6/21 at (outside facility) COVID(-) 7/13/21 at Medical Center O2 96% 7/14/21
CDC Split Type:

Write-up: Despite completing COVID19 vaccine series in March, the oatient developed bodyaches, headache, congestion and was diagnosed with COVID(+) pneumonia. She is currently hospitalized with dyspnea and bilateral multilobal pneumonia.


VAERS ID: 1470203 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-12
Onset:2021-07-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Headache, Immediate post-injection reaction, Injection site pain, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sucralfate, Lansoprazole, Colesterol, Qsymia, Iodine, Berberine, multi vitamine, calcium, omega oil/C Q10, vitamin D, melatonin, Ambien, Tylenol, Femring, Testosterone, Valacyclovir, calcium, probiotic,
Current Illness: none
Preexisting Conditions: back pain
Allergies: hydrocodone no food allergies
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Immediate strong pain from injection that dissipated after 10-15 minutes; next morning low grade fever and moderate headache and moderate muscle/joint/body aches. Most symptoms dissipated after 3-4 hours after taking Advil.


VAERS ID: 1470272 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004CZ1A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Hyperventilation, Impaired work ability, Lethargy, Malaise, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), 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:

Write-up: After the vaccine 4 hours later I started to hyperventilate. Woke up next morning throwing up, diarrhea , extreme lethargy, muscle aches and absolutely no energy. I''ve missed 3 days of work and I can''t get out of bed I''m so sick. I can''t provide for my family in the shape I''m in. I truly need help. My medical doctor told me yesterday all my symptoms WERE VACCINE RELATED


VAERS ID: 1470281 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-07
Onset:2021-07-14
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac monitoring normal, Cardiac stress test normal, Echocardiogram normal, Electrocardiogram normal, Feeling abnormal, Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Cardiomyopathy (broad), Dehydration (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, Amlodipine, Pantoprazole, Bystolic, Simvastatin, calcium, vitamin D, align
Current Illness: I was feeling fine.
Preexisting Conditions: Hashimoto''s disease High blood pressure High cholesterol
Allergies: Demerol
Diagnostic Lab Data: heart monitor for 48 hours, echocardiogram, several EKG''s, and a stress test
CDC Split Type:

Write-up: I began having a high heart rate and I felt my heart beating out of my chest. Heart rate was up to 115. I felt pretty weird. I went to cardiologist and had all the cardiac tests done: wore a heart monitor for 48 hours, echocardiogram, several EKG''s, and a stress test. All the tests came back normal. But I still didn''t feel good. Cardiologist put me on Bystolic and it helps.


VAERS ID: 1470302 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-25
Onset:2021-07-14
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (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: metoprolol, lisinopril/hctx, citalopram, gemfibrozil
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came in on 7/14/21 complaining of mumbnes in his left side of neck shoulder an arm


VAERS ID: 1470306 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 / 1 LA / IM

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

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

Write-up: Patient received the Pfizer vaccine and is only 10yrs old in error.


VAERS ID: 1470319 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-07-12
Onset:2021-07-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (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
Allergies: NKA
Diagnostic Lab Data: Patient was advised to seek medical help
CDC Split Type:

Write-up: Patient is experiencing chest pain and pressure, increased heart rate.


VAERS ID: 1470322 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-01
Onset:2021-07-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Fatigue, Headache, Oropharyngeal pain, Pain, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Moderne COVID-19 vaccine EUA Sore and swollen throat Achy Fatigue , weak Light headache


VAERS ID: 1470356 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-27
Onset:2021-07-14
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Crying, Dyspnoea, Gait disturbance, Menstrual disorder, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (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: Pro air Zyrtec Albuterol
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Seasonal Cats Dust mites
Diagnostic Lab Data: None to date.
CDC Split Type:

Write-up: Pt. called me crying in pain saying her stomach hurts and she''s having trouble walking. She said she has her menstrual cycle and it has never been this bad. She said she didn''t get it last month at all. Prior to this, she said her cycles were normal. She also had pain in her thighs and trouble breathing which resulted in her needing her rescue inhaler. At this time she has been given ibuprofen and is resting with a heating pad. I as pts. mom am concerned that this may be related to vaccine.


VAERS ID: 1470362 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

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

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

Write-up: Patient was given Pfizer as her first dose at another location but was given Moderna as her second at another facility. Patient was held for 30 minutes and reported that she felt fine. Moderna was contacted for directives. Per Moderna, patient does not need any other doses and patient was informed.


VAERS ID: 1470369 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0175 / 1 OT / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dizziness
SMQs:, Anticholinergic syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: light headed, chest pain. Evaluated by EMS- Refusal to transport.


VAERS ID: 1470370 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-13
Onset:2021-07-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / IM

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

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

Write-up: Open vial on 07/12/2021 at 9:00 am. Use by expiration date is 07/12/2021 at 9:00 pm. Vaccine was administered from open vial on 07/13/2021 at 1:15 pm. Patient was called and informed. She is doing well no adverse side effect noticed during her 15-30 minute wait period at time of administration and called today 07/14/2021 at 10:00 am, patient has no adverse side effects.


VAERS ID: 1470372 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, 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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient received first dose of Pfizer COVID-19 vaccination. She was asked all the appropriate questions prior to administration. She had no past experiences or allergies that would be a cause for concern. After administration she expressed confidence that she felt fine. She went to the waiting area to wait 15 minutes prior to exiting the pharmacy. Within 5 minutes her mother notified the pharmacist that she passed out. Upon examination, she indeed fainted while sitting in a chair. The pharmacist called 911 while an intern when to check her vitals. Within 30 seconds, the patient awoke and was a little confused but felt better. Paramedics came and she was checked out and sent home with her mother.


VAERS ID: 1470383 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-16
Onset:2021-07-14
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure fluctuation, Chills, Diarrhoea, Electrocardiogram, Pain, Pharyngeal swelling, Pyrexia, X-ray
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: FLU VACCINE
Other Medications: COVID VATAMINS, ZINC, VITAMIN D, VITAMIN C
Current Illness: FIBROID SURGERY,
Preexisting Conditions: POSITIVE FOR COVID-19 APRIL 5TH 2021. TESTED NEGATIVE ON APRIL 26TH 2021
Allergies: PENICILLIN, ASPIRIN, FLU VACCINE REACTION, ANESTHESIA
Diagnostic Lab Data: EKG, XRAY, OXIGEN SUPPLY,
CDC Split Type:

Write-up: BODYACHES, SWOLLEN THROAT, CHILLS, DIARHEA, FEVER 100, BLOOD PRESSURE HIGH AND LOW.


VAERS ID: 1470386 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0196 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, levothyroxine, loratadine, meclizine
Current Illness:
Preexisting Conditions: asthma, hypothyroid
Allergies: morphine
Diagnostic Lab Data: HR and BP
CDC Split Type:

Write-up: patient was dizzy shortly after vaccine, then symptoms subsided after deep breathing and relaxation. Ten minutes later patient became tachycardic to 160 bpm and was brought to ED


VAERS ID: 1470389 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O21B21-A / 2 - / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given 2nd dose of vaccine 1 week early.


VAERS ID: 1470398 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / N/A LA / IM

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

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

Write-up: Patient came in today (7/14/21) to receive 2nd dose of Moderna after receiving 1st dose on 6/14/21. Front staff and vaccinator did not notice she received Moderna and she was given a dose of Pfizer on accident. We monitored her for 20 minutes and she had no adverse reactions. She was advised by me not to receive a 2nd dose of Moderna or Pfizer. I explained how the MOA of both brands are similar. She was given our information to contact us with any questions or concerns.


VAERS ID: 1470428 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: PATIENT WAS GIVEN JANSSEN COVID-19 VACCINE AND SHE IS 17 Y.O.. APPROVED AGE FOR JANSSEN IS 18+


VAERS ID: 1470442 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / IM

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

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

Write-up: Patient became very dizzy and light-headed a few minutes after receiving the vaccine, and fell to the ground. Patient reported feeling dizzy and was very pale. He did not lose consciousness. We helped him to a chair and observed him for another 30 minutes. He was given some water and candy. After 30 minutes, the color returned to his face and he reported feeling better.


VAERS ID: 1470454 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 / 3 LA / IM

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

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

Write-up: Patient stated on consent form she has never received the vaccine she was receiving. When went to log it into our state registry she had previously received two other doses of COVID-19 Pfizer on 1/24 and 2/14. I think called pt and she did confirm this was her third. Her response was in Israel they are doing 3 doses for immunocompromised people were getting 3rd doses (pt just finished chemo) and she has been getting antibody tests every month. First 3 months she had antibodies and now third month she did not.


VAERS ID: 1470460 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, 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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Additional Details: Patient passed out in waiting area 5 minutes after being given vaccination. 911 was called, NP assisted, patient came to and was given water and something to eat. Paramedics checked vitals and patient was okay to leave on her own.


VAERS ID: 1470464 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / UNK - / IM

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

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

Write-up: PATIENT HAD SYNCOPY 15 MINUTES AFTER RECEIVING VACCINE. THERE WAS A FEW SECONDS OF CONVULSION BUT PATIENT regained consciousness right after, breathing was normal. patient was alert and not disoriented. no medical treatments were given.


VAERS ID: 1470479 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0191 / 2 LA / IM

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

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

Write-up: Vasovagal reaction to vaccine, dizziness, diaphoresis, pale. Had client lie down and raised legs. Lasted 4-5 minutes. Completely recovered


VAERS ID: 1470489 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0179 / 2 LA / IM

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

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

Write-up: Pt was in for her second COVID vaccine at our COVID clinic. Her first dose was Moderna. Pt was given Pfizer for her second dose. Administration error.


VAERS ID: 1470511 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test negative
SMQs:, 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: unknown
Current Illness: unknown
Preexisting Conditions: immunocompromised
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient previously received both doses of Moderna and tolerated well. patients doctor ran spike protein test to verify immunity, even though patient is immunocompromised (therefore he was originally told the efficacy could be decreased). Patient states he was not immune and needed another dose of vaccine. patient and doctor were explained what the EUA allowed for us to do. Dr wrote script for patient to receive a dose of j&j vaccine.


VAERS ID: 1470512 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0191 / 2 LA / IM

Administered by: Private       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:
Current Illness:
Preexisting Conditions: HTN s/p CVA wheelchair-bound s/p MVA Type 2 DM Obesity CAD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient previously received Moderna vaccine on 6/23/2021. Patiwnt mistakenly given Pfizer vaccine 21 days later. No immediate adverse reactions noted by patient who was informed of administration error.


VAERS ID: 1470545 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Gait disturbance, Immediate post-injection reaction
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Immediately after injection patient began complaining of dizziness. VS WNL. After 15 minutes of sitting, patient got up to walk out and reported difficulty walking. Monitored patient another 15 minutes and symptoms resolved.


VAERS ID: 1470561 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-12
Onset:2021-07-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site swelling, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Redness and swelling at injection site 2 days following injection fever, nausea and fatigue 1 day following injection


VAERS ID: 1470566 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-13
Onset:2021-07-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, Pulse absent, Respiratory arrest, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (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: acidophilus advair albuterol sulfate atrovent benadryl carvedilol celebrex chlorpromazine cholecalciferol colace combivent b-12 dicloxacillin diltiazem pepcid lasix hydroxychloroquine levofloxacin levothyroxine lorazepam losartan morphine m
Current Illness: copd,pulmonary fibrosis,sicca syndrome,CHF,HTN
Preexisting Conditions: GERD
Allergies: cefuroxime axetil,nitrofurantoin,rocephine,sulfa,nickel
Diagnostic Lab Data: CXR 7/14/21
CDC Split Type:

Write-up: During the morning hours of 7/14/21 patient became increasingly SOB and eventually went unresponsive, with no pulse or respirations, CPR initiated and EMS transported to Medical center.


VAERS ID: 1470583 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EQ0177 / 2 RA / IM

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

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

Write-up: None


VAERS ID: 1470590 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient has fainted after receiving bloodwork, NOT VACCINE, in past
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted a few minutes after vaccine.


VAERS ID: 1470601 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dry mouth, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: N/A
Preexisting Conditions: TYPE 2 DIABETES
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient suddenly felt sick - dizzy and nauseous - complained of dry mouth - gave a bottle of water and also checked blood pressure 117/84 HR 90 - no sign of breathing difficulty


VAERS ID: 1470602 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: The patient received the Janssen Covid-19 vaccine after already receiving the Moderna COVID-19 Vaccine series. The patient never disclosed that he already received Moderna. No adverse events or side effects have been reported. The patient is aware to monitor and report any changes.


VAERS ID: 1470603 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Oxygen sat 98%.
CDC Split Type:

Write-up: After vaccinating, light headed and a little swelling in throat but says it happens out of the blue to him at times. Took Claritin and was fine. O2 sat 98%.


VAERS ID: 1470624 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0186 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Heat therapy, Hyperhidrosis, Lung disorder, Presyncope, Pruritus
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen 400mg po q8 prn pain. Zyrtec 10mg po daily.
Current Illness: Hx of CoVID-19 (symptomatic 23JUN21, + PCR 27JUN21)
Preexisting Conditions: Currently receiving Venom Immunotherapy (VIT) vaccine for allergic reaction to bee venom, last doses given 12JUL21.***Venom Immunotherapy (VIT) vaccine given 12JUL21**** Administered 1ml SQ RX 02204609 honey bee 100mcg vial per schedule maint in Right arm Administered 1ml SQ RX02204611 mixed vespid 300mcg vial per schedule maint in Left arm Administered 1ml SQ RX 02204612 wasp 100mcg vial per schedule maint in Right Upper arm
Allergies: Anaphylaxis to Bee stings
Diagnostic Lab Data: Pt given 0.3mg of Epinephrine at 1418 on 14JUL21in R thigh via epi-pen.
CDC Split Type:

Write-up: Pt is a 19 y/o F who suddenly endorsed feeling dizzy, hot, short of breathe, and peri-oral itchiness ~ 10min after receiving first dose of Pfizer vaccine (done at 1357). PMHx pertinent for hx of anaphylaxis to bee stings, currently being treated with allergy shots, last injections given 12JUL21. Pt was immediately evaluated, with initial VS done at 1415 with BP 110/70, SPO2 99%, HR of 94, RR $g20. Endorse chest tightness. Lungs CTA B/L, pt noted to be diaphoretic. Patient had a near syncopal episode and was placed in supine position and given an epi-pen 0.3mg at 1418. EMS was called. Repeat VS at 1420 found BP of 115/60, SpO2 100%, HR 100, RR $g20. Lungs still CTA b/l. Patient endorsed improved SOB and less peri-oral itching. Chest tightness improved, Pt was AOX3. EMS arrived at 1435, pt stable. Transferred pt to EMS.


VAERS ID: 1470628 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: AMOXIL
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT RECEIVED SHOT. FEW SECONDS LATER HE FAINTED. PHARMACY CALLED 911. PHARMACIST CHECKED PULSE AND PT WAS DOING OK. NO EPIPEN WAS GIVEN. EMS TOOK PATIENT TO THE HOPSITAL TO GEIT IT CHECKED OUT.


VAERS ID: 1470637 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0196 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Rash, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Rash within minutes that led to coughing uncontrollably and her throat felt "weird"


VAERS ID: 1470650 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hyperhidrosis, Hypotension, Loss of consciousness, Pallor, Tremor
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), 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: NONE
Preexisting Conditions: NONE
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: FIRST COVID VACCINE WAS SUCCESSFULLY ADMINISTERED & WHILE PATIENT STILL SEATED IN CHAIR, BEGAN TO FALL TO ONE SIDE. THE IMMUNIZER GRABBED HIS ARM SO THAT HE WOULDN''T FALL OVER AND NOTICED HE WAS SHAKING. HE QUICKLY GAINED CONCIOUSNESS AND WAS BREATHING NORMALLY AND AWARE. HE WAS VERY PALE AND SWEATING & WHEN WE CHECKED HIS BP IT WAS LOW. WE ALSO APPLIED ICE PACK TO HIS FOREHEAD, BACK OF NECK AND WRISTS & CALLED EMS. THEY ARRIVED AND CHECKED PATIENT AND EVERYTHING WAS NORMAL.


VAERS ID: 1470654 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0198 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Immediate post-injection reaction, Neck pain, Refusal of treatment by patient
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient denies
Current Illness: Patient denies
Preexisting Conditions: Patient denies
Allergies: Iodine Morphine
Diagnostic Lab Data: VS with RN, EKG w/EMS
CDC Split Type:

Write-up: Immediately post vaccination @ 1217, Pt c/o chest pain that radiates to left arm & up left side of neck. EMS called. Initially pt states pain 6/10, denies any other Sx. Pt VS @ 1219: 132/60, HR 75, O2 99% RA, RR 16, 98.7. @ 1220 states 3/10, @ 1230, prior to EMS arrival, pt states 0/10. EMS arrival @ 1235, EKG NSR, per EMS, pt refuses hospital transport & signs AMA form. Pt d/c w/family & spouse @ 1248.


VAERS ID: 1470662 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-25
Onset:2021-07-14
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Extra dose administered
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (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: Alprazolam, Lunesta, Sildenefil
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse events reported but patient previously received two doses of Moderna on 2/14/21 and 3/15/21 at a different pharmacy. He wasn''t aware that he was already fully vaccinated. He asked for and received first dose of Pfizer on 6/25/21 and we discovered that he shouldn''t have when he came in for his 2nd dose of Pfizer. Patient reported no side effects or issues. However, he was very confused.


VAERS ID: 1470669 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

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

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

Write-up: Administration error - Patient was given the COVID-19 Janssen vaccine at 17 years old (only approved for $g/= 18 at this time). No adverse reaction has been observed or reported at this time.


VAERS ID: 1470687 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ferrous Sulfate Supplement (does not take daily)
Current Illness: None
Preexisting Conditions: "Low Iron"
Allergies: None
Diagnostic Lab Data: Blood Pressure Heart Rate Pulse Oximetry
CDC Split Type:

Write-up: Patient had syncope episode, brief (less than 10 second) loss of consciousness.


VAERS ID: 1470688 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Unknown  
Location: Arkansas  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0173 / 1 LA / IM

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

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

Write-up: 0.3ml of UNDILUTED Pfizer Vaccine was administered to patient. Patient was monitored for an hour with no adverse reactions noted. Patient had no complaints. Vital Signs stable. Patient instructed and signed up for V-Safe. Instructed to report symptoms to V-Safe and Provider if needed.


VAERS ID: 1470691 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Oropharyngeal discomfort, 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: Diabetes, Asthma, Obesity
Current Illness: Migraines, Acid Reflux
Preexisting Conditions: Diabetes, Obesity, Asthma
Allergies: Toradol, Iodine, Shellfish, Lobster, Fish, Milk, Tomatoes, Watermelon, Peanuts
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. reported itchy throat and the feeling of her throat closing at 1:40 PM. Diphenhydramine HCl 50 mg. (1 capsule) was given orally. Pt reported symptoms had subsided at 2:00 PM. Prescription Info: Exp. Date: 08/2021 and Lot # 182681


VAERS ID: 1470699 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0180 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac monitoring, Dyspnoea, Hypoaesthesia oral, Sinus rhythm, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: Pt had Pfizer covid vac this morning at 10:25 am. She tolerated injection well, waited 15 mins and left w/o symptoms. Her uncle drove her back to clinic at approx 11:13 am with pt stating she was SOB, throat felt like it was closing and her lips felt numb. Epi autoinjector pen 0.3mg was administered at 11:14 am and RN arrived on scene at that time and VS were taken: 134/89-104-99%. Pt verbalized less difficulty breathing, and no longer feeling throat closing. RN and Dr. arrived and MD provided assessment. Pt was taken to treatment room via w/c and placed on table. Pt was monitored and transported to ER when EMS arrived.


VAERS ID: 1470715 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Dizziness, Exposure during pregnancy, Feeling hot, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypoglycaemia (broad)

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

Write-up: Pt is approximately 5 months pregnant. She started experiencing dizziness, sweatiness, warmth, and heavy feeling to her body about 5 minutes after receiving the vaccine. Patient has a history of anxiety. After resting in the counseling for about 10 minutes. Patient reported feeling better. Water bottle was given to her and she was observed at all times. Pt reported her first reaction to the Pfizer vaccine was a sore arm.


VAERS ID: 1470723 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

Administered by: Work       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: This patient received her first dose on June 30, 2021. She is a healthcare worker at a long term care facility. The administrator was notified that the on-site clinic would be held at the facility on 07/14/2021, and the administrator told the employee to appear that day for the second shot. The screening form was completed after the time vaccination was given. It was during that time that it was noted that the first dose had transpired 2 weeks, not 4 weeks, prior to the second being given. Patient was asymptomatic and monitored for the required time. Notified her that CDC would be contacted via VAERS and we would advise her accordingly. CDC was contacted via phone this day and CDC technician reported that patient was considered "fully vaccinated" and reminded this writer to complete the VAERS.


VAERS ID: 1470726 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

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

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

Write-up: Pt is 16 yrs old and given Pfizer on 6/16/21 for the first dose and Moderna for the second dose on 7/14/21


VAERS ID: 1470736 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Discomfort, Dizziness, Hypotension, Malaise, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: unkown
Current Illness: unknown
Preexisting Conditions: unkown
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 2-3 minutes after receiving her vaccine this patient began feeling nauseas and dizzy. We had her put her head between her legs and then moved her to laying down with her feet elevated about 30 seconds later when she wasn''t feeling any better. She never lost consciousness and never vomited. Patient was speaking well and alert the whole time but didn''t feel comfortable sitting up. Her blood pressure was on the low side but patient said she runs low ( it was ranging between high 80''s/60''s to 110''s/60''s ) After approximately 30 minutes of not feeling better we called 911 and the EMS came and evaluated her. Her vitals were all fine and the patient declined going to the hospital. She was able to stand at that point and walked out of the store.


VAERS ID: 1470741 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

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

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

Write-up: Modern Covid-19 vaccine administered to a 14 year old child


VAERS ID: 1470751 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Injection site hypoaesthesia
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: patient felt very dizzy and faint immediately after receiving the vaccine. She said her arm where she got the vaccine felt numb. her blood pressure was 88/54 HR 60 O2 98 when first checked. her BP was checked every 5 minutes for 30 minutes and was in the range of 88/54 -118/93 her HR was 60-75 and her O2 remained in the 96-99 range. She was given an icepack to put on her arm, a cold towel for her forehead and neck and she lay down on the floor. her feet were elevated the entire time she was lying down. She eventually was able to sit up and said was feeling better. her final bp reading was 118/93 HR 75 O2 99


VAERS ID: 1470755 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Pt received J&J vaccine at 4:15p (no allergies/no previous reaction to vaccine) She felt dizzy shortly after; water was provided. Within 5 minutes patient become limp, unconscious and was not responding. 911 was called to respond; within 20 seconds, she became conscious again and was alert and responding (she knew her name and where she was at). Police, then fire department arrived to take patient''s vitals. Everything was normal and she signed off to refuse additional medical attention. Patient felt fine when she left the pharmacy.


VAERS ID: 1470757 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0217 / 1 LA / IM

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

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

Write-up: PATIENT RECEIVED J&J VACCINE FROM MECKLENBURG COUNTY HEALTH DEPARTMENT. HE DID NOT FILL OUT ANY INFOMATION IN VACCINE CONSENT FORM. HE RECIVED PFIZER VACCINE. HE WANTED TO HAVE MRNA VACCINE ON TOP OF J&J VACCINE. Pharamcist is reporting duplication of vaccine.


VAERS ID: 1470766 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C321A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: today (7/14/21) patient came in for a second Covid 19 vaccine dose (1st dose -given 6/23/21- was Pfizer''s Covid 19 vaccine). The dose given today was Moderna Covid 19 (in error)


VAERS ID: 1470767 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0168 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Sensation of foreign body
SMQs:, Anaphylactic reaction (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: no illness at time of vaccination- unknown illness prior
Preexisting Conditions: none noted
Allergies: none
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: symptoms of lump in throat 17 mins after vaccination given. Zyrtec 10mg po given at 1303. outcome: no improvement or worsening of symptoms - was transferred to the PEDS dept.


VAERS ID: 1470769 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 ER8736 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Paraesthesia oral, Speech disorder
SMQs:, Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: upper respiratory infection 3-4 weeks ago
Preexisting Conditions:
Allergies: Tree nut allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 29 minutes after vaccine administration, patient complained of tingling on the sides of her tongue. She was speaking normally, breathing was regular and unlabored. Vital signs @ 1420 were: BP- 137/59, HR 61, RR 16 breaths/min, O2 Sat 97% Patient stated she was very anxious about getting vaccine and thought symptoms wee due to "nerves." We continued to observe. At 1434 Patient stated, "my whole tongue feles tingly and its hard to talk." She continued speaking with me without any change in voice, her breathing remained unlabored. We gave patient one 25 mg tablet of Benadryl. Vital signs were: BP 152/63, HR 69, RR 12 breaths per minute, steady and unlabored, SpO2 99% At 1510 patient said she was feeling better. Vital signs: BP 134/56, HR 60, RR 14, SpO2 98%. At that point patient said she felt ok to leave. She carries Benadryl and epi pen with her at all times for nut allergy and verbalized understanding of when and how to use her medications if needed. She said she has a telephone visit set up with her allergist in August. I told her she would need a note from her allergist to be receive 2nd vaccine.


VAERS ID: 1470781 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0127 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaZOLAMIDE (DIAMOX) 125 MG Tablet ALPRAZolam (XANAX) 0.25 MG Tablet BuPROPion HCl 200 MG TABLET SR 12 HR buPROPion SR (WELLBUTRIN SR) 150 MG TABLET SR 12 HR Cholecalciferol (VITAMIN D) 2000 UNIT Tablet DULoxetine (CYMBALTA) 60 MG Capsule
Current Illness: n/a
Preexisting Conditions: Cardiovascular HTN (hypertension), benign 7 years ago Endocrine Hypothyroid 7 years ago Musculoskeletal Other intervertebral disc degeneration, lumbar region 10 months ago Metabolic Hypovitaminosis D 7 years ago Mental/Behavioral Health Anxiety 5 years ago Other Ganglion cyst 12 years ago Fibromyalgia 7 years ago
Allergies: Medication allergy Gabapentin No severity specified - Swelling Medication allergy Lyrica [pregabalin] No severity specified - Swelling Medication allergy Spironolactone No severity specified - Rash, Swelling Medication allergy Sulfa Antibiotics No severity specified - Other (see Comments), Rash
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt stated she felt her tongue was swelling. VSS BP 146/87 p88 r16 O2 sats 99% room air. Seen by Dr, pt instructed to take antihistamine. Pt discharged to home. Instructed to take antihistamine prior to next dose


VAERS ID: 1470782 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0196 / 3 LA / IM

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

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

Write-up: Patient received Pfizer COVID vaccine. Per protocol, sat in chair outside pharmacy for 15 minutes. Upon being asked by the technician if he felt dizzy or funny at all, the patient responded no and the tech informed him he was free to go. A few minutes later, around noon, as he was walking in the OTC area, the patient fell in a prone position and said he was dizzy and fell. He was conscious and coherent the entire time. We took his blood pressure and blood sugar readings after the patient was moved to a bench in a seated position and the readings were normal. Patient stated he did not want us to call anyone to drive him home.


VAERS ID: 1470795 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0178 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Erythema, Nasal pruritus, Pruritus, Respiratory tract congestion, Swelling face
SMQs:, Anaphylactic reaction (narrow), 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: the first dose of Pfizer, 3/26/2021 lot # ER8733
Other Medications: baclofen (LIORESAL) 20 mg tablet celecoxib (CeleBREX) 200 mg capsule diclofenac sodium (VOLTAREN) 1 % topical gel EPINEPHrine (EPIPEN) 0.3 mg/0.3 mL (1:1,000) injection fondaparinux (ARIXTRA) 10 mg/0.8 mL injection syringe hydrOXYchloroQUIN
Current Illness: Circulatory Pulmonary embolism (CMS/HCC) Endocrine, Nutritional and Metabolic Vitamin D deficiency Severe obesity (BMI 35.0-39.9) with comorbidity (CMS/HCC) Hematology and Immunology Factor V Leiden mutation Neurology Bilateral carpal tunnel syndrome Chronic back pain post laminectomy Musculoskeletal and Connective Hypermobility syndrome Leg length discrepancy Sjogren''s syndrome Possible dx, has sicca symptoms, abnormal Schirmer test Fibromyalgia Other History of rheumatoid arthritis History of juvenile rheumatoid arthritis Allergy to yellow jackets History of deep venous thrombosis recurrent History of CVA (cerebrovascular accident) History of 2019 novel coronavirus disease (COVID-19)
Preexisting Conditions: Circulatory Pulmonary embolism (CMS/HCC) Endocrine, Nutritional and Metabolic Vitamin D deficiency Severe obesity (BMI 35.0-39.9) with comorbidity (CMS/HCC) Hematology and Immunology Factor V Leiden mutation Neurology Bilateral carpal tunnel syndrome Chronic back pain post laminectomy Musculoskeletal and Connective Hypermobility syndrome Leg length discrepancy Sjogren''s syndrome Possible dx, has sicca symptoms, abnormal Schirmer test Fibromyalgia Other History of rheumatoid arthritis History of juvenile rheumatoid arthritis Allergy to yellow jackets History of deep venous thrombosis recurrent History of CVA (cerebrovascular accident) History of 2019 novel coronavirus disease (COVID-19)
Allergies: AlbuterolAnaphylaxis Other AllergenOther (See Comments), Anaphylaxis AspirinNausea And Vomiting, Other (See Comments) ErythromycinUnknown HydromorphoneItching MeperidineHives, Unknown Methotrexate (Bulk)Hives, Rash-Mild MorphineOther (See Comments)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Received second dose of Pfizer vaccine at 5:29pm on July 14, 2021, at 5:42pm patient began to have facial itching, cough, congestion, nasal itching, facial swelling, facial redness vitals taken BP 144/80, 98 O2 on room air, HR78, RR 22. 50 mg of Diphenhydramine hydrochloride given intramuscular to left deltoid. Patient reported relief of symptoms 7-10 minutes after administration. Vitals at 6:10pm 138/82, 98 Or on room air, HR 71, afebrile, 16 RR.


VAERS ID: 1470813 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-09
Onset:2021-07-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: Dermatologic. Swollen rash at injection site; very itchy; bright red. Slight relief via topical hydrocortisone cream and oral benadryl.


VAERS ID: 1470818 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-06
Onset:2021-07-14
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia
SMQs:, 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: metformin 500mg, lipitor80mg, carvedilol 3.125mg , potassium chloride 10Meq, torsemide 20mg
Current Illness: unknown
Preexisting Conditions: diabetes
Allergies: dicloxacillin, doxycycline, levaquin , lisinopril, metronidazole, minocycline, prednisone, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: patients son reports joint pain


VAERS ID: 1470845 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Immediate post-injection reaction, Injection site pain, Nausea, Pallor, Skin warm, Somnolence, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: positive Covid Test Nov 2020
Allergies: reported: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient immediately reported the shot hurt more than usual shot and that he was feeling dizzy (he described it as "the spins"). He stated getting warm to the touch and started sweating profusely. About 4-5 minutes after the shot he said he was nauseous. About a minute later he threw up. He said that throwing up helped a little. RPh asked if he wanted some orange juice. He said he did and he took a few sips. He continued to feel warm to the touch and was sweating quite a bit. He also was quite pale. RPh continued to monitor him, providing cool compresses to forehead and back of neck and continued to have him sip on orange juice (drank about 20 ounces aver 30 minutes). He reported feeling better at 10:45am (about 30 minutes after shot.) RPh kept him for observation for another 15 minutes at which time he felt good enough to go home. Girlfriend drove him home. RPh called to check on patient at 6pm. Girlfriend reported he was doing ok and hadn''t had any other reactions. He had just been sleeping all day.


VAERS ID: 1470850 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-10
Onset:2021-07-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device material issue, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: PATIENT RECEIVED A VACCINE FROM A VIAL THAT WAS PUNCTURED BUT REFRIGERATED FOR 48 HOURS. AS OF NOW, NO ADVERSE EVENTS REPORTED.


VAERS ID: 1470860 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0196 / 1 LA / IM

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

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

Write-up: Patient got the Pfizer vaccine and fainted upon standing up. He was caught by his mother who was with him. He quickly became alert and we sat him in a chair, elevated the feet, and got a fan. Patient stated he felt as if he was going to vomit which began quickly after his statement. Patient BP and breathing was normal. Patient did want to go to the hospital to be checked which he did.


VAERS ID: 1471011 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0175 / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Fatigue
SMQs:, Guillain-Barre 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: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 13:25 Patient received vaccination. 13:38 Observation staff noted patient looked fatigue and requested clinician to examine patient. 13:40 Clinician inquires about s/sx. Patient appeared not in distress. Speech cohesive and comprehensive. Patient noted body weakness 5 minutes post-vaccination. 13:42 Clinician asked scriber to obtain water for patient and RN to continue observing while clinician obtains sphygmomanometer and stethoscope. 13:43 Clinician obtained vital signs manually. BP: 132/84 P: 74 RRR. No adventitious sounds. Clinician continued to monitor for additional 15 minutes. 13:58 Patient informed clinician he feels better. Clinician observed patient completed one 8 fl oz water bottle. Clinician informed patient to rest and push fluids for rest of day however patient needs to return to work. So informed him to perform light duties if he needs to return to work. Clinician provided precaution to seek medical attention if patient develops difficulty breathing or chest pain/discomfort. Patient verbalizes understanding.


VAERS ID: 1471013 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-10
Onset:2021-07-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

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

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

Write-up: PATIENT RECEIVED A VACCINE FROM A PUNCTURED VIAL THAT HAD BEEN REFRIGERATED FOR 48 HOURS. NO ADVERSE EVENTS HAVE BEEN.


VAERS ID: 1471016 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-10
Onset:2021-07-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device leakage
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: PATIENT RECEIVED A VACCINE FROM A PUNCTURED BUT REFRIGERATED VIAL 48 HOURS AFTER 1ST PUNCTURE. NO ADVERSE EVENTS REPORTED.


VAERS ID: 1471018 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0175 / 1 LA / IM

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

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

Write-up: Itching on stomach. Evaluated by EMS-Cleared


VAERS ID: 1471039 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysstasia, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient experienced dizziness and her left palm became extremely itchy. She stated her left arm felt "hot", but mostly had issues with the itchiness of her left palm and in between her fingers. She was unable to stand after 15 minutes and remained quite dizzy.


VAERS ID: 1471041 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Fall, Immediate post-injection reaction, Loss of consciousness, Tremor
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), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: 10 Seconds after receiving the Vaccine the patient fell over in his chair and on how way to the ground I caught him and laid him down on his back. During this time the patient''s eyes rolled into the back of his head and had small tremors occuring throughout his body. This lasted approxiamtely 10 seconds before the patient regained consciousness. The patient has had no history of seizures or any issues with the first dose. The patient had reported that they had not ate anything all day and felt like their glucose was low. After observing the patient for 30 minutes after the incident they reporting feeling okay and just that they probably needed to eat something. A follow up call with the patients mother was completed 2 hours later and the patient was feeling better and eating. They were informed to call back with any issues.


VAERS ID: 1471045 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0196 / 1 LA / IM

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

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

Write-up: patient became light headed, dizzy, and nauseous, 10-15 minutes after dose was administered


VAERS ID: 1471046 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0196 / 2 RA / -

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

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

Write-up: Patient was given saline instead of actual vaccine.


VAERS ID: 1471047 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0202 / 1 LA / IM

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

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

Write-up: ABOUT 5-10 MINUTES AFTER THE DOSE WAS ADMINISTERED THE PATIENT STARTED FEELING FAINT. SHE HAD WALKED AWAY FROM THE PHARMACY AFTER THE BROTHER WAS GIVEN A SHOT AND THE PARENTS HELPED HER TO THE FLOOR. SHE PASSED OUT. SHE HAD WORKED OUT TODAY AND NOT EATEN OR WAS NOT WELL HYDRATED PRIOR TO VACCINE WHICH MAY HAVE CONTRIBUTED TO THE SYNCOPE. SHE CAME TO AND PASSED OUT ABOUT 15 LATER THIS TIME WAS SITTING IN THE CHAIR. THE MEDIC TEAM ARRIVED SHORTLY AFTERWARDS AND ASSESSED THE PATIENT. SHE WAS NOT TAKEN TO THE ER BUT INSTEAD THE PARENTS WANTED TO TAKE HER HOME.


VAERS ID: 1471061 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

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

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

Write-up: Patient received this second dose of Moderna vaccine from our public health clinic and his first dose was Pfizer 21 days prior to this vaccination. The patient left the clinic after 15 minutes of observation with no signs of distress.


VAERS ID: 1471068 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None reported -- hadn''t eaten all day
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: Not aware of any tests and/or lab reports
CDC Split Type:

Write-up: Pt grandmother reported him feeling dizzy, Never lost consciousness. Never had difficulty breathing. Vomited on the floor several mins following vaccine. Rescue was called per pt request. Cleared by EMTs.


VAERS ID: 1471069 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0175 / 2 LA / IM

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

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

Write-up: Second dose completed on day 47 instead of the recommended by 42 days


VAERS ID: 1471267 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

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

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

Write-up: Received 2nd dose on day 120 instead of the recommended by day 42.


VAERS ID: 1471272 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0196 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Vaccination 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: Aspirin Tablet 81 MG,Metoprolol Tartrate Tablet 25 MG,Oyster Shell Calcium/Vitamin D Tablet 500-200 MG-UNIT (Calcium Carbonate-Vitamin D),Cholecalciferol Tablet 50 MCG (2000 UT),amLODIPine Besylate Tablet 10 MG, Gabapentin Capsule 100 MG, T
Current Illness: A-FIb, DM,SCHIZOAFFECTIVE DISORDER, UNSPECIFIED SEQUELAE OF CEREBRAL INFARCTION, HTN,
Preexisting Conditions: A-FIb, DM,SCHIZOAFFECTIVE DISORDER, UNSPECIFIED SEQUELAE OF CEREBRAL INFARCTION, HTN,
Allergies: NKA
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Resident given Pfizer dose 1 after having received Moderna two dose series in April. Resident remains free from adverse reaction at this time.


VAERS ID: 1471277 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0044D21A / 2 LA / IM

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

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

Write-up: shortness of breath


VAERS ID: 1471282 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient received vaccine and seat to wait for 15 minutes, then started feeling dizzy and sweating. Took patient''s blood pressure and was slightly elevated, revised blood pressure and after third reading BP was lower and patient started feeling better.


VAERS ID: 1471287 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0178 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: First dose administered 5/14/21, second dose administered outside the recommended interval on 7/14/21 (on day 61). Patient expressed no adverse effects.


VAERS ID: 1471295 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-14
Onset:2021-07-14
   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: Unknown       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: Attende reported lightheadedness immediately after vaccine administration, however opted to remain seating over the offered cot. Frequent Vital signs taken, all within normal history of attendee (per report). Declined EMS call. Observed for a longer span of time. Ambulated with standbyAssistx1 to bathroom, continued remainder of Observation period with improvement to point of discharge and ambulated without assistance upon departure.


VAERS ID: 1471296 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 FA7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE KNOWN
Current Illness: NONE REPORTED
Preexisting Conditions: NONE REPORTED
Allergies: NONE REPORTED
Diagnostic Lab Data: BLOOD PRESSURE AND BLOOD GLUCOSE WERE TAKEN BY EMS. RESULTS ARE UNKNOWN.
CDC Split Type:

Write-up: PATIENT FELT LIGHT HEADED AND FELT LIKE SHE WAS GOING TO PASS OUT. SHE REQUESTED TO SIT ON THE FLOOR. UPON MOVING TO THE FLOOR, SHE TOLD HER HUSBAND SHE WAS GOING TO PASS OUT. HER EYES CLOSED SO 911 WAS CALLED IMMEDIATELY. SHE OPENED HER EYES SHORTLY AFTER AND WAS TOLD HELP WAS ON THE WAY. EMS CAME, ASKED HER SOME QUESTIONS, TOOK HER BLOOD PRESSURE AND BLOOD GLUCOSE. EMS WALKED HER OUT OF THE STORE.


VAERS ID: 1471310 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 LA / IM

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

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

Write-up: Patient came in for second COVID-19 vaccination. Asked for Pfizer at drop off window. Pharmacist confirmed twice he needed Pfizer in the vaccination room. He left the room. I had an uneasy feeling about the conversation and checked MICR to confirm he had his first vaccination. He had a Moderna COVID-19 vaccination in April as his first dose. When I went to tell him, he had already left without waiting the requested 15 minute observation.


VAERS ID: 1471478 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 LA / IM

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

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

Write-up: patient fainted-- gave water and monitored bp--


VAERS ID: 1471480 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: Past Adverse Reaction to Chemotherapy treatment
Diagnostic Lab Data: BP taken several times for 30 min after vaccine and was 81/50
CDC Split Type:

Write-up: Several minutes after vaccines patient became light headed, he then passed out for several minutes and became very stiff. When patient came to he was disoriented (didn''t know where he was or who I was). Patient felt nauseous. Patients blood pressure was 81/50. Patient was taken to ED for further evaluation.


VAERS ID: 1471487 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 - / 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: Patient denied
Current Illness: Patient denied
Preexisting Conditions: Patient denied
Allergies: Patient denied
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: No reported adverse event. Mixing different MRNA vaccines to complete vaccines series.


VAERS ID: 1471495 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-13
Onset:2021-07-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site discolouration, Injection site induration, Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, metoprolol, verapamil, magnesium, potassium, hydrocortisone, niacin, symbicort, qvar, spiriva, protonix
Current Illness: Allergic reaction to butter.
Preexisting Conditions: Tachycardia, mixed thyroiditis, edema, adrenal insufficiency, asthma, depression/anxiety.
Allergies: Cephalosporins, latex, aloe moisture gloves, ferrets, tuberculin serum (ppd)., dairy
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Hardened bump on arm. Pink area around injection site. Low grade temperature. Very sore arm.


VAERS ID: 1471496 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature decreased, Feeling hot, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: About 2 seconds after Moderna vaccine was given to patient, pt reported he was going to vomit. Pt was provided with a bucket to vomit if needed but did not end up doing so. Pt experienced physical sweating and was given some paper towels at his request. Pt denied ice pack at this time. About 3 minutes passed, symptoms subsided and patient was able to articulate what happened. Patient states he felt a major drop in temp. to freezing and then all of a sudden to boiling thus experiencing nausea. Pharmacist kept pt on observation for a 30 minute waiting time.


VAERS ID: 1471500 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: Pt received 1st dose of moderna vaccine and immediately reported nausea. Patient reported feeling dizziness after previous vaccinations so pharmacist was planning for observation time of 30 minutes regardless. After current vaccination, pt immediately reported nausea and then shortly after dizziness, pt was sitting down for observation time of 30 minutes and reported feeling ok before going home with her partner.


VAERS ID: 1471654 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-10
Onset:2021-07-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Arthralgia, Chills, Pyrexia, Rash, Rash macular, Rash papular, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: losartan, atorvastatin, atenolol, flomax, plavix, aspirin
Current Illness:
Preexisting Conditions: CAD s/p stent x5, HLD, HTN
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient initially devleoped joint pain, fever, chills, vomiting abd distention on 7/11/21 then on 7/14/21 awoke with diffuse maculopapular rash over entire body and came to ED.


VAERS ID: 1471657 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Feeling abnormal, Feeling hot, Flushing, Head injury, Lip injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: PT HAD RECEIVED MODERNA VACCINE AND WAS SITTING DOWN AND WAITING FOR 15 MINUTES BEFORE LEAVING. AFTER 11 MINUTES PT STOOD UP AND I THOUGHT SHE SAT BACK DOWN, BUT PATIENT HAD FAINTED . PT WAS UNAWARE OF WHAT HAPPENED, SHE HIT HER HEAD ON THE CONCRETE FLOOR,BIT HER LIP, AND WAS CONFUSED. PT BECAME VERY HOT AND FLUSHED, WAS ABLE TO TALK TO HER BOYFRIEND AND TO ME. AFTER DRINKING A SMALL AMOUNT OF WATER AND STILL NOT FEELING AND BETTER AFTER A FEW MINUTES, BOYFRIEND ASKED FOR US TO CALL AMBULANCE. PT WAS TAKEN OUTSIDE OF STORE ON A STRETCHER FOR FURTHER EVALUATION


VAERS ID: 1471662 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 - / UNK LA / SYR

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

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

Write-up: Large rash on arm spreading slightly onto back. Will be calling to see pediatrician tomorrow first thing if not showing improvement.


VAERS ID: 1471666 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-21
Onset:2021-07-14
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood potassium decreased, Blood pressure increased, Chest X-ray, Chills, Computerised tomogram, Decreased appetite, Dehydration, Diarrhoea, Fatigue, Flank pain, Haemorrhage, Headache, Magnetic resonance imaging head, Myalgia, Nausea, Oesophagogastroduodenoscopy, Pyrexia, Venogram
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Hypokalaemia (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, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: morphine, oxycodone, levothyroxine, birth control-Mono-Linyah, b12, oxycodone, tizanidine, naproxen, Lyrica, multivitamin, clonazepam, fluoxetine, sumatriptan, HCTZ, Omeprazole, Cetirizine 10mg
Current Illness: I have two autoimmune illnesses Fibromyalgia and CRPS/RSD I also have Hypothyroidism
Preexisting Conditions: stage 3 kidney disease, chronic migraines, autoimmune illnesses & Fibromyalgia and CRPS/RSD
Allergies: Effexor, steroids
Diagnostic Lab Data: MRI Brain MRV EGD Potassium low dehydrated chest xray Cat scan
CDC Split Type:

Write-up: Tiredness Headache Muscle pain Chills Fever Nausea Diarrhea before going to hospital all day and at the hospital all day where i actually bled Blood pressure spiking when I normally normal it was 175/117 Loss of appetite Stabbing head pain, felt like it was going to explode flank plane


VAERS ID: 1471845 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-11
Onset:2021-07-14
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Tinnitus
SMQs:, Hearing impairment (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: Diazepam, hydro morph one,was not on hrt at time, didn''t take that day
Current Illness: Lupus, sle
Preexisting Conditions: Same
Allergies: Compazine, ambien
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left side head , ear feels full, muffled but ringing. Have to turn my head to hear TV, rheumatologist apt August 3rd coming up. I have had lupus since 20 yes old, this ear feeling is unlike anything I have experience in left ear. Frightening.


VAERS ID: 1472395 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-14
   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 - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Fall, Lymphadenopathy, Pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: qvar daily and albuterol prn
Current Illness: none
Preexisting Conditions: asthma
Allergies: none
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: Vasovagal syncope at 7:30pm on 7/14. Patient was lightheaded immediately prior to event and woke up on the floor. HR 45, BP 94/46 immediately after event. EMS was called. Blood sugar was normal. Patient''s family brought patient to ED for evaluation. Patient was back to baseline in the ED. Of note, patient also reporting right axillary swelling and pain after vaccination (that started on 7/13)


VAERS ID: 1474005 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0171 / N/A RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Discoloured vomit, Discomfort, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Anxiety, nausea, vomiting. Pt. complained of anxiety after receiving the 2nd dose of Pfizer vaccine. Pt. observed vomiting clear emesis with mild discomfort. Emergency personnel notified and pt. refused transport for further evaluation.


VAERS ID: 1474028 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-14
Onset:2021-07-14
   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 EW0171 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Asthma
Allergies: Penicillin
Diagnostic Lab Data: Vital signs: 127/82, P 66, Resp. 18, O2Sat 100. 144/82, P 82, Resp. 18, O2Sat 98%, Blood G 122.
CDC Split Type:

Write-up: Client verbalized feeling lightheaded after receiving the vaccine. On site Fire Rescue evaluated and treated client. Per Fire Rescue, client will be transported for further evaluation. At 2:32pm, client was transported to the ER via Fire Rescue-Client''s family is aware.


VAERS ID: 1474029 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild


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