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

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



Case Details (Reverse Sorted by Onset Date)

This is page 37 out of 4,799

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VAERS ID: 1440921 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: lightheaded/nausea, possibly passed out short period


VAERS ID: 1440925 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-07-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Unknown       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: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: First dose received Pfizer, no ASE as per client. Received Moderna vaccine today, tolerated well, no ASE.


VAERS ID: 1440945 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 LA / IM

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

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

Write-up: Patient got light headed and fell. Patient stated that she did not eat or drink anything before the vaccine and this is why she got light headed and fell. I had the patient stay in the pharmacy for another 20min to monitor for more symptoms. Patient requested some water to drink, she was informed to just sip on it, she also was given some glucose tablets to help raise her blood sugar. After 20 minutes patient stated she was fine and left. She was told that if she had other serious reactions that she should go to the emergency room immediately.


VAERS ID: 1440948 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Chest discomfort, Dizziness, Dyspnoea, Electrocardiogram, Headache
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase; Flovent; Albuterol MDI
Current Illness: None reported
Preexisting Conditions: Asthma, Anxiety about Health, diverticulosis, muscle spasticity, abnormal celiac antibody panel, joint pain,
Allergies: Baclofen; codeine, diphenhydramine HCL, epinephrine, Porcine, Shellfish direvitives
Diagnostic Lab Data: Not known at this time. Being assessed at local hospital
CDC Split Type:

Write-up: During 15 minute observation period, complained of chest tightness, trouble breathing, headache, lightheadedness. B/P was elevated at 183/109, HR90, O2 96% lungs clear, cardiac RRR epi not given due to allergy. Oxygen placed at 2 liters per minute, given 125mg of solumedrol IM . 1143 B/P 194/102, hear rate 92. 911 initiated. 12 lead EKG done and read by Medical Director. 0.4mg NTG SL given, ASA 324mg chewed. At 1149 EMS here . O2 sat was 91%. Last B/p was 194/102. Transported to the ER by EMTs


VAERS ID: 1440956 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 RA / IM

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

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

Write-up: Patient complained of tingling in her hand and numbness that was slowly working its way up from her hand through her arm.


VAERS ID: 1440960 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Pallor, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received 2nd dose of covid vaccine. After vaccine was administered she appeared anxious. After about a minute, patient appeared to have a short seizure for 10 seconds. Patient appeared pale afterwards. Patient stated she had a history of passing out after vaccines. Ambulance came and evaluated her. She was released to go home with parent.


VAERS ID: 1440961 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prazosin 1mg capsule by oral route every bedtime Paxil 20mg tablet by oral route every evening Clindamycin 1% pads TOPICAL Q HS apply to face benzoyl peroxide 5% topical gel apply affected area every bedtime
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received Pfizer COVID-19 vaccine on 7/1/2021. After vaccine was administered it was found that patient had previously received Johnson and Johnson COVID-19 Vaccine on 3/11/2021.


VAERS ID: 1440962 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pt came into the Covid Vaccine clinic requesting his first covid vaccine. Per pt he came in yesterday and nurse noticed under immunization tab when reconciling immunizations two moderna vaccines are documented as external administration. Pt called yesterday and they were not able to resolve the issue apparently there is another pt with same name, last name and DOB. Pt would like to receive his first vaccine today. Spoke about issue encountered. Pt can receive vaccine today if he has not received COVID-19 vaccine in the past.


VAERS ID: 1440967 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: Patient received a Janssen shot on 7/1/21 around 9:45 AM. After the shot, he stood in the line for the pharmacy and he said he suddenly feels very light headed and almost fainted after getting a shot. I provided a water and told him to get rested on the chair and check up on him every 5 minutes to make sure he is alright. He said he had allergic (anaphylaxis) reaction in the past and he said he usually does not get vaccinated yearly (flu etc) and the most recent vaccine that he received was the tetanus shot in 4-6 years ago. He said he feels fine (no rash/no more cold sweat) after resting about 20 minutes on the chair and told him to stay around 10 more minutes. Before he left the pharmacy(30 minutes after the shot), I told him if he feels any allergic reaction coming through, go to nearest emergency room/hospital.


VAERS ID: 1440973 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-22
Onset:2021-07-01
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dicyclomine, ondansetron, amoxicillin, levothyroxine
Current Illness: IBS, viral uri
Preexisting Conditions: IBS
Allergies: armour thyroid
Diagnostic Lab Data: rapid pcr-pos
CDC Split Type:

Write-up: pt received second Moderna does on 5-20-21; lot 002C21A IM Pt has since developed Covid on 7-1-21


VAERS ID: 1440987 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphonia, Eye pruritus, Hypersensitivity, Injection site pruritus, Irregular breathing, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Liquid benadryl given at 11:59am following reports of itching of nose and eyes. Changes in voice or breathing which pt contributes to allergic reaction. 2nd benadryl given at 12:10pm, itchiness began to decrease, some itching at vaccination site. 12:30pm, pt reports increase in itchiness on head. Pt left at 12:46pm still reporting itching on head


VAERS ID: 1441007 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

Write-up: Fainted, came to and left with mother and sibling about 25min with 0 complaints


VAERS ID: 1441022 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: Benign essential hypertension Moderate persistent asthma Coronary arteriosclerosis in native artery Other Fibromyalgia Trochanteric bursitis of right hip Bilateral primary osteoarthritis of knee Chronic pain of both knees Polyarthralgia Primary osteoarthritis of both hands History of radiofrequency ablation (RFA) for complex right atrial arrhythmia Morbid obesity (H)
Allergies: Amoxicillin, Biaxin, dust, levofloxacin, losartan, mold, fruit with pits or cores, peanut, pollen, red dye and sunflower seeds
Diagnostic Lab Data: BP: 146/96 7/1/21
CDC Split Type:

Write-up: Patient c/o itchiness in her face. No rash noted. No sob noted, BP WNL. Administered 25mg diphenhydramine per standing house order. Provider on-site notified. Instructed staff to watch patient for an extra 15 min. Patient felt okay and went home after 15 min.


VAERS ID: 1441035 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Melatonin
Current Illness: None
Preexisting Conditions: A-Fib, high B/P, heart disease
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type: NA

Write-up: Client called for appointment for 2nd covid 19 vaccine. Came to appointment 7/1/2021 and was given vaccine. When filling out vaccine card, I noted two vaccines already on card. System also shows two vaccines given. Patient stated he didn''t remember getting the second one. Possibly received 3rd covid vaccine dose. First dose was given 4/1/21, second dose shown given on 4/29/21, and third dose today. Patient denied any adverse reactions with previous vaccine.


VAERS ID: 1441045 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Feeling cold, Musculoskeletal stiffness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Patient in Clinic to for services and review vaccines and request COVID vaccine, Trumenba and Hep A. Gave Pfizer and grandmother requested to wait 15 mins before giving other vaccines. Patient was sitting on table, fainted after about 8-10 mins.Granmother caught her and placed back on table in supine position. Patient very pale, legs stiffened and feet turned inward. Feet were elevated and fan turned on patient. Patient aroused within 1 min. B/P 110/60. Denied difficulty breathing. Dr was present. Patient was cold and clammy. Heart rate 100. Ambulance was called. Ambulance arrived within 10 mins. Patient ambulated to stretcher. Ambulance transported to Hospital.


VAERS ID: 1441053 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: On Thursday, 7/1/21, patient received her second dose of Pfizer Covid-19 vaccine (LOT #: EW0191, exp: on 8/2021) at 12:04 pm on her left deltoid. During assessment questions, client denied any underlying medical conditions or allergic reactions and was to be a 15 minute observation. Client stated she takes Captopril when needed however has not taken any medication for two years. At 12:10 pm, while waiting in Observation Area, client stated to RNs, she is feeling "dizzy for a moment and a tingling sensation in left arm." Client also stated she was "feeling nervous at beginning of vaccine" and was also nervous when she received four other vaccines 10 days prior. Those vaccines were: TB, Tetanus, Hepatitis & Flu with no allergic reaction at the time. At 12:12pm, client was seated with anti-gravity and vitals were started and taken every 5 minutes. Client was also given a bottle of water and offered Benadryl to which the client denied. At 12:12pm, BP: 148/74, HR: 88, O2 sat: 98%. At 12:17pm, BP: 162/78, HR: 84, O2 sat: 98%. At 12:25pm, BP: 170/93, HR: 94, O2 sat: 98%. At 12:40 pm, BP: 152/87, HR: 88, O2: 98%. At this time, client told RN she was no longer dizzy or experiencing any tingling sensation. No further interventions needed. Client was educated by RN on signs and symptoms of adverse reactions and when to go to the ED/call MD. Client was also encouraged to sign-up on v-safe. Client left vaccination site with a steady gait at approximately 12:50 pm and was driven home by a relative.


VAERS ID: 1441061 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 - / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Paraesthesia oral, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt received vaccine at approx. 3:30. At approx. 3:55 pt felt tingling of lips, tightness in chest, slight difficulty breathing and tongue swelling. Vitals obtained b/p 129/85 HR 91 O2 sat 100%. AT3:56 pt given epinephrine 0.3 mg IM to left thigh. Pt started to feel some relief but feeling resumed after 10 minutes. 911 called at 4:04pm Arrived at 4:09 . Taken to hospital by ambulance for further observation. AT disch100% heart rate 80arge b/p 127/66, O2


VAERS ID: 1441066 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: We are about to give patient their 2nd shot, but they are about 2 months later for their shot. They were told by their physician that they should wait for at least 90 days after their first shot for greatest effect. The patient had a covid immune globulin shot in January and his 1st shot on 4-27-21 and was told by physician to wait this long. I am submitting this report to inform authorities of why 2nd is so late


VAERS ID: 1441071 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / IM

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

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

Write-up: Given at age 10.


VAERS ID: 1441080 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased
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: Trikafta
Current Illness:
Preexisting Conditions: Cystic fibrosis
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported feeling lightheaded and dizzy within 10 minutes of vaccine administration. Her pulse was also steadily rising (as reported on patient-owned pulse oximeter). She asked that we call 911. While waiting for emergency personnel, the patient admitted to coughing up blood and jaundice over the past week. Emergency medical professionals escorted her to the nearest hospital.


VAERS ID: 1441086 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Consciousness fluctuating, Pallor, Presyncope
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient was given second dose of Pfizer Vaccine and had a vasovagal reaction about 10 seconds after administration. Patient was going in and out of consciousness for around 30 seconds to 1 minute with visibly pale skin on her face. Patient was brought down to the ground to lie down. She has a slightly lowered blood pressure, no fever, strong OSAT and pulse of 78. After lying down for 5 minutes, pt was able to sit for 20 minutes and then was ok to leave.


VAERS ID: 1441091 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: Dizziness when standing, light-headedness


VAERS ID: 1441098 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norco 7.5
Current Illness:
Preexisting Conditions: Acute bronchitis, Asthma, benign prostatic hypertrophy, DM2, peripheral edema, peripheral neuropathy
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the covid-19 vaccine instead of shingrix. He had already gotten his covid-19 shots 2 months ago according to the patient. This was his third covid-19 shot. He went ahead and got the shingrix vaccine shortly afterward the same day once he was aware of the mistake. The patient has not experienced any adverse events so far.


VAERS ID: 1441101 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient fainted/passed out approx 10 minutes after vaccine admin, was shaky and sweating


VAERS ID: 1441103 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt dizzy and lightheaded shortly after administration. He states that he often works himself up over medical issues. BP dropped to 86/60 at one point. EMS was called and took over situation.


VAERS ID: 1441107 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood pressure taken on 7/1/21. Only two readings were written down - 124/82 and 118/79
CDC Split Type:

Write-up: Patient came back to pharmacy complaining of numbnes in left side of face and arm. In mild distress, patient admitted could be due to anxiety as she is prone to attacks, but was unsure. Patient was not exhibiting any other signs or symptoms nor did she describe anything other than the numbness. She was asked if there was any accompanying pain, but there was not. Patient was asked to sit down and blood pressure was taken multiple times in which none were significantly out of range. Patient called primary care provider who advised her to head to the ER, after which she contacted someone to come pick her up. Subsequent attempts to contact patient for follow up have been unsuccessful.


VAERS ID: 1441109 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 3 LA / SYR
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LA / SYR

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: Butalbital/Acetaminophen/Caff, Amitriptyline, Topiramate, Tramadol, Anastrozole, Gabapentin, Aspirin
Current Illness: none
Preexisting Conditions: neuropathy from chemo
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I took my 2 daughters to pharmacy to get their 2nd covid shot. I was there to receive my 1st shingles vaccine. The pharmacist mistakenly gave me the #2 covid vaccine too. I had already received the 2nd covid vaccine on June 7. The pharmacist realized his mistake then went and got the correct shingles vaccine and gave me it. He didn''t offer any info or guidelines to follow, or what I should be on the lookout for as far as how I may feel. When I got home I called a different pharmacy and the pharmacist there told me to report it on this website.


VAERS ID: 1441110 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling cold, Unresponsive to stimuli, Visual impairment
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 25mg, Methylphenidate ER 36mg, Methylphenidate 10mg, L-Methyl-folate 15mg
Current Illness:
Preexisting Conditions: ADHD Anxiety/Depression and Folate deficiency
Allergies: Non
Diagnostic Lab Data: None Known at this time
CDC Split Type:

Write-up: Patient complained of dizziness and feeling clammy. Patient was given an ice pack. Patient was not able to answer question (What day is it?) and Mom requested that paramedics be called. While waiting for the paramedics patient continued to complain of dizziness, feeling clammy/cold and changes in vison (zig zag lines).Just prior to paramedics arriving Patient was able to sit up on her own, answer questions (What day is it and Who is the President?), but still complaining of feeling cold and vision problems, Paramedics arrived and took Patient to the Ambulance to further evaluate her.


VAERS ID: 1441111 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Electrocardiogram, Seizure like phenomena, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (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: Diclofenac , Flexeril
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: not known
Diagnostic Lab Data: ekg
CDC Split Type:

Write-up: Pt. had an adverse reaction approximately 5-10 minutes after recieving immunization. Pt. had a hard to describe reaction that resulted in a mixture between syncope/seizure type reaction with some symptoms of both. Upon further communication it was conveyed to me that the patients ekg was abnormal and they believe he had a undiagnosed cardiac condition that was brought to light from the stress of recieving the vaccine.


VAERS ID: 1441112 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Feeling hot, Hyperhidrosis, Hypopnoea, Respiratory rate increased, Tachypnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient denies
Current Illness: Patient denies
Preexisting Conditions: Patient denies
Allergies: Patient denies
Diagnostic Lab Data: Vitals: 1408: 167/79, HR 99, RR 21, O2 99% RA Neuro checks: Pupils PERRLA, Vitals @ 1425: 121/62, HR 80, RR 14, O2 99% RA
CDC Split Type:

Write-up: In Post vaccination area pt stated "throat feels smaller", & "I feel hot". Pt seated in chair, appeared very anxious, pt tachypneic w/short, rapid breathing, diaphoretic, denies allergies to foods & meds, & denies hx of anaphylactic reaction, denies med hx, states no meds. Pt throat appeared WNL visually, no abnormality seen, pt also able to swallow & speak clearly, RN sat w/Pt to help calm down, used therapeutic nursing, calm voice, & active listening for Pt teaching of vaccine & what to expect post vaccine upcoming days, how to treat & care for common s/e to vaccine, & informed pt when to call dr & when to go to ER & call 911. Pt verbalized all understanding & stated "feel so much better & throat feels fine". States no needs at this time. Please see vitals below.


VAERS ID: 1441113 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pantoprazole, potassium chlor, magnesium ox , furosemide, rosuvastatin, clopidogrel, spironolactone, irbesartan
Current Illness: no
Preexisting Conditions: heart
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated before vaccination that he had no reaction to 1st dose of Moderna.15 minutes after injection, patient started feeling faint. When speaking to him, he would look at me but didn''t seem to understand what I was saying as he wasn''t responding to questions. He said in a weak voice that he felt faint and hot and didn''t communicate much other than that. He was shakey and sweaty. We gave him an ice pack for the back of his neck, took his blood pressure/pulse, and called an ambulance. BP was 110/64, pulse 101. About 10 minutes later he had to use the restroom and we assisted him to the restroom. Upon returning to the pharmacy, the paramedics were on scene and he was feeling and looking better. They took his BP again and it was 127/72. The paramedics stayed with him for a while, but he was unwilling to go to the ER. They took his BP again which was 139/85 and pulse 66. After paramedics left about a half an hour later, he stayed seated at the pharmacy and was supervised for another 20min. Patient stated he felt fine and went home.


VAERS ID: 1441120 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products, 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient arrived for 2:20 pm appointment. Patient care technician (PCT) collected ID/insurance and registered patient. During registration, patient filled out vaccine consent form and signed. Appointment was listed as "Other- COVID scheduling" but no specific vaccine was was listed in the details. NP was finishing a meeting with the Clinic Manager and additional patients were arriving to register. NP called patient back at approximately 2:30 pm and verified name and DOB. NP reviewed consent with patient and told him that this would be the second dose and reviewed possible side effects. However, NP does not recall whether she mentioned the specific vaccine he was receiving today when she was reviewing the second dose side effects with patient. NP glanced at vaccine card and saw a 1st dose sticker with a date of 5/2/21 and although, past the 42 day range, NP believed recommendations were still to vaccinate. Therefore, NP placed Pfizer sticker on vaccine card, dated and signed. However, NP did not verify the manufacturer of the first dose when she looked a patient''s card. 0.3 mL of Pfizer was given to patient in his right deltoid. Patient remained in waiting area for 15 minutes as recommended and then left with no adverse reactions. At approximately, 3:45 p.m, Patient returned to clinic to inform NP that his card showed a first dose of Moderna and now second dose of Pfizer. NP reviewed card and verified in patient''s chart that he had reieved Moderna 0.5 mL on 5/2/21 and now Pfizer 0.3 mL on 7/1/21. NP admitted to this being her error and asked patient to remain seated while she contacted her manager. Clinic manager was notified and also notified clinic director. NP was instructed to place a VAERS report and occurrence report. As of this time, patient has experienced no adverse side effects and reports no physical complaints. Moderna Mfr was contacted by but they were unable to provide guidance on patient''s next steps. CDC Administration Errors and Deviations document reviewed which indicated that patient not receive another dose of either Moderna or Pfizer. Patient was contacted to follow up and instructed to not receive any additional doses per the CDC document.


VAERS ID: 1441124 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, 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: 1512 - Pfizer dose reconstitution expiration time 1522 - Pfizer dose drawn on demand from vial, which was stored at 73 degrees F, and administered to patient, IM, right deltoid. 1525 - Pfizer dose noted to be expired per EUA recommendations. Call placed to Pfizer, they cannot make recommendations outside EUA but have data to support reconstitution expiration extension by 18 hours for a total of 24 hours.


VAERS ID: 1441127 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Patient began to feel light headed and like her head was spinning. She proceeded to move to the chair and fainted. She quickly recovered ( less than 30 seconds). She was able to walk to the chair, she felt back to normal after a few more minutes. She was observed for about 20 minutes. When she left she was feeling back to herself.


VAERS ID: 1441132 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient vaccinated with Pfizer at 11:03 am and started to exhibit symptoms at 11:08. Patient had cold, clammy skin and tingling in both hands. Vitals were 120/80; HR 52; R 17; SAT 100% on RA.


VAERS ID: 1441319 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Facial pain, Immediate post-injection reaction, Throat irritation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Hypertension (narrow), 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: ferrous sulfate 325mg bupropion er/sr 150mg
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Hydrocodone-severe itching
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt developed dizziness, face pain, and scratchy throat immediately after vaccine. Pt had slight elevated blood pressure (160/100 which came down to 139/102 over the next 3-4 readings over 30-45 min). Pt remained in IMZ room with ice pack and legs elevated for ~ one hour. Pt''s symptoms did not progress any further and the throat issue seemed to go away according to Pt so she went home with her sister.


VAERS ID: 1441323 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, 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: No adverse events noted. After administration of 2nd Moderna COVID-19 vaccine. data entry staff noted that patient received Janssen COVID vaccine prior to starting Moderna series. Janssen vaccine given 4.27. 1st Moderna administered 4.29. 2nd Moderna administered 7/1. Janssen vaccine was not disclosed prior to Moderna administration, and given by another health center. Report submitted for record keeping only.


VAERS ID: 1441324 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 LA / SYR

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? 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: Moderna vaccine was administered to patient past the 12 hour beyond use time. No adverse reactions occurred or have been reported by the vaccinated individual. Moderna manufacturer was contacted and we are awaiting a return call from a vaccination expert. No Adverse reactions were observed by pharmacist within 15 minutes after vaccination. Patient did not contact us as of 6 hours after vaccination to report adverse reactions.


VAERS ID: 1441331 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Lip swelling, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness:
Preexisting Conditions:
Allergies: Codeine related products, beees .
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient received her second vaccine ( Covid-Pfizer) the 5 minutes later, she started feeling her tongue and lips swell and started coughing. 911 was called and Epinephrine was administered, 3 - 4 minutes later she started breathing better and EMS showed up.


VAERS ID: 1441333 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: patient slumped sideways in chair a few minutes after receiving covid vaccine due to fear of needles. she was only out 15-20 seconds. no injuries.


VAERS ID: 1441342 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / -

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

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

Write-up: After the patient got the first dose of covid shot, patient started to feel light headed and sweating. Patient also stated that he started can''t see thing or heard thing. But after he drink some water and sitting down waiting for ambulant he was feeling ok. EMT came and checked him out and he was ok


VAERS ID: 1441343 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 RA / SYR

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

Write-up: Moderna vaccine was administered to patient past the 12 hour beyond use time. No Adverse reactions were observed by the pharmacist within 15 minutes after vaccination. Patient did not contact us as of 6 hours after vaccination to report adverse reactions. Moderna manufacturer was contacted and we are awaiting a return call from a vaccination expert.


VAERS ID: 1441344 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Dysstasia, Injection site pain, Mobility decreased, Pain, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: The site of my injection in my right arm has been extremely sore to the point where I can barely lift it. My entire body hurts/aches as well. My shoulders, back, arms, and legs have been extremely sore all day to the point that it is hard to stand or turn my neck.


VAERS ID: 1441346 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-29
Onset:2021-07-01
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine 75mg
Current Illness: Strep in early june
Preexisting Conditions: Factor V Leiden
Allergies: Wasps
Diagnostic Lab Data:
CDC Split Type:

Write-up: Random bouts of dizziness and feeling of lost balance.


VAERS ID: 1441351 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hypoaesthesia, Malaise, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: PATIENT, WAS GIVEN THE 1ST DOSE OF PFIZER VACCINE. FEW MINUTES AFTER THE VACCINE PATIENT REPORTED FEELING DIZZY, PATIENT STATED SHE DID NOT FEEL VERY WELL, AND PATIENT HAS REPORTED HISTORY OF FAINTING AFTER VACCINATION. PATIENT WAS ADVISED TO LAY ON THE GROUND FOR WHILE SHE FELT LITTLE BETTER. HOWEVER SHE STATED SHE FEELING DIZZY, HAS HEADACHE AND REPORTED TINGLE /NUMBNESS IN HER LEGS. AMBULANCE WAS CALLED AND TOOK THE PATIENT. I FOLLOWED UP WITH THE PATIENT,. PATIENT WAS IN OKAY CONDITION, I SPOKE TO THE PATIENTS FAMILY MEMBER THEY STATED THAT THE DOCTOR SAID PATIENT FELT DIZZY DUE TO VASOVAGAL SYNCOPE. NO OTHER SIDE EFFECT WAS REPORTED.


VAERS ID: 1441354 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 RA / SYR

Administered by: Pharmacy       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna vaccine was administered to the patient past the 12 hour beyond use time. No adverse reactions were observed by the pharmacist within 15 minutes after vaccination. Patient did not contact us as of 6 hours after vaccination to report adverse reactions.


VAERS ID: 1441355 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Dizziness
SMQs:, Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: after pfizer dose 1
Other Medications:
Current Illness: reaction to vaccine for firxt dose of pfizer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient told that she fainted after she got the first dose of pfizer vaccine. she cautioned us that it may happen again. the patient dad is with her. After 5 minutes getting the vaccine she felt dizzy and she started crying and we called 911 and before the paramedics came the patient recovered and refused to go to the hospital.


VAERS ID: 1441358 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Headache
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Labetolol 100mg 2x daily Venlafaxine ER 75mg Prenatal vitamin
Current Illness: None
Preexisting Conditions: Hypertension Anxiety
Allergies: Nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild headache Fourth pregnancy; due date 1/25/22; history of miscarriage


VAERS ID: 1441362 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: V/S: HR, BP, RR, SP02, EKG all within normal limits. Orthostatic Hypotension (Negative)
CDC Split Type:

Write-up: Pt complained of feeling dizzy but did not want to be taken to the ER. No additional symptoms.


VAERS ID: 1441364 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 LA / SYR

Administered by: Pharmacy       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna vaccine was administered to patient past the 12 hour beyond use time. No adverse reactions were observed by the pharmacist within 15 minutes after vaccination. Patient did not contact us as of 6 hours after vaccination to report reaction. Moderna manufacturer was contacted and we are awaiting a return call from a vaccination expert.


VAERS ID: 1441367 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dehydration, Encephalopathy, Fall, Hyponatraemia, Hypophagia, Nausea, Spinal compression fracture
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Osteoporosis/osteopenia (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed nausea, poor oral intake, dehydration and hyponatremia. This resulted in encephalopathy, falls, and spinal compression fracture


VAERS ID: 1441369 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: 1530 - Patient received first dose of Pfizer vaccine, had syncopal episode and hit back of her head (in observation area). Stated she did not have anything to eat today and she feels anxious/nervous when she comes to the hospital or doctor''s office. Mother assisted patient off the ground and onto a chair. Assisted patient onto gurney, vital signs taken 119/80, HR 90, 97% on RA, resp 18. Awake, alert and oriented, complains of pain on back of her head 4/10. Mother agreed to have paramedics called for transfer to emergency room. 1600 - Paramedics arrived, evaluated patient. Mother refused paramedic transport. Patient assisted onto wheelchair, mother stated she will take patient to emergency room in wheelchair. Risks/benefits explained. Mother gave verbal understanding.


VAERS ID: 1441519 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

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

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

Write-up: Pt was discharged from post observation and in parking lot and became nauseous with emesis . States nausea onset occurred when he exited the clinic. Pt was observed by RN inside clinic and quickly exited the building to assist pt and provide chair to be seated. 1050EMTS called and 1052 arrived. Pt continuing to have emesis and be lightheaded. Denies trouble with breathing. 1100 BP 162/92 HR 70 O2st 98 . Pt monitored and assessed denies nausea and without emesis. 1105 BP 168/palpable HR70 O2sat 97, 1115 Pt standing without vertigo nausea and released by EMTS and escorted to car by wife.


VAERS ID: 1441521 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 2 LA / IM

Administered by: Pharmacy       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? 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: Vaccine administered on July 1 may have been opened on Tuesday May 29, which is outside of the 12 hour allotted time window. Certified Pharmacy Technician administered vaccine assuming another pharmacist had already opened vial that was in refrigerator. Pharmacist does not recall opening a vial on July1. It could have been remainder of doses from 6-29-21. Vial was discarded and new vial was opened for subsequent doses in the day. Patient waited in the pharmacy for 30 minutes and noted no adverse events.


VAERS ID: 1441524 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure via skin contact, Syringe issue, Underdose
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: When giving the vaccine the fluid came out of the hub and squirted on the patient''s shirt and arm. Also there was liquid on the immunizer''s hands. The immunizer said most did not get into the patient''s arm, thus we revaccinated.


VAERS ID: 1441540 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt reports fainting in the past to vaccines.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt fainted after being administering janssen covid vaccine. regained conscous within a few seconds and laid on the floor for about 30 minutes until he felt better.


VAERS ID: 1441552 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Seizure, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Seizures
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting about 3 minutes after receiving the vaccine patient began to have shaking in right hand and arm. Patient reported that he felt like he was going to have a seizure. After about 15 minutes patients shaking in arm got worse and then patient had a seizure. Following patients seizure he continued to have shakiness in hand and arm for approximately another 20 minutes. After this patients arm and hand returned to normal and patient was fine.


VAERS ID: 1441557 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Malaise, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (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: Per patient Fluoxetine - diagnosis Anxiety
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient appeared to faint, was sweating profusely and generalized feeling of malaise. Patient was giving water and Fire-Rescue called. Fire-rescue examined the patient and cleared him to leave after feeling better


VAERS ID: 1441681 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 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: NONE KNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: NO ADVERSE EVENT. VACCINE GIVEN. PATIENT STATED THAT SHE HAD NOT HAD ANOTHER COVID VACCINE ON HER FORM AND CONFIRMED TO ME AT THE TIME THAT THE INFORMATION WAS CORRECT. HOWEVER, WHEN WE ENTERED THE VACCINE DATA INTO DATABASE WE NOTED THAT SHE RECIEVED P


VAERS ID: 1441684 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given non diluted mrna vaccine.


VAERS ID: 1441695 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 RA / IM

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

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

Write-up: Patient had received Pfizer series (2 shots) at another location; date unknown to us. Patient claimed that her antibody test showed negative after her second shot so her doctor recommended her to redo the series. She made appointment at our pharmacy for Moderna shot 7/1/21 first dose. On her consent form, she checked NO to question "Have you received a vaccine for COVID in the past". We gave her the shot then billed insurance afterwards. Insurance came back with rejection that patient had Pfizer series. We contacted patient and she confirmed she already had Pfizer series. The case was reported to pharmacy manager and regional supervisor. We were advised to fill out this report for CDC future use. Patient had NO adverse effects but this form had to be filled out so some of the questions would not be relevant regardless of the answers.


VAERS ID: 1441697 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After 3 minutes of administering the vaccine, patient c/o feeling hot and sweating. It looks like she is experiencing vasovagal syncope. She was able to communicate. She was given ice pack to place on her forehead. When ask if she has eaten or drink anything today. She response no. She was given water and 1 Lindor Chocolate . She felt better. She was able to text her husband to let him know what''s going on. She drank a total of 1 and 1/2 bottle of water ( about 20 oz) . She was instructed to sit on the chair the entire time. After 30 minutes , she was able to stand up and walk to her car no problem. Her husband drove her home. We talked to her about 3 hour later and she reported of doing fine.


VAERS ID: 1441806 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Hyperhidrosis, Malaise, Muscle contracture, Nausea
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), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: One or two minutes after administration, patient said we was feeling light-headed, and then that he didn''t feel well. He was instructed to focus on his breathing. He did this for a moment (maybe a minute) and then his head fell forward and he slumped forward in the chair. He was held stable in the chair by the pharmacist. After a short time (less than a minute) the patient''s upper body (bilateral arm and hand) muscles contracted (maybe a seizure?) and then he relaxed and sat up. He was alert, a little disoriented initially and had no recollection of his reaction other than feeling light-headed and unwell. He then became sweaty and felt a little nauseated. The pharmacy called 911 and the patient left with the medics. At that time he was alert and oriented, but still not feeling well.


VAERS ID: 1441808 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-07-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site abscess
SMQs:

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

Write-up: patient called up to pharmacy at request of medical office. said he had to have abscess drained at site of injection, 2 weeks after injection given at pharmacy


VAERS ID: 1441809 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated he never received a COVID vaccine. Pfizer was administered. Upon billing the patient''s insurance, it was noted he had already received the Janssen vaccine.


VAERS ID: 1441812 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-09
Onset:2021-07-01
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Heavy, painful periods for past 2 cycles since vaccine


VAERS ID: 1441814 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-17
Onset:2021-07-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Hypoaesthesia, Magnetic resonance imaging
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness:
Preexisting Conditions: rheumatoid arthritis
Allergies: none
Diagnostic Lab Data: Medical Clinic Urgent Care 6/29/21. Blood work was completed. Referred to a neurologist and to complete an MRI. 7/1/21 visit at Neurologist completed an MRI scan at Diagnostic Institute. Another appointment is to be scheduled by tomorrow for another MRI.
CDC Split Type:

Write-up: My left arm felt numb the first two days. The third day my hand felt numb and then my whole left side of my body felt numb. It has been numb ever since.


VAERS ID: 1441819 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

Administered by: Other       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: It was the end of the day and the patients date of birth was overlooked. The patient was monitored for 15 minutes following the vaccine administration and no adverse events occurred.


VAERS ID: 1441824 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cognitive disorder, Dizziness, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Symptoms of dizziness/lighheadness started 5 min after injection. got severely worse over the next 5 min, culminating in me fainting. lost balance when i fainted. symptoms slowly improved over 30 min after lying down. it''s now 7 hours later and minor dizziness/lightheadedness/minor cognitive symptoms persist.


VAERS ID: 1441883 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chills, Headache, Hypokinesia, Pain, Pain in extremity, Somnolence
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (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: Ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt sleepy almost immediately after napped for a few hours then was fine. My arm started to feel sore around the midnight and my lower back began hurting. Then around 3am I began getting the chills, my body was in so much pain like achy, a headache, and I could barely move my arm. It?s been over 24 hours after the shot I still have chills, body aches, headache, lower back area hurts really bad, and my right arm is still really sore.


VAERS ID: 1441887 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Migraine
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PT HAS A HISTORY OF SENSORY MIGRAINE. SHE DIDN''T HAVE A MIGRAINE WHEN SHE CAME IN TO GET HER SHOT. SHE THINKS THAT MIGRAINE COULD ALSO BE CAUSED BY THE SITUATION. SHE WENT FROM OUTSIDE THE PHARMACY WHERE THERE WAS BRIGHT LIGHTS AND NOISE AND HAD TO WAIT 30 MINUTES IN A QUIET, DARKER WAITING AREA
Allergies: PEPPERMINT
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT REPORTED GETTING A MIGRAINE 10 MINUTES AFTER RECEIVING THE VACCINE.


VAERS ID: 1441889 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-07-01
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

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

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

Write-up: THERE WERE NO ADVERSE EVENTS. AS STATED BY THE MANUFACTURER, THIS IS AN OFF LABEL USE BECAUSE THE PATIENT IS 15 YEARS OLD.


VAERS ID: 1441892 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Immediate post-injection reaction, Skin warm, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: PATIENT FELT DIZZY IMMEDIATELY AFTER VACCINATION, STARTED SWEATING PROFUSELY, FELT THIRSTY. HIS BODY WAS WARM AND WANTED TO LIE DOWN. HE LIED DOWN WITH FEET ELEVATED. STARTED FEELING BETTER AFTER 15 MINUTES.


VAERS ID: 1441904 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-28
Onset:2021-07-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: I was in the shower and had my eyes closed for a couple minutes. I could see the red of my eyelids. Suddenly, I thought the power/lights suddenly went out because everything became pitch black vs the light red you normally see from the eyelids. However, when I opened my eyes, everything was lit. When I close my eyes again, it goes pitch black, as if I have some cover over my eyelids.


VAERS ID: 1441914 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Very heavy vaginal bleeding


VAERS ID: 1442341 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest pain, Echocardiogram, Electrocardiogram normal, Troponin increased
SMQs:, Myocardial infarction (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Menactra on 07/11/2016 at age 11years. Severe swelling, redness, and pain at injection site. Told that they had an allergy.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Severe local reaction to Menactra Vaccine (Meningococcal ACWY) with swelling/redness/pain at injection site.
Diagnostic Lab Data: in ER: troponin elevated at 1.9. ECG normal. Admitted to hospital for ongoing care. Echo pending.
CDC Split Type:

Write-up: Chest pain and weakness on evening of 7/1/21 after working for 8 hours and while taking a bath. Chest pain worsened and went to ER.


VAERS ID: 1442798 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Hypoaesthesia, Palpitations
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lorazepam
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: None
Diagnostic Lab Data: BP 122/81, P: 104, O2 100%; BP 118/81, P: 99, O2 100%; BP 121/80, P: 98, O2 100%.
CDC Split Type:

Write-up: Patient began feeling chest pains and numbness to right arm. Patient also complained of palpitations. Patient instructed on breathing techniques. EMS called over. Vitals taken. Patient''s symptoms subsided. Pulse back in range. Normal sinus rhythm per EMS.


VAERS ID: 1442831 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Nausea, Seizure
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Nausea-Mild, Systemic: Seizure-Mild, Additional Details: Felt tired, and sick to stomach, then slumped over and convulsed about 10 min post-injection, was laid on her side, then paramedics arrived 15 min post-injection


VAERS ID: 1442833 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

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

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

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


VAERS ID: 1442835 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Dyspnoea, Flushing, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Severe, Systemic: Weakness-Severe, Additional Details: Fully recovered


VAERS ID: 1442839 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Hypotension, Nausea, Seizure, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Severe, Systemic: Nausea-Severe, Systemic: Seizure-Medium, Systemic: Shakiness-Medium


VAERS ID: 1442841 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Hyperventilation, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (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: Chest Tightness / Heaviness / Pain-Mild, Systemic: Hyperventilation-Mild, Systemic: Nausea-Mild


VAERS ID: 1442843 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Eye swelling, Mouth swelling, Nausea, Panic attack, Paraesthesia, Swelling face, Swollen tongue, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Nausea-Mild, Systemic: Tachycardia-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Vomiting-Mild, Additional Details: 911 was called. Evaluated and all vitals were good. Rescue felt it was a panic attack. Mom told to follow up with ER visit- rescue offered to call ambulance but mom denied. Patient left feeling better.


VAERS ID: 1442845 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Mild


VAERS ID: 1442846 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Pruritus, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Itching at Injection Site-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Additional Details: patient given benadryl. itching worsened before administration but has improved since. rph called patient- she was drowsy from the benadryl but reported improved itching


VAERS ID: 1442848 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: After vaccination patient and mom were directed to the waiting area and asked to wait for 15 minutes. Mom and Pt decided to leave the waiting area and walk around. Shortly after pt fainted and hit her arm. She had mild scrapes on her arm. We had her lay on the pharmacy bench with her feet up for 30 minutes. We gave her apple juice to drink. After that she was fine


VAERS ID: 1442849 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1442851 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Error: Improper Storage (temperature)-


VAERS ID: 1442852 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Error: Improper Storage (temperature)-


VAERS ID: 1442853 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Pain in extremity
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Systemic: Patient experienced swelling of left ankle and pain in left foot-Medium


VAERS ID: 1442856 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Dizziness, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: patient cried after a normal shot..then hyperventilate (boyfriend explain that she is afraid of shots and needles and this happen all the time-Mild, Systemic: Hyperventilation-Mild, Additional Details: normal IM shot. No redness or bruise @inject site. No pain reported but patient cried/hyperventilation/feel faint...boyfriend refuse ambulance saying "this happen all the time. she is afraid of shots". then due to hydrpventilating..she feel dizzy and almost faint (but not faint). after sit on floor for 30 minutes, she is able to walk away with her boyfriend. According to her boyfriend, the sight of blood or needle make her very scaried. Boyfriend won''t let me call ambulance due to possible cost


VAERS ID: 1443012 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

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

Write-up: Pt contacted MD office day after vaccine to report mild chest tightness and wheezing. No apparent intervention(s) made.


VAERS ID: 1443048 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2020-12-22
Onset:2021-07-01
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 Pfizer COVID vaccine on 12/22/20 and 1/11/21. 7/1 pt tested positive for COVID requiring home quarantine.


VAERS ID: 1443062 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Patient reported he was due for 2nd dose of Pfizer vaccination and had computer generated appointment for 7/1/2021. He stated that it was three weeks since his first vaccine but he didn?t have his original card with the date. After questions were reviewed by RN the second dose was given. However a few minutes after it was nite that the computer had the first dose vaccine date as 6/17/2021 which makes it 2 weeks. when questioned patient insisted this date of 6/17/2021 was wrong but he didn?t have any proof of this.


VAERS ID: 1443071 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Cognitive disorder, Cold sweat, Malaise, Pallor, Pulse abnormal
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: see attached med list (too many- times me out each time I try to enter them!)
Current Illness:
Preexisting Conditions: HTN, a-fib, post CVA, CKD, COPD
Allergies: NKDA
Diagnostic Lab Data: ??-- can obtain from Hospital ER - visit on 7/1/21
CDC Split Type:

Write-up: ****Pt administered first Moderna COVID-19 vaccine today. Pt started complaining of "feeling like bad", and wife states he is very clammy- only a few minutes after injection. Pt alert and oriented to place and self. Pt looks visibly clammy and pale. He is cognitive and able to answer questions. Pt denies CP, SOB, chest pressure, nausea, pain when asked. 1105am: blood pressure (automatic cuff): 61/39, HR= 50. 1108am: blood sugar: 148 Pt has been alert and answering questions, also able to drink water. Pt started to become less cognitive at this time, and there were delays with answering questions, also had to repeat questions more than once. 11:12am- Called Doctor over to assess pt (this is Doctor''s pt) 11:16am- Per Doctor : thready pulse and he is not as alert as normal- call EMS. EMS called at 11:16am. 11:19am -Manual blood pressure reading: 64/38 with ''thready pulse'' Pt is able to answer questions only occasionally, which his wife says is not his baseline/not normal. 11:25am- EMS arrived to take patient to Hospital, pt wife and son at bedside and will accompany pt to ER. Pt''s wife notified to contact us once discharged to schedule f/u appt (pt was scheduled to see Doctor later today)- also notified we will NOT administer his second Moderna COVID vaccine d/t his reaction to the first. Pt''s wife verbalized understanding and very appreciative for assistance today.


VAERS ID: 1443116 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-14
Onset:2021-07-01
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Caesarean section, Exposure during pregnancy, SARS-CoV-2 test positive, Twin pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive SARS-CoV-2 by PCR from specimen collected on 7/1/2021
CDC Split Type:

Write-up: Patient was admitted to labor and delivery at Hospital and screened positive for COVID-19, asymptomatic at that time. Delivered twins via C-section, birth weight 6 lb 2 oz and 5 lb 10 oz. Possible COVID history in 11/2020 and $g14 days post completion of vaccination.


VAERS ID: 1443119 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 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: OXYBUTYNIN CL 5MG ER TAB DAILY POTASSIUM CL 20MEQ SA TAB 1/2 TAB DAILY
Current Illness: NONE
Preexisting Conditions: HISTORY OF COLON CANCER TYPE 2 DIABETES HYSTERECTOMY HYPERLIPIDEMIA
Allergies: METFORMIN
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient had received a Moderna vaccine as their first dose. Patient returned for 2nd dose and was given Pfizer in error.


VAERS ID: 1443127 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: severe body aches, headache, fever, extreme exhaustion, loss of appetite


VAERS ID: 1443130 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-02
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 2 LA / IM

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

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

Write-up: 20-YEAR-OLD FEMALE, REFERS THAT AT THE MOMENT SHE DOES NOT HAVE KNOWN ALLERGIES, NOR SUFFER FROM MEDICAL CONDITIONS. AFTER THE INOCULATION THE PATIENT REFERS FEELING Dizzy AND NAUSED. PRESENTS 3 TO 4 VOMITS CONTINUOUSLY. VITAL SIGNS ARE MEASURED EVERY 15 MINUTES.


VAERS ID: 1443134 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-29
Onset:2021-07-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Haematocrit normal, Haemoglobin normal, Hypotension, Paronychia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (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: Ingrown toenail with local infection ~1 week prior to vaccination
Preexisting Conditions: Asthma
Allergies: NKA
Diagnostic Lab Data: Hgb: 14/0 g/dL HCT: 41% Heart rate: 87 Physical exam within normal except for R big toe ingrown toenail and healing paronychia.
CDC Split Type:

Write-up: Dizziness, lightheadedness, and hypotension to 82/51


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