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

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



Case Details (Reverse Sorted by Onset Date)

This is page 374 out of 6,867

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VAERS ID: 1546271 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-21
Onset:2021-07-14
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Alanine aminotransferase, Aspartate aminotransferase, C-reactive protein, Computerised tomogram, Lipase, Pancreatitis acute, SARS-CoV-2 test, White blood cell count
SMQs:, Acute pancreatitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210717; Test Name: ALAT; Result Unstructured Data: Test Result:13 IU/l; Comments: normal; Test Date: 20210717; Test Name: AST; Result Unstructured Data: Test Result:13 IU/l; Comments: normal; Test Date: 20210717; Test Name: contrast CT; Result Unstructured Data: Test Result:The pancreas is oedematous, enhanced in contrast w; Comments: The pancreas is oedematous, enhanced in contrast with infiltration of peri-pancreatic fat associated with a thin layer of fluid in the pouch of Douglas; normal morphological appearance of the liver, intra- and extra-hepatic bile ducts, vesicle, spleen, 2 kidneys and adrenals; permeable celio-mesenteric vascular system. No visible retro-peritoneal or iliac coeliomenteric adenomegaly. Probable Balthazar grade D acute pancreatitis with a severity score = 3; Test Date: 20210717; Test Name: c-reactive protein; Result Unstructured Data: Test Result:0.9 mg/l; Comments: no inflammatory syndrome; Test Date: 20210716; Test Name: lipase; Result Unstructured Data: Test Result:239 IU/l; Comments: 4N; Test Date: 20210717; Test Name: lipase; Result Unstructured Data: Test Result:217 IU/l; Comments: 3.5 N; Test Date: 20210718; Test Name: sars-cov-2 pcr test; Test Result: Negative ; Test Date: 20210717; Test Name: white blood cells; Result Unstructured Data: Test Result:4.7 g/l
CDC Split Type: FRPFIZER INC202100966873

Write-up: Acute pancreatitis; This is a spontaneous report from a contactable consumer (patient) downloaded from the WEB FR-AFSSAPS-SE20211895. A 33-year-old female patient received the first dose of bnt162b2 (COMIRNATY, solution for injection) intramuscular on 21Jun2021 (Batch/Lot number was not reported) as dose 1, single for COVID-19 immunisation. Medical history and concomitant medications were reported as none. Patient is not an individual at risk of developing a severe form of COVID-19. No history of COVID-19. Patient has been tested on 18Jul2021: Polymerase Chain Reaction test was negative. Date of onset of the reaction was reported as 14Jul2021 (Day 23). Description of side effect was acute pancreatitis. Day 23 (14Jul2021): onset of diffuse abdominal pain. Day 24 (15Jul2021): medical consultation leading to the introduction of pantoprazole, aluminum hydroxide, magnesium carbonate (GAVISCON), trimethylphloroglucinol (SPASFON) and paracetamol (DOLIPRANE) + prescription for blood panel. Day 25 (16Jul2021): lipases measured at 239 IU/l or 4N. Day 26 (17Jul2021): Visit to the Emergency Room due to persistent pain and elevation of lipase. Clinical examination: afebrile patient, diffuse abdominal pain on palpation with marked epigastric pain, transfixing in a over the back, analgesic foetal position, diagnosis of acute pancreatitis within 72 hours of the first symptoms. Blood test: normal liver function (aspartate aminotransferase and alanine aminotransferase 13 IU/l), lipase 217 IU/l (3.5 N), no inflammatory syndrome (C-reactive protein 0.9 mg/l and white blood cells 4.7 g/l). Computed tomography with contrast: The pancreas is oedematous, enhanced in contrast with infiltration of peri-pancreatic fat associated with a thin layer of fluid in the pouch of Douglas; normal morphological appearance of the liver, intra- and extra-hepatic bile ducts, vesicle, spleen, 2 kidneys and adrenals; permeable celio-mesenteric vascular system. No visible retro-peritoneal or iliac coeliomenteric adenomegaly. Probable Balthazar grade D acute pancreatitis with a severity score = 3. Treatment received was analgesia, on an empty stomach. Aetiological assessment/ differential diagnosis: no alcoholism, no obvious argument in favour of a biliary cause according to the computed tomography scan and the blood test, but assay of transaminases within 72 hours of the 1st clinical signs and absence of abdominal ultrasound, metabolic cause not investigated (no assay of calcium or triglycerides), no obvious argument in favour of an infectious cause: no fever, no inflammatory syndrome, negative Severe Acute Respiratory Syndrome-CoV-2 serology, no auto-immune assessment. Outcome: Day 27 (18Jul2021): more pain but patient nauseous in the morning with 2 episodes of vomiting (potentially attributed to tramadol (TOPALGIC) prescribed at night). Soft, yielding, painless abdomen. Increase in hydration, trial step feed and light diet. Discharged home. Conclusion: 1st episode of acute pancreatitis on Day 23 of COMIRNATY Dose 1 in a 33-year-old female patient with no previous history. No aetiology found but partial assessment (no abdominal ultrasound, metabolic cause not investigated). Therapeutic measures were taken as a result of acute pancreatitis. The event was reported as serious, hospitalization from an unspecified date to 18Jul2021. The outcome of the event was recovering at the time of report. No follow-up attempts are possible. No further information expected. Information on batch/lot number cannot be obtained.


VAERS ID: 1546450 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Blood test abnormal, Chest discomfort, Echocardiogram, Fatigue, Inflammation
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased
Allergies:
Diagnostic Lab Data: Test Name: Blood tests for heart and pulmonary embolism; Result Unstructured Data: Test Result:Not a heart problem or blood clot; Test Name: Heart ultrasound; Result Unstructured Data: Test Result:Not a heart problem or blood clot
CDC Split Type: GBPFIZER INC202100969058

Write-up: Blood test abnormal; inflammation; Chest tightness; Fatigue; This is a spontaneous report from a contactable consumer (patient) received from the regulatory authority report number is GB-MHRA-WEBCOVID-202107281158265980-MTNY0, Safety Report Unique Identifier GB-MHRA-ADR 25719521. A 34-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 14Jul2021 (at age of 34-year-old) as dose 2, single for COVID-19 immunisation. Medical history included lactation decreased. Patient has not had symptoms associated with COVID-19 and not had a COVID-19 test. Patient is not pregnant and is not currently breastfeeding. Concomitant medications were not reported. The patient experienced blood test abnormal and inflammation on an unspecified date; chest tightness and fatigue on 14Jul2021. The events were medically significant. The patient underwent lab tests and procedures which included heart ultrasound and blood tests for heart and pulmonary embolism which showed not a heart problem or blood clot. Therapeutic measures were taken as a result of the chest tightness and included treatment with ibuprofen from 14Jul2021 to 15Jul2021. Outcome of the blood test abnormal and inflammation was unknown while of the remaining events was not recovered. The clinical course was reported as follows: Not a heart problem or blood clot (as reported, pending clarification) as I had a heart ultrasound and blood tests. Doctor suspects inflammation. Patient has not tested positive for COVID-19 since having the vaccine. Patient is not enrolled in clinical trial. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1546465 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-07-14
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET8885 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation delayed, SARS-CoV-2 test, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Fertility disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC202100969389

Write-up: Clot blood; Late period; Heavy periods; This is a spontaneous report from a contactable consumer received from the regulatory authority report number is GB-MHRA-WEBCOVID-202107281323313000-T5ZI3. Sender''s (Case) Safety Report Unique Identifier: GB-MHRA-ADR 25720185. A 31-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 01Jun2021 (Lot Number: ET8885) as single dose for covid-19 immunisation. The patient''s medical history was not reported. No medication taken. Patient had not had symptoms associated with COVID-19. Patient is not pregnant. The patient''s concomitant medications were not reported. On 14Jul2021, the patient experienced late period, heavy periods and clot blood. It was reported that: Period 5 days late. Usually very punctual. Very heavy period, again unusual. Few blood clots size of 5p coin. The patient underwent lab tests and procedures which included COVID-19 virus test: No - Negative COVID-19 test on an unspecified date. Patient has not tested positive for COVID-19 since having the vaccine. Patient was not enrolled in clinical trial. The outcome of Heavy periods was recovered on an unspecified date, of the other events was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1546751 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-07-14
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Polymenorrhoea
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: HRJNJFOC20210815186

Write-up: LONG MENSTRUATION; HEAVY MENSTRUATION; MENSTRUATION THAT LASTED FOR 6 DAYS AND THEN STARTED AGAIN AFTER 4 DAYS; This spontaneous report received from a consumer via a Regulatory Authority [Regulatory Authority, HR-HALMED-300050035] concerned a 34 year old female patient. The patient''s weight was 78 kilograms, and height was not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XD976 and expiry: unknown) 0.5 ml, 1 total, administered on 01-JUN-2021 for covid-19 vaccination. No concomitant medications were reported. On 14-JUL-2021, the patient experienced long menstruation, heavy menstruation, and had menstruation that lasted for 6 days and then started again after 4 days. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the long menstruation, heavy menstruation and menstruation that lasted for 6 days and then started again after 4 days was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0-20210815186-COVID-19 VACCINE AD26.COV2.S-Long menstruation, Heavy menstruation and Menstruation that lasted for 6 days and then started again after 4 days. These events are considered un-assessable. The events have a compatible/suggestive temporal relationship, are unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the events.


VAERS ID: 1546895 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-13
Onset:2021-07-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC5947 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Body temperature, Hyperthermia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (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: Medical History/Concurrent Conditions: Hospitalisation; Late effects of cerebral infarction; Oral intake reduced (due to late effects of cerebral infarction and poor oral intake)
Allergies:
Diagnostic Lab Data: Test Name: blood sampling; Result Unstructured Data: Test Result:no abnormalities; Test Date: 20210713; Test Name: body temperature; Result Unstructured Data: Test Result:36.7 Centigrade; Test Date: 20210714; Test Name: body temperature; Result Unstructured Data: Test Result:more than 39 Centigrade
CDC Split Type: JPPFIZER INC202100959765

Write-up: Pyrexia; hyperthermia (more than 39 degrees Centigrade); This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is v21121414. A 79-year-old female patient received BNT162B2 (COMIRNATY), via an unspecified route of administration on 13Jul2021 11:00 (Batch/Lot Number: FC5947; Expiration Date: 30Sep2021), at the age of 79-years-old, as dose 2, single for COVID-19 immunization. Medical history included late effects of cerebral infarction and poor oral intake. The patient''s concomitant medications were not reported. Historical vaccine included BNT162B2 (COMIRNATY) Lot number EY5422, Expiration date 31Aug2021, on 22Jun2021 as dose 1, single for COVID-19 immunization; no side reaction. The patient was a 79-year and 1-month-old female (age at the second dose of vaccination). Body temperature before vaccination was 36.7 degrees Centigrade. On 14Jul2021 at 05:00 (1 day after vaccination), the patient experienced pyrexia. On 22Jul2021 (9 days after vaccination), the outcome of the event was recovered. The course of the event was as follows: patient was hospitalized at reporter''s hospital since August 2020 due to late effects of cerebral infarction and poor oral intake. On 13Jul2021 (the day of vaccination), patient received the second vaccination. On 14Jul2021 (one day after the vaccination) the patient experienced hyperthermia (more than 39 degrees Centigrade) continued and even after orally taking Paracetamol, hyperthermia was observed until 19Jul2021 (6 days after vaccination). Examinations such as blood sampling were performed, but there were no abnormalities that caused pyrexia, so it was considered to be a side reaction of Comirnaty vaccination. The outcome of the events was recovered on 22Jul2021.


VAERS ID: 1547188 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD5996 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHPFIZER INC202100970355

Write-up: Anaphylaxis; This is a spontaneous report from a contactable other healthcare professional (HCP). This is a report received from the Regulatory Authority. Regulatory authority report number PH-PHFDA-300092672. A 50-year-old female patient received BNT162B2 (COMIRNATY), via an unspecified route of administration on 14Jul2021 (Batch/Lot Number: FD5996) (at the age of 50-years-old) as dose number unknown, single for COVID-19 immunisation. It was unknown if patient is pregnant at time of vaccination. The patient''s medical history and concomitant medications were not reported. The patient experienced anaphylaxis on 14Jul2021 at 15:00. The outcome of the events was recovered on unspecified date in Jul2021. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1547194 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Unknown  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD5996 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHPFIZER INC202100970365

Write-up: Anaphylaxis; This is a spontaneous report from a contactable other health professional. This is a report received from the Regulatory Authority. Regulatory authority report number PH-PHFDA-300092674. A 21-year-old patient of an unspecified gender received bnt162b2 (COMIRNATY, Lot Number: FD5996), via an unspecified route of administration on 14Jul2021 as dose number unknown, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient experienced anaphylaxis on 14Jul2021 14:59 with outcome of recovered. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1575568 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-13
Onset:2021-07-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE 2296 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Antinuclear antibody, Blood creatine phosphokinase, Borrelia test, C-reactive protein, Cytomegalovirus test, Echocardiogram, Electrocardiogram, Epstein-Barr virus test, HIV test, Hepatitis B virus test, Hepatitis C virus test, Investigation, Magnetic resonance imaging heart, Mycobacterium test, Myocarditis, Parvovirus B19 test, SARS-CoV-2 test, Troponin, White blood cell count
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210717; Test Name: antinuclear factor; Test Result: Negative ; Comments: negative, no monoclonal gammopathy; Test Date: 20210717; Test Name: CK; Result Unstructured Data: Test Result:1051 IU/l; Comments: CK at 1051 U / L (n : 39-308 U / L); Test Date: 20210719; Test Name: CK; Result Unstructured Data: Test Result:119 IU/l; Comments: 19Jul: CK: 119 U / L; Test Date: 20210717; Test Name: Borreliosis; Test Result: Negative ; Test Date: 20210717; Test Name: CRP; Result Unstructured Data: Test Result:13.6 mg/l; Comments: CRP at 13.6 mg / L (n: <5 mg / L); Test Date: 20210717; Test Name: CMV; Test Result: Negative ; Test Date: 20210717; Test Name: echocardiography; Result Unstructured Data: Test Result:unremarkable; Comments: The echocardiography (17Jul) is unremarkable, in particular the ejection fraction of the left ventricle is preserved, without any sign of disturbed segmental kinetics; Test Date: 20210717; Test Name: Electrocardiogram; Result Unstructured Data: Test Result:ST I elevation; Comments: sinus rhythm, PR <200msec, normal-focused fine QRS, ST I elevation, avL, V2 and V3. ST III sub-shift, avF; Test Date: 20210722; Test Name: Electrocardiogram; Result Unstructured Data: Test Result:ST elevation; Comments: an ST elevation in V2-V3 persists on the control ECG; Test Date: 20210717; Test Name: EBV; Test Result: Negative ; Test Date: 20210717; Test Name: HBV; Test Result: Negative ; Test Date: 20210717; Test Name: HCV; Test Result: Negative ; Test Date: 20210717; Test Name: HIV; Test Result: Negative ; Test Date: 20210717; Test Name: ANCA anti-MPO IgG; Test Result: Negative ; Test Date: 20210717; Test Name: ANCA anti-PR3 IgG; Test Result: Negative ; Test Date: 20210717; Test Name: Anti-basement membrane IgG; Test Result: Negative ; Test Date: 20210719; Test Name: Magnetic resonance imaging heart; Result Unstructured Data: Test Result:intramyocardial edema; Comments: left ventricle not dilated, not hypertrophied. Normal myocardial thickness (maximum 10 mm). Normal left ventricular systolic function (LVEF 61%). Very extensive antero-lateral basal to apical late sub-epicardial enhancement with anterior (mid-ventricular and anteroapical) and infero-lateral (basal to apical) extension compatible with acute myocarditis. T2 mapping: T2 map signal increased mainly in anterolateral medioventricular and infero-lateral basal and medoventricular, indicating intramyocardial edema.; Test Date: 20210717; Test Name: Quantiferon; Test Result: Negative ; Test Date: 20210717; Test Name: Parvovirus B19; Test Result: Negative ; Test Date: 20210717; Test Name: SARS-CoV-2 PCR swab; Test Result: Negative ; Comments: SARS-CoV-2 PCR swab dated 17Jul2021: negative; Test Date: 20210717; Test Name: Troponin; Result Unstructured Data: Test Result:13.812 ng/L; Comments: high troponins at 13.812 ng / L (n: <60 ng / L) with upward kinetics and a peak measured on 17Jul at 14239 ng / L; Test Date: 20210717; Test Name: Troponin; Result Unstructured Data: Test Result:14239 ng/L; Comments: high troponins at 13.812 ng / L (n: <60 ng / L) with upward kinetics and a peak measured on 17Jul at 14239 ng / L; Test Date: 20210722; Test Name: Troponin; Result Unstructured Data: Test Result:174 ng/L; Comments: decrease in kinetics (174 ng / L at the discharge); Test Date: 20210717; Test Name: leukocytes; Result Unstructured Data: Test Result:14.5 x10 9/l
CDC Split Type: CHPFIZER INC202101000492

Write-up: Myocarditis; This is a spontaneous report received from a contactable physician via a regulatory authority. Regulatory authority report number CH-SM-2021-20463. A 16-years-old male patient received second dose of BNT162B2 (COMIRANTY; Solution for injection; Batch/Lot Number: FE 2296), via intramuscular route on 13Jul2021 (at the age of 16-years-old) as DOSE 2, SINGLE for COVID-19 immunization. The patient medical and concomitant medication history were reported. The patient previously received first dose of BNT162B2 (COMIRANTY; Solution for injection; Batch/Lot Number: FC 8736), via intramuscular route on 15Jun2021 as DOSE 1, SINGLE for COVID-19 immunization. On 14Jul, patient presented the onset of retrosternal chest pain in a context of post-vaccine flu syndrome, motivating patient to consult on 17Jul2021. On arrival it was hemodynamically stable, there was no sign of overload. The patient underwent lab tests and procedures which included antinuclear antibody: negative, no monoclonal gammopathy on 17Jul2021. Blood creatine phosphokinase: 1051 iu/l CK at 1051 U / L (n : 39-308 U / L) on 17Jul2021. Blood creatine phosphokinase: 119 iu/l on 19Jul2021 19Jul2021: CK: 119 U / L. Borrelia test: negative on 17Jul2021. C-reactive protein: 13.6 mg/l CRP at 13.6 mg / L (n: <5 mg / L) on 17Jul2021. Cytomegalovirus test: negative on 17Jul2021. Echocardiogram: The echocardiography (17Jul2021) was unremarkable, in particular the ejection fraction of the left ventricle was preserved, without any sign of disturbed segmental kinetics on 17Jul2021. Electrocardiogram: ST i elevation sinus rhythm, PR <200msec, normal-focused fine QRS, ST I elevation, avL, V2 and V3. ST III sub-shift, avF on 17Jul2021. Electrocardiogram: ST elevation an ST elevation in V2-V3 persists on the control ECG on 22Jul2021. Epsteinbarr virus test: negative on 17Jul2021. Hepatitis b virus test: negative on 17Jul2021. Hepatitis c virus test: negative on 17Jul2021. HIV test: negative on 17Jul2021. Investigation ANCA anti-MPO IgG: negative on 17Jul2021. Investigation ANCA anti-PR3 IgG: negative on 17Jul2021. Investigation Anti-basement membrane IgG: negative on 17Jul2021. Magnetic resonance imaging heart: left ventricle not dilated, not hypertrophied. Normal myocardial thickness (maximum 10 mm). Normal left ventricular systolic function (LVEF 61%). Very extensive antero-lateral basal to apical late sub-epicardial enhancement with anterior (mid-ventricular and anteroapical) and inferolateral (basal to apical) extension compatible with acute myocarditis. T2 mapping: T2 map signal increased mainly in anterolateral medio-ventricular and inferolateral basal and medoventricular, indicating intramyocardial edema on 19Jul2021. Mycobacterium test: Negative on 17Jul2021. Parvovirus B19 test: Negative on 19Jul2021. SARS-CoV-2 test: Negative on 17Jul2021. Troponin: high troponins at 13.812 ng / L (n: <60 ng / L) with upward kinetics and a peak measured on 17Jul at 14239 ng / L and high troponins at 13.812 ng / L (n: <60 ng / L) with upward kinetics and a peak measured on 17Jul at 14239 ng / Lon 17Jul2021. Troponin: decrease in kinetics (174 ng / L at the discharge) on 22Jul2021. White blood cell count: 14.5 x10 9/l on 17Jul2021. Treatment with metoprolol and Ramipril was introduced. The assessment was completed by cardiac magnetic resonance imaging (19Jul): left ventricle not dilated, not hypertrophied. Normal myocardial thickness (maximum 10 mm). Normal left ventricular systolic function (LVEF 61%). Very extensive antero-lateral basal to apical late sub-epicardial enhancement with anterior (mid-ventricular and anteroapical) and inferolateral (basal to apical) extension, compatible with acute myocarditis. T2 mapping: increased T2 map signal ramipril mainly in anterolateral medioventricular and inferolateral basal and medoventricular testifying to intramyocardial edema. The patient did not present with recurrence of chest pain during hospitalization. Telemetry monitoring does not show arrhythmia. Monitoring of troponins shows a decrease in kinetics (174 ng / L at the discharge). It should be noted that an ST elevation in V2-V3 persists on the control ECGs but which was considered as a normal course of the disease, without argument for an acute event in view of the absence of recurrence of chest pain and the kinetics of troponins down. A return home was possible on 22Jul2021. A causal relationship between COMIRNATY and Myocarditis was assessed as being Probable/Likely. This case was reported as serious (Caused/prolonged hospitalization). The outcome of the event was recovered on 22Jul2021. Sender''s comments: This patient presented with the onset of chest pain, 1 day after the vaccination booster administration with Comirnaty, attributed to perimyocarditis. The occurrence of this type of side effect is not described in the characteristics of this vaccine, however the chronological sequence between vaccination and myocarditis suggests an association. In view of the above, the implication of the Comirnaty vaccine in the occurrence of myocarditis in this patient is considered probable. No follow-up attempts possible. No further information expected.


VAERS ID: 1576467 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-05
Onset:2021-07-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PV46696 / 2 - / -
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Deep vein thrombosis, Drug ineffective, Interchange of vaccine products, Magnetic resonance imaging, Off label use, SARS-CoV-2 test, Thrombosis
SMQs:, Lack of efficacy/effect (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Medication errors (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OMEPRAZOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Suspected COVID-19 (Unsure when symptoms started Unsure when symptoms stopped)
Allergies:
Diagnostic Lab Data: Test Name: MRI scan; Result Unstructured Data: Test Result:Unknown results; Test Date: 20210720; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Yes - Positive COVID-19 test
CDC Split Type: GBPFIZER INC202101014484

Write-up: i was diagnosed with a blood clot behind my left knee; drug ineffective; Interchange of vaccine products; Offlabel use; SARS-CoV-2 infection; DVT of calf; This is a spontaneous report from a contactable consumer. This is a report received from a regulatory authority. Regulatory authority report number GB-MHRA-WEBCOVID-202108072259362680-Q59AD, Safety Report Unique Identifier GB-MHRA-ADR 25771054. A 40-year-old male patient received bnt162b2 (BNT162B2, Solution for injection, Lot Number: PV46696, expiry date: not reported) dose 2 via an unspecified route of administration on 05Jul2021 as single dose for covid-19 immunisation. The patient received covid-19 vaccine nrvv ad (chadox1 ncov-19) (COVID-19 VACCINE ASTRAZENECA, Lot number not reported) dose 1 via an unspecified route of administration on an unspecified date as single dose for covid-19 immunisation. Medical history included suspected covid-19 from an unknown date and unknown if ongoing, Unsure when symptoms started and stopped. Concomitant medication included omeprazole taken for gastrooesophageal reflux disease from 05Jul2021 to an unspecified stop date. On an unspecified date, the patient was diagnosed with a blood clot behind left knee. On 14Jul2021, the patient experienced dvt of calf (deep vein thrombosis). On 20Jul2021, the patient experienced sars-cov-2 infection. Interchange of vaccine products, off label use and drug ineffective considered as events. Case narrative as reported: I was diagnosed with a blood clot behind my left knee, calf and thigh. I have had no problems like this before! I went to a walk in centre for my 2nd dose of AstraZeneca vaccine! I found out from the hospital that I have been given a different jab! I am now on blood thinning tablets for 6 months. Patient is not enrolled in clinical trial. The patient''s hospitalization was prolonged as a result of the events. On 20Jul2021, the patient underwent lab tests and procedures which included sars-cov-2 test: positive, on an unspecified date magnetic resonance imaging with unknown results. The outcome of diagnosed with a blood clot behind my left knee was reported as not recovered. The outcome of sars-cov-2 infection and dvt of calf (deep vein thrombosis was reported as recovering. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1581953 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC5029 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Extensive swelling of vaccinated limb, Malaise, Myalgia, Pyrexia, Vaccination site reaction
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: BEPFIZER INC202100988555

Write-up: Shivering; Myalgia; Feeling unwell; Fever; Extensive swelling of the arm; Reaction at the injection site; This is a spontaneous report received from a contactable consumer downloaded from a regulatory authority. The regulatory authority report number is BE-FAMHP-DHH-N2021-102083. An 18-year-old female patient received bnt162b2 (COMIRNATY), dose 1 via an unspecified route of administration on 14Jul2021 at age of 18-year-old (Lot Number: FC5029) at single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient experienced shivering, myalgia, feeling unwell, fever, extensive swelling of the arm, reaction at the injection site, all on 14Jul2021. The report was serious for disability. It was unknown if patient received any treatment. The outcome of the events was resolved with residual injures in Jul2021. Reporter Comment: Treatment - Unknown, evolution of the ADR - Recovered with residual injuries. No follow-up attempts are needed. No further information expected. ; Reporter''s Comments: Treatment - Unknown, evolution of the ADR - Recovered with residual injuries.


VAERS ID: 1586912 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dysmenorrhoea, Headache, Heavy menstrual bleeding, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: L-Thyroxine 75mg Vitamin B12 Vitamin D Vitamin K2 Omega 3
Current Illness:
Preexisting Conditions: Hashimoto syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fever, nausea and body aches on the evening of the vaccination day and on the next day. When my next period came, it was very heavy (heavy flow and higher pain than usual).


VAERS ID: 1465980 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / IM

Administered by: Military       Purchased by: ?
Symptoms: Electrocardiogram, Laboratory test, Myocardial necrosis marker, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Syncope fever


VAERS ID: 1465984 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Military       Purchased by: ?
Symptoms: Electrocardiogram, Laboratory test, Myalgia, Myocardial necrosis marker, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Syncope, fever, myalgias


VAERS ID: 1466146 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-05
Onset:2021-07-13
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Muscle spasms, Sleep disorder
SMQs:, Dystonia (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: Simvastatin Metformin Irbastartin
Current Illness:
Preexisting Conditions: Diabetic type2
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: All of a sudden I?ve been having lower leg cramps. Both legs. It?s like Charlie horse but severe where I have to get up and walk to fix it. Woke me up at night. Happened twice now.


VAERS ID: 1466473 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Crying, Dyspnoea, Headache, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions: Epilepsy
Allergies: Previous severe reaction to oxycodone that required medical treatment and hospitalization
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mother called to report pt having the following side effects: fever 102.5, whole body muscle aches, headache, anxiety and shortness of breath. She stated she went to bed around 10:30pm on 7/12/21 with not issues and when she awoke about 2am her daughter was on the couch crying and in pain from the body aches and headache. Mother calling to report event and questions about seeking medical treatment. Advised to go for evaluation or call emergency services if pt is having difficulty breathing or is short of breath.


VAERS ID: 1466486 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-11
Onset:2021-07-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in chest, shortness of breath on 2nd day


VAERS ID: 1466505 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-09
Onset:2021-07-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011021A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Pain, Rhinorrhoea
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient was taking OTC prenatal vitamin and OTC probiotic.
Current Illness: Patient denies any illness at time of vaccine or one month prior.
Preexisting Conditions: Pt denies any chronic health conditions.
Allergies: Allergic to ceclor
Diagnostic Lab Data: Physical exam done on 7/13/21
CDC Split Type:

Write-up: Pt states that she got her second Moderna vaccina on Friday, July 9. Said she got some soreness and sniffles right after and then got better. Last night, Monday night at around 0415 Tuesday morning, she woke up from sleep with "excruciating pain" in her upper left arm (injection site). Said it was very localized to the deltoid muscle. Took some ibuprofen and went back to sleep. Said pain is better now - 2/10 at rest and goes up to 6/10 with movement. Upon exam, left deltoid area is very tender to palpation.


VAERS ID: 1466542 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0144 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dosage 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Taking Atorvastatin Calcium 40 MG Tablet Taking Aspirin 81 MG Tablet Chewable Taking Lisinopril 20 MG Tablet Taking Metoprolol Tartrate 25 MG Tablet Taking Metoprolol Tartrate 25 MG Tablet Taking amLODIPine Besylate 10 MG Tablet
Current Illness: L85.3 Xerosis cutis F20.0 Paranoid schizophrenia E78.5 Dyslipidemia Z71.6 Tobacco abuse counseling K21.9 Gastroesophageal reflux disease, esophagitis presence not specified F20.9 Schizophrenia, unspecified type E78.6 Hypocholesterolemia I10 Hypertension E11.9 Type 2 diabetes mellitus without complications F17.200 Tobacco use disorder
Preexisting Conditions: L85.3 Xerosis cutis F20.0 Paranoid schizophrenia E78.5 Dyslipidemia Z71.6 Tobacco abuse counseling K21.9 Gastroesophageal reflux disease, esophagitis presence not specified F20.9 Schizophrenia, unspecified type E78.6 Hypocholesterolemia I10 Hypertension E11.9 Type 2 diabetes mellitus without complications F17.200 Tobacco use disorder
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was administered the incorrect dosage of the Pfizer vaccine on 7/12/2021 at approximately 2:30 pm. Patient received all 6 doses of the pfizer instead of 1 dose from the vial. Patient was observed for 15 mins, no side effect or reaction observed. Incident was reported at 6:15 pm 7/12. Patient was notified at 6:30 pm via phone call by practice manager and a nurse , patient reported to be feeling OK with no reaction. Advised patient to call 911 to be monitored at the ER for 24 hours, patient agreed. Patient will be contacted on 7/13 for follow up.


VAERS ID: 1466588 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, 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), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient stood up from a seated position after receiving vaccine, lost consciousness, fell to floor. Event happened with a few mintues after receiving dose. Patient maintained open airway/breathing and had pulse. Patient was seated and regained consciousness. Emergency services arrived, assessed patient and transported to hospital.


VAERS ID: 1466609 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1075 / 2 RA / IM

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

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

Write-up: Pfizer vaccine given as second dose. Received Moderna for first dose. First dose of Moderna given 6/17/21.


VAERS ID: 1466630 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-08
Onset:2021-07-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: chest pain, palpitations, elevated HR today: 121/84 HR102


VAERS ID: 1466675 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-01
Onset:2021-07-13
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Hypoaesthesia, New daily persistent headache
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: I do not have health insurance due to its high costs. I am a single mom and simply can?t afford it.
CDC Split Type:

Write-up: 1. It started with a severe headache, which is now a daily occurrence. 2. In the last few weeks, I started feeling numbness (primarily arms and legs). I measured my pulse - it was 51 yesterday . Numbness is getting worse. 3. I have been experiencing severe fatigue since the vaccine. It never went away.


VAERS ID: 1466676 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Patient was administered the shot and shortly after started experiencing a shaking episode (not a seizure) and hot flashes.


VAERS ID: 1466682 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: She experienced nausea and vomiting throughout the night. Roughly 6 hours later she feels much better.


VAERS ID: 1466707 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

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

Write-up: METALLIC TASTE IN MOUTH IMMEDIATLY AFTER SHOT WAS GIVEN LIGHT HEADED/DIZZY/NAUSEOUS WITHIN 5 MINTUES OF SHOT 2nd reaction subsided after staying seated for about 10 minutes


VAERS ID: 1466722 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CITALOPRAM 20MG TABLETS. TYLENOL
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT BRIEFLY LOST CONSCIOUSNESS($g1 MIN). REGAINED CONSCIOUSNESS AND HAD DISCOLORATION OF FACE AND LIPS. EMS WAS NOTIFIED.


VAERS ID: 1466734 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hallucination
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)

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

Write-up: I experienced hallucinations around 0500, lasting only a few minutes. Very dark, disturbing imagery. I have never experienced any hallucinations before, even bad dreams are very rare for me and are never close to this severity. No drugs or alcohol used, no stressful events or scary movies prior to the event. No history of mental illness. This was very out of the ordinary. Reporting simply to inform as a person with mental health concerns may have a more severe reaction.


VAERS ID: 1466750 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), 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: Syncope, nausea Duration of approximately 20 to 30 minutes in total Loss of consciousness was only 30 seconds or less


VAERS ID: 1466755 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Incontinence, Musculoskeletal stiffness, Nervousness, Pallor, Presyncope, Pulse abnormal, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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: propranolol, cetirizine, Isibloom, flonase
Current Illness:
Preexisting Conditions:
Allergies: zithromax
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated she was nervous and received the vaccine without incidence. After receiving the vaccine while sitting the patient had what appeared to be a vasovagal response. She became pail and her eyes rolled back in her head. Patient appeared to have a seizure stuck both arms straight out and was incontinent. Patients was moved to the floor where her color returned and her pulse improved. Patient was taken to hospital via ambulance.


VAERS ID: 1466762 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO181 / 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: UNK
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Child was 11 years old. Vaccinated on 7/13/21.


VAERS ID: 1466784 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / ID

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral, Palpitations, Paraesthesia oral, Pharyngeal swelling, Tongue disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: renal tubular acidosis
Preexisting Conditions: renal tubular acidosis
Allergies: unknown
Diagnostic Lab Data: Pulse ox of 99 and holding, started reviewing at 1150 am until patient taken to ambulance shortly after.
CDC Split Type:

Write-up: Patient received second dose of Pfizer Covid-19 vaccine about 1105 am. About 1115 am patient complained of feeling lightheaded and dizzy. Patient was given some cold water and advised to sit for about 15 minutes to see if the dizziness would pass. About 1135 am patient complained that her lips felt a tingling sensation and her tongue felt thick. At 1140 am patient was administered 25 mg of diphenhydramine to help with current symptoms. Shortly after patient complained her throat felt swollen, her lips were numb and her tongue felt even more thick. Patient was administered 1 dose of Epi-pen at 1145 am in right outer upper thigh. Shortly before EMS arrived at 1150 am patient reported that her throat still felt swollen and that her heart was racing. EMS arrived at 1150 am and events and medication reviewed with EMS. EMS reviewed patient''s vital signs, which were stable with a pulse ox holding at 99, and then transported her to the ambulance.


VAERS ID: 1466789 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

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

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

Write-up: None.


VAERS ID: 1466802 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Posture abnormal, Seizure, Snoring
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 30 seconds after injection was administered, the patient''s face went blank and their head fell back. I took their mask off and they were snoring. I tried to get the patient to the ground and they started seizing and clutching at me. When the patient''s knees hit the ground, they came to and asked what had happened. The whole incident took a total of less than 5 minutes. EMTs were called and they checked out the patient and confirmed their vitals were ok. Patient stayed for 30 minutes after incident for monitoring and had returned to normal.


VAERS ID: 1466818 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient reported after the fact, that episode of syncope occurred with 1st dose
Other Medications: Blood pressure medications
Current Illness: none
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Homebound patient vaccinated with 2nd dose Pfizer at around 10:30 am after the first 15 minutes of observation, around 10:45 patient looked dizzy as she was getting ready to get up from the sitting position to escort us out. At this time, the patient indicated that this happened with the last dose. I noticed her dizziness and pale advised the patient to lie down legs propped up and gave her some water to drink. Attempted to take blood pressure with her own blood pressure cuff but the batteries died out. Continued to monitor for another 15 minutes, while patient continued to lie down and sipping water. After an additional 15 minutes passed I remembered we had a blood pressure cuff in the emergency kit , blood pressure reading was 138/56 and pulse was 76. Pt stated she felt better and wanted to escort us to the door. I advised against getting up and discussed the event with her son in law. Advised to monitor mother in law, call 911 if symptoms worsen. I also asked the son in law to escort us to the door so that the patient did not feel the need to get up out of the bed. Placed a call to person of contact on homebound list, Daughter currently out of town. Advise daughter of the event and to follow-up with her mother to see if she is okay, call 911 if symptoms worsen, and to follow up with PCP regarding event and any other concerns.


VAERS ID: 1466835 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: PATIENT RECEIVED UN-DILUTED PFIZER VACCINE EXHIBITED FEVER 101, ACHY AND FATUGUED


VAERS ID: 1466859 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: None.


VAERS ID: 1466876 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Paraesthesia oral, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Patient had stated that they had an anaphylactic reaction with aspirin & ibuprofen. Prior to vaccination they were asked to stay in the area for 30 minutes for observation. About 25 minutes following vaccine patient was feeling a heavy chest and tongue was feeling funny. Pharmacist administered 50mg of liquid Diphenhydramine to the patient 30 minutes following vaccination and she waited in the pharmacy area until symptoms cleared. Only symptoms when she left was a little bit of drowsiness.


VAERS ID: 1466938 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Off label use
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: N/A
Current Illness: N/A
Preexisting Conditions: No
Allergies: KNDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Off label use


VAERS ID: 1466940 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue
SMQs:

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

Write-up: PT STATED SHE FELT TIRED AFTER WAITING 15 MINS.


VAERS ID: 1466961 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Limb discomfort, Oral pruritus, Oropharyngeal discomfort, Panic attack, Pharyngeal swelling, Piloerection, Pruritus, Throat clearing, Throat irritation, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
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: None
Preexisting Conditions: Pt was hospitalized with severe Covid in february
Allergies: Pcn, morphine, seasonal allergies
Diagnostic Lab Data: Sent to we by ambulance
CDC Split Type:

Write-up: Began itching around the nose and the mouth after about 8 to 10 minutes and the skin around nose and mouth began turning red. Continued getting worse she took a Benadryl tablet. She began mildly panicking. Then she felt goose bumps on her arms began getting hives, throat began itching and closing, increased panic, trying to clear throat. Felt throat swelling. nurse administered epinephrine 0.5mg called ambulance.


VAERS ID: 1466968 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Complains of heart palpitations , pulse 120 when checked. Please went down to 105.


VAERS ID: 1466973 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 RA / IM

Administered by: School       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:
Current Illness:
Preexisting Conditions: Juvenile Rheumatoid Arthritis
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt came into the clinic requesting dose #1 . He was acting nervous & claustraphic (not wanting to be inside). I did not check the state system to see whether or not he had received prior doses before administering the vaccine today. It wasn''t until afterwards that it was determined that he had received Phizer on 2/8/21 & 3/1/21. He received the 3 rd dose today. He was feeling fine when he left the clinic after observation.


VAERS ID: 1466976 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

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

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

Write-up: Pt did not dilute Pfizer vaccine before administration. According to two Ladies she received 0.3mL of undiluted Pfizer vaccine.


VAERS ID: 1466984 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

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

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

Write-up: Staff did not dilute Pfizer vaccine before administration. According to the Pt''s received 0.3mL of undiluted Pfizer vaccine.


VAERS ID: 1466993 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), 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: Not known
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt. left the vaccination room and walked over 2 isles and then up past the middle of the store. Pt grabbed the mother''s arm and the mom helped her slow her decent to floor. Mom stated pt. fainted and unresponsive for a couple of minutes. Pt. regained consciousness and needed no further treatment.


VAERS ID: 1466994 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: Patient threw up 8 minutes after the vaccine was administered. Felt a little dizzy after the shot she said. No other side effect. Heart rate was normal. Sat down for 30 min in our waiting room. After 20 min mark, patient was given Gatorade. Felt better, dizziness went away. Left after 30 min. Offered to call 911 patient refused. Possibly related to nerves


VAERS ID: 1467003 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-03-06
Onset:2021-07-13
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Guillain-Barre


VAERS ID: 1467011 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Cardiomyopathy, Chest pain, Feeling hot, Lip swelling, Malaise, Sensory disturbance, Swelling face, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Hypersensitivity (narrow), 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: January 2021, Covid-19 Pfizer--hives and diagnosed cardiomyopathy per client report
Other Medications: Unknown
Current Illness: N/A
Preexisting Conditions:
Allergies: Peanuts, Tree Nuts, Pollen, Apples, Miralax (developed after first Pfizer dose in January 2021)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received Pfizer in January and had a significant reaction, including hives for several days and a chest pain with a subsequent diagnosis of cardiomyopathy. She consulted with her provider who recommended that she try to take some Miralax to see if she had a reaction, which she did, including swelling of her face/lips. She states that her provider then recommended the Janssen as a second dose instead of the Pfizer. Client received the vaccine at 12:12 pm, noticed two small hives on her left forearm a few minutes later, and then reported that she did not feel well at 12:20 pm. She was placed on a cot with a BP reading of 130//72, P -88, O2-99%. She took some oral Benadryl that she brought at 12:30 pm. She reported that her face felt "funny" and she felt hot, but started to feel better when she laid down. 12:40 pm BP 118/76, P-82, O2 98%. Client reported that her throat felt a little scratchy, but that she was also very anxious. 12:50 pm Client reported that she started to feel better. 12:52 pm O2 98%, P - 80. 1:00 P- 85, O2 99%. Client felt well and left with her father.


VAERS ID: 1467048 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ataxia, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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: Asthma
Allergies: NKDA
Diagnostic Lab Data: 7/13/2021 11:15am = BP (left leg): 99/45, HR: 77, SPO2: 99% (laying down) 11:20am= BP (left leg): 104/50, HR: 113, SPO2: 99% (laying down) 11:25am= BP (left leg): 118/73, HR: 95, SPO2:99% (laying down) 11:33am= BP (left leg): 121/75, HR: 70, SPO2: 99% (sitting down) 11:41am= BP (left leg): 114/80, HR: 92, SPO2: 99% (sitting down) 11:45am= BP (left leg): 118/60, HR: 102, SPO2: 99% (standing up)
CDC Split Type:

Write-up: Patient came in for second dose of vaccine. Patient and mother read and consented to the vaccination and read the prevaccination checklist. patient advised of potential side effects and recommendations of care for next few days (stay hydrated, possible soreness, take Advil or Tylenol for possible low grade fever or headache). Patient asked about hydration and meal prior to visit. Patient presented with nervousness/ anxiety and mother/ patient still consented to vaccination. vaccination was given, patient was taken to waiting area with crackers and juice given. while waiting the patient became diaphoretic. As patient walked to the back with mother to use restroom, patient showed signs of ataxia. patient was assisted into recovery position and never lost consciousness. Vital signs taken at 11:15 am BP: 99/45 (left leg), HR: 77, SPO2: 99%. Patient was fanned to cool off and decreased in diaphoresis. vital signs taken again at 5 min intervals. Patient monitored for 30 minutes, encouraged fluids with total intake of 700mL fluid. Last set of vitals taken while standing at 11:45 am were BP: 118/60, HR: 102, SPO2: 99%). Patient was given more fluids and monitored for 15 more minutes and then discharged from the clinic with parents.


VAERS ID: 1467064 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

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

Write-up: Vaccine was administered and 10 minutes later patient indicated he was getting dizzy with some vision changes and was sweating profusely. He was administered water and a snack and 20 minutes later was feeling better.


VAERS ID: 1467077 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: seasonal allergies worse this year- runny nose, sneezing, cough
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called this morning. He said he had raised red, itchy blotches all over. He said he had some benadryl at home and was going to take some. I followed up with him just now at 3pm. he said the welts have gone down and he''s not as itchy.


VAERS ID: 1467078 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: After his vaccination, patient was waiting 15 minutes in waiting room. Patient knocked on door and said he didn''t feel well. I closed door and turned to grab epi-pen and diphenhydramine. When I turned back around, patient fell on the floor and was unresponsive. I asked my technician to call 911. Patient regained consciousness in about 10 seconds and I told him an ambulance was coming. I observed his breathing to be normal. He sat up against the wall in a cold sweat and told me this has happened to him one time when he donated blood. The ambulance and paramedic arrived very promptly. They took him to the ambulance.


VAERS ID: 1467090 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-23
Onset:2021-07-13
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALBUTEROL HFA 90MCG PROAIR
Current Illness: None
Preexisting Conditions: None
Allergies: Tapazole, zithromaz, celexa, ciprofloxacin, sulfa drugs, levaquin, darvocet-N, Hydrocodone, Demerol
Diagnostic Lab Data: Jul 13, 2021@09:07:10 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: None


VAERS ID: 1467103 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Heart rate of 135 and elevated blood pressure


VAERS ID: 1467106 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

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

Write-up: patient lost consciousness twice, lost all his color, and it was reported that he was tremoring as if having a seizure


VAERS ID: 1467135 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: patient inquired about the covid vaccine offered at this location. She was informed it was pfizer. She inquired if it is given at walk-in or by appointment basis. She completed consent & release form, and had answered NO to the question "have you ever received a dose of covid-19 vaccine". Upon billing claim, insurance rejected stating "manufacturer different than initial dose". I logged into database, discovered that patient received 2 doses of Moderna on 1/17/21 and 2/14/21.


VAERS ID: 1467140 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immune thrombocytopenia, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: osteoarthritis
Preexisting Conditions: osteoarthritis
Allergies: none
Diagnostic Lab Data: platelets currently 6 07/13/21
CDC Split Type:

Write-up: Patient developed ITP 3 weeks after, severe. Platelets dropped to 1


VAERS ID: 1467156 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-02-12
Onset:2021-07-13
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: DM type 2, HTN
Preexisting Conditions: DM type 2, HTN
Allergies: No allergies
Diagnostic Lab Data: Jul 13, 2021@11:11:27 FLU A (CEPHEID) NEGATIVE , FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Covid screening


VAERS ID: 1467161 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-04
Onset:2021-07-13
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Disability, Headache, Magnetic resonance imaging head abnormal, Migraine, White matter lesion
SMQs:

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: Sertraline (Zoloft)
Current Illness: None
Preexisting Conditions: Episodic migraine
Allergies: Sulfa
Diagnostic Lab Data: MIDAS (Migrant Disability Assessment) questionnaire, June 4, 2021. Score 51=Severe Disability HIT-6 Headache Impact Test, June 4, 2021 . Score 54 MRI Brain Scan June 23, 2021. Result--no masses or hemorrhages, evidence of white matter disease typical of migraine
CDC Split Type:

Write-up: Approximately two weeks after receiving my first COVID vaccine, the frequency, intensity and duration of my migraines increased dramatically. For about 20 years I''ve had one or two migraine headaches per month, usually associated with my menstrual cycle. Since March 20th until now (July 13th) I have averaged 19 headache days per month. I have now been diagnosed with chronic migraine with a MIDAS score (Migraine Disability Assessment test) indicating severe disability.


VAERS ID: 1467166 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

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

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

Write-up: Patient was advised after the Moderna vaccine to sit down for 15 minutes for observation. 5 minutes after sitting down, patient felt nauseous, went black out , where he described it as "brain shutting down" and having a "vivid dream for 30 seconds". This last approximately 15-30 seconds. After blacking out he was able to open his eyes , completely conscious and alert. We offered him water and cracker and patient stated he felt much better, and declined 911.


VAERS ID: 1467174 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

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

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

Write-up: Approximately 5 minutes after receiving the Moderna vaccine, dose 2, the patient appeared to lose consciousness. Patient was seated in chair at the time and was with her sister. The sister held on to her so that she would not fall over (patient dropped cell phone on floor). About a minute or so later, the patient appeared to be conscious again and was resting in the waiting area of the pharmacy. At first the patient appeared confused and unaware of what was going on. Patient was given a bottle of water and paramedics were called. Paramedics arrived about 10 minutes later, checked all vitals and talked to the patient. Vitals appeared fine and no abnormalities noted. Paramedics then left and the pharmacist interviewed the patient, who by this time was aware and responsive. She indicated that she fainted shortly after receiving the vaccine but felt better after the paramedics left.


VAERS ID: 1467177 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 6 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Famotidine 20mg Cyclobenzaprine 10mg ProAir HFA
Current Illness: none
Preexisting Conditions: GI reflux
Allergies: Acetaminophen ASA Cipro Hydrocodone Naproxen PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt stated dizziness within 5 min of administration. bp checked and informed provider. pt vitals monitored. Pt had vomiting at 12:06 and informed provider Fair. Pt sx improved at 12:30 and released after informing provider. 11:42am- o2- 98, Pulse- 82 bp 129/82 in left arm, sitting, auto 11:45am- BP 132/86 manual in left arm lying down 12:07- BP 132/86 Manual right arm sitting


VAERS ID: 1467180 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 OT / IM

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

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

Write-up: Vomiting. Evaluated by EMS-Cleared


VAERS ID: 1467182 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: LESS THAN 5 MINUTES AFTER RECIEVING THEIR VACCINATION, THE CLIENT WAS FOUND LAYING DOWN ON A ROW OF CHAIRS IN THE OBSERVATION AREA. CLIENT REPORTS HAVING FELT WARM, FLUSHED, AND LIGHT HEADED. CLIENT REMAINED LAYING DOWN FOR SEVERAL MINUTES (AROUND 30 MINUTES). CLIENT WAS GIVEN WATER AND CLIENT''S FATHER GAVE HER STARBURSTS TO HELP, AS THE CLIENT STILL FELT LIGHTHEADED. CLIENT DENIES THIS EVENT HAPPENING BEFORE AND REPORTS HAVING HAD FOOD FOR LUNCH. CLIENT WAS ABLE TO WALK OUT OF THE ROOM ON HER OWN AFTER EATING STARBURSTS. NO OTHER CONCERNS PRESENTED.


VAERS ID: 1467190 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, Muscular weakness, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Fluticasone-Salmeterol, Singulair, Flonase, Loratadine
Current Illness: None
Preexisting Conditions: Asthma
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: @1045 Nurse was called to the hallway because pt was feeling tachycardic. C/O dizziness, SOB, tachycardia with rate of 100s+ Upon seeing pt, he reported that the HR is better. C/O feeling hot, dizzy, numbness and weakness to bilat hands, SOB. Resp even and unlabored. RR22. VS 170/95 (110) 59 98%. Team alert was initially called but pt refused to go to the ED. Team alert cancelled. Pt wants to rest and wait it out. Assisted back to room. Pt ambulated with supervision and support of RN. Pt refused to use the wheelchair. Water provided. Pt was able to ambulate towards to room without any difficulties. Able to speak in full sentences. @VS 1117 VS 150/89 59. Pt''s symptoms are starting to get better. Dizziness is really mild. Denies SOB. Slightly better numbness and weakness to hands. Instructed to increase fluid intake. @1125 VS 140/92 (107) 60 97%RA. Pt is feeling better. Denies dizziness, tingling to hands. C/O mild weakness to hands but able to move it better than initial encounter. Pt stated that he wishes to leave, go to cafeteria and eat. Pt is confident of going home. Pt has a ride home, mother will drive him home. Checked with the Dr. Per MD, okay to go home. Encourage pt to follow up with PMD and to go to the ED for new symptoms or worsening symptoms. Pt verbalized understanding. @1142 VS 151/82 (109) 61 Pt stood up. Feeling better. Gait stable. Denies any dizziness. Mild weakness to bilat hands. No sob noted. No s/sx of distress noted. Resp even and unlabored.


VAERS ID: 1467196 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
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:
CDC Split Type:

Write-up: Pfizer vial was diluted with 0.8 cc provided sterile NACL. Pt was given 0.3 cc dose from the vial resulting in a higher-than-authorized vaccine dose. Pt was observed for 15 min and let in satisfactory condition. Error was noticed 3 hours after administration, unable to reach pt at the time of this report but we are still trying.


VAERS ID: 1467212 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Condition aggravated, Dizziness, Feeling of body temperature change, Immediate post-injection reaction, Muscle spasms, Nausea, Tachycardia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), 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: thimethopin antibiotic started 4 days ago, 400mg magnesium, protopic for chronic vitaligo.
Current Illness: Sinus infection, prostate infection, chronic nausea, chronic vitaligo.
Preexisting Conditions: nausea and vitaligo.
Allergies: None.
Diagnostic Lab Data: Vital signs completed at time of event and 20 minutes after. At time of event: BP 121/70, HR 110, O2 99 20 minutes later: BP 124/70, HR 97, O2 99
CDC Split Type:

Write-up: Immediate stomach ache, pt threw up, nausea, tachycardia, leg spasm, hot/cold, dizzy.


VAERS ID: 1467214 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dysstasia, Nausea, Ocular discomfort, Retching
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Lisinopril, estrogen, Glimepiride, Onglyza, Omeprazole, Naproxen, Alvesco, Albuterol, Meloxicam, Solifenacin, Lidocaine, Acetaminophen
Current Illness: None
Preexisting Conditions: DM 2 DM 2 W HYPERLIPIDEMIA HYPERLIPIDEMIA GERD (GASTROESOPHAGEAL REFLUX DISEASE) HTN (HYPERTENSION) MIGRAINE ATHEROSCLEROSIS OF AORTA RIGHT SHOULDER JOINT PAIN VARICOSE VEINS HX OF BACK SURGERY BILAT HEARING LOSS HX OF APPENDECTOMY HX OF TOTAL HYSTERECTOMY ALLERGIC RHINITIS BILAT TINNITUS STRESS SCIATICA, LEFT SIDE CHRONIC NECK PAIN $g 3 MONTHS LEFT HIP JOINT PAIN LEFT CENTRAL PERFORATION OF EARDRUM CERVICAL SPONDYLOSIS OSTEOARTHRITIS OF LEFT HIP MEDICATION THERAPY MANAGEMENT PROGRAM 2018 TREADMILL STRESS TEST NEGATIVE FOR ANGINA PECTORIS CHRONIC LOW BACK PAIN LUMBAR SPONDYLOSIS HEARING PROBLEM RIGHT KNEE JOINT PAIN OSTEOARTHRITIS OF BILAT KNEES MIXED URINARY INCONTINENCE CHRONIC GASTRITIS URINARY INCONTINENCE OSTEOARTHRITIS OF RIGHT SHOULDER CORONAVIRUS COVID-19 DISEASE CORONAVIRUS COVID-19 PNEUMONIA
Allergies: Atorvastatin, Bactrim, Glipizide, Metformin, Pravastatin, Simvastatin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: @1135 Pt''s granddaughter called out because pt felt dizziness upon getting up. Pt is 30 mins post vaccination, Pfizer 1st dose. C/O dizziness and tingling sensation to L hand. @1135 VS sitting 128/69 (103) 74 with dizziness @1136 VS standing 151/82 (109) 82 with increased dizziness, wobbly upon getting up. Needs to be supported by nurse and granddaughter. Water provided. Encouraged patient to finish bottle of water. Daughter arrived, was able to translate better. Per pt, she has pressure to R eye and was feeling dizzy post vaccination. Pt didn''t tell granddaughter and nurse these symptoms. Tried standing patient up, complained of dizziness and nausea. Was gagging. Nonpharmacologic interventions provided, effective. Pt stated that her nausea is better. @ 1153 VS sitting 68 98%RA 122/74 (94) @ 1154 VS standing 120/84 (96) 76HR 100% Denies any dizziness. C/O very mild nausea. Pt refused to stay longer, wants to go to get some food. Daughter agreed to patient''s plan and is confident to take pt home. Instructed to have pt follow up to her PMD and to go to the ER if symptoms worse or new symptoms arise. Encourage increased fluid intake as tolerated. Pt, daughter verbalized understanding.


VAERS ID: 1467218 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None given
Current Illness: None given
Preexisting Conditions: None given
Allergies: None given
Diagnostic Lab Data: Blood pressure taken 115/78 on 7/13/2021
CDC Split Type:

Write-up: Patient became dizzy, weak and woozy/nauseous. He reported that he may have passed out for a quick moment.


VAERS ID: 1467251 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: 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: N/A
CDC Split Type:

Write-up: On July 7th it was discovered that when the Pfizer vaccination was taken out of the fridge and mixed it was dated with the incorrect date. It was dated as the 7th however was actually supposed to be the 6th. It was also discovered that the staff had not thrown the Pfizer vaccination away when they left on the 6th. This resulted in a patient receiving the Pfizer vaccination that had set out all night. Pfizer vaccination had actually been taken out of fridge at 8:54am and then mixed at 9:01am then drawn into syringes and was dated the 7th however was actually the 6th. One vaccination was given that day then the next day the 7th a staff member looked at the dates and times and then gave the injection to a patient. When I discovered the error I contacted Pfizer to see what next steps need to be done.


VAERS ID: 1467259 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pfizer vaccine dose 1, 6/22/2021
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: BP and HR 12:20pm 99/60 - 63 12:25pm 100/63 -59 12:30pm 101/62 - 71
CDC Split Type:

Write-up: pt reported dizziness and nausea after 15 mins at 12:20pm getting his 2nd dose of pfizer covid vaccine. Pt had similar episode of nausea/dizziness when getting his 1st shot 3 weeks ago. Pt was instructed to lay down and drink some Gatorade. Pharmacist on duty started measuring his BP every 5 mins with reading as below 99/60, HR:63 (12;20pm), 100/63, HR 59 (12:25pm), 101/62 Hr 71(12:30am). Pt ''s nausea and dizziness was gone after 10 mins laying down at 12:20pm. Pt recovered completely without other complication and left the pharmacy at 12:40pm


VAERS ID: 1467270 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cooling therapy, Feeling hot, Pallor
SMQs:, Hypotonic-hyporesponsive episode (broad)

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

Write-up: WITHIN A FEW SECONDS AFTER RECIEVING THEIR VACCINE, THE CLINE T TURNED WHITE AND SAID SHE FELT HOT. AFTER SITTING IN THE CHAIR FOR A COUPLE MINUTES, THE CLIENT WAS HELPED TO THE FLOOR AND FEET ELEVATED. WITHIN A MINUTE THE CLIENT FELT BETTER AND WAS ABLE TO SIT. SHORTLY AFTER, THE CLIENT THEN WAS ABLE TO WALK. WET COMPRESS AND A FAN HELPED CLIENT COOL. NO OTHER ISSUES OR CONCERNS.


VAERS ID: 1467280 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a seizure about 5 to 10minutes after vaccine was administered. Full body seizure and patient slide down to the floor from the chair he was sitting. Seizure lasted about 30 seconds. We had the patient lie on the ground until ambulance arrived. Patient was able to answer questions and said he felt calm after seizure was over. Patient was able to walk and fully alert when ambulance arrived. Patient was taken to hospital by ambulance.


VAERS ID: 1467283 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Hyperhidrosis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: dizziness, sweating, headache, numbness in arms. given 25mg diphenhydramine liquid and water. he did not pass out but felt as if he might. he rested in the waiting area until he felt he could leave safely on his own (about 30 minutes).


VAERS ID: 1467291 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: PATIENT APPEARED VERY PALE, FELT NAUSEOUS, DIZZY, AND SWEATING. NO BREATHING PROBLEM, NO SWELLING OF LIPS OR THROAT. ACCOMPANYING FRIEND SAID PATIENT DID NOT HAVE ANY BREAKFAST BEFORE VACCINATION. PHARMACY STAFF HELP ALLEVIATE PATIENT''S LEGS AND ENSURED ADEQUATE VENTILATION.


VAERS ID: 1467301 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

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

Write-up: patient felt light headed and paramedics came and said she was fine and she refused going to hospital


VAERS ID: 1467312 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-01-25
Onset:2021-07-13
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glyb uride/metformin, Atorvastatin, Gabapentin, Pioglitazone, omeprazole, Vit D3, Famotidine, lisinopril, Aspirin 81 mg. Calcium
Current Illness: None
Preexisting Conditions: Peripheeral sensory nnewuopathy, DM type 2, GERD''s, Coronary Arteriosclerosis, hx of MI, Osteoporosis
Allergies: Bee venom, Tylenol, tomato, banana, oranges, Benoxinate/fluorescein
Diagnostic Lab Data: Jul 13, 2021@13:29:08 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: Loss of taste


VAERS ID: 1467314 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: influenza
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: cipro,dilaudid,morphine,oxycodone,oxycontin,penicillin,percocet,rocephin,sulfa,tylenol-codeine. prior history of reaction to flu vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented red itchy rash from face down to legs, pt took 50 mg of benadryl prior to coming to clinic. pt was given in clinic 125 mg solu-medrol and 20 mg of pepcid, symptoms resolved pt sent home


VAERS ID: 1467328 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 RA / IM

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

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

Write-up: PT ARRIVED AT STORE 7/13/2021 AND MODERNA VACCINE WAS ADMINISTERED. PT CLAIMED TO HAVE NEVER RECEIVED COVID VACCINE. VACCINE REGISTRY WAS REVIEWED LATER AND FOUND THAT PT HAD RECEIVED: 3/26/2021 - MODERNA (DOSE 1) 4/29/2021 - MODERNA (DOSE 2) 5/28/2021 - JANSSEN (DOSE 1) *7/13/2021 - MODERNA (DOSE 3)*


VAERS ID: 1467513 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-09
Onset:2021-07-13
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Breast feeding, Contusion, Exposure via breast milk, Immune thrombocytopenia, Immunoglobulin therapy, Injection site haemorrhage, Platelet count decreased, Red blood cell count normal, White blood cell count normal
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Neonatal exposures via breast milk (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: They think he was experiencing ITP or Immune Thrombocytopenic Purpura. His platelet count was 5 and should be between 159-350 His body thinks he has a virus and is attacking his platelets. They treated him with immunoglobulins. Update on Alek. A normal platelet count should be between 159-350. Alek?s was 5.
CDC Split Type:

Write-up: The adverse reaction was with my son who is breast fed not with my wife. On June 28th we took our son to the doctors for a normal 6 month visit and showed them some of the bruises he had on his arms caused by our daughter grabbing his arms. They asked normal questions about any bleeding he may have had from circumcision or past shots and we told them none. They said the bruising is okay but to be careful with how our daughter plays with him. He got his 6 month shots and we went home. My wife noticed that he was bleeding through the bandaids and his shorts so we went back to the doctors office. They were now concerned and sent us to Hospital. Hospital did extensive blood work and ruled out things like Leukemia and things like lupus for now since his red and white blood cell count was normal. However his Platelet Count is extremely low. They think he was experiencing ITP or Immune Thrombocytopenic Purpura. His platelet count was 5 and should be between 159-350 His body thinks he has a virus and is attacking his platelets. They treated him with immunoglobulins. Update on Alek. A normal platelet count should be between 159-350 was 5. The infusion of immunoglobulins he got last night worked. He got his results back and they were good news. He increase to 132 and then 218. The hope is that he will maintain or increase the platelet count from here on out. He?s had a few blood tests last week and his count is very high and hopefully will level out. My concern is this: My wife had her 2nd Pfizer shot on June 9th. We started noticing the bruising on or around the 12th or 13th. I?ve asked at least a dozen doctors and nurses if the virus that my son?s immune system was fighting could have been caused by my wife?s 2nd Pfizer vaccine since she breast feeds. No one can give me an answer nor will they do any testing. Not to mention my son is a COVID baby. My wife and I both had COVID while she was pregnant with him. If anything you would think someone would care enough to at least test him for COVID or the antibodies. But no. Everyone just blows me off. Maybe what happened to him and his case could save another little babies life. If it wasn?t for the bruising on his arms caused by my daughter who knows what could have happened. Some doctors say he could have had a brain bleed and died.


VAERS ID: 1467518 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dosage 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: I''m reporting a possible error regarding the administration of a Pfizer vaccine. When administering a vaccine to a patient I''m not sure if 0.3 mL or 0.5 mL was drawn up. I realized as I was administering the subsequent shot that I was unsure of the dose, and that I used a syringe normally designated for Moderna/JJ doses for a Pfizer dose. The vial itself was not short any doses, but I am reporting out of an abundance of caution.


VAERS ID: 1467523 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / 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: yes 1st pfizer vaccine she passed out. please see above
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient fainted in her chair about 10 mins after vaccine was administered. Patient did not hit her head. Patient was given water, asked to lie down, and monitored for an additional 15 minutes until she felt better


VAERS ID: 1467528 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad)

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

Write-up: Patient was anxious about getting a shot before but she was ok during administration, and after waiting 15 minutes. Store staff reported that she was lying on the ground at parking lot. Main symptoms were muscle weakness and dizziness so she couldn''t stand up. EMT came in but pt refused to take ambulance. Per patient, she will go to hospital with her husband.


VAERS ID: 1467532 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The patient received the pfizer vaccine to the patient for the first dose. About 5 minutes after the vaccine the patient experienced adverse effects and could not breathe. Due to this we administered a epipen to the patient and the patient was able to breath afterwards. We also called the EMT who examined the patient. The EMT said the patient was okay and did not have to take the patient to the ER.


VAERS ID: 1467533 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Head discomfort, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

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

Write-up: Patient was administed the Pfizer Covid vaccination. She was waiting in the waiting room for 15 minutes. After 7 to 10 minutes she notified staff that her arm was swelling and she did not feel right. Pharmacist went to talk with patient. Her arm was swelling and her head did not feel right. She reported she was dizzy and felt faint. 911 was called immediately. Theyresponded and after examination patient was transported to hospital.


VAERS ID: 1467534 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Eye movement disorder, Feeling hot, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Ocular motility 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: Patient experienced dizziness with first dose of Pfizer vaccine
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: AMOXICILLIN
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient came into pharmacy to receive 2nd COVID-19 Vaccine dose. I screened patient and there was no contraindications. Patient mentioned she was dizzy after the first dose and it resolved quickly and gets dizzy with most vaccines and lab-work. Patient stated she ate food and drank a lot of water prior to coming as she had not eaten last time. I recommended patient just stay still in chair for few minutes after administration to avoid dizziness. I administered vaccine at 9:36 am and patient was fine, and verbally speaking for couple minutes and then stated she wanted water and was feeling dizzy and hot. I called the patients husband from the waiting area and at that moment the patients eyes went inwards and it seemed like she was passing out. Patient was conscious, and kept talking but looked very pale and clammy. I dialed 911 and EMT responded after few minutes. Patients blood pressure was 93/67 and pulse was 75 bpm according to EMTs. Patient declined to go to hospital and patient and husband sat in the waiting area for a bit and left pharmacy at 10:30 am.


VAERS ID: 1467548 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007021A / 1 LA / IM

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

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

Write-up: I administered a moderna vaccine to a 17 year old. No adverse reaction.


VAERS ID: 1467549 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-09
Onset:2021-07-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site infection, Skin infection
SMQs:

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

Write-up: PATIENT REPORTED ON 7/13/21 THAT SHE HAD TO GO TO AN URGENT CARE AND SHE WAS PRESCRIBED ANTIBIOTICS DUE TO SKIN INFECTION AT INJECTION SITE


VAERS ID: 1467550 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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:
CDC Split Type:

Write-up: The patient reported to pharmacy around 6:45pm with pain near his pectoral muscle that had begun around 6:30 pm. The pain was mostly in his armpit and was severe enough that he couldn''t lift his arm without pain increasing. His vaccine occurred around 4:20pm and he then returned to work stocking shelves.


VAERS ID: 1467745 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram normal, Fall, Feeling hot, Head injury, Loss of consciousness, Nausea, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: propanolo er capsules, methylphenidate er osm tablet
Current Illness: None known.
Preexisting Conditions: Acne, ADHD, anxiety
Allergies: No known allergies.
Diagnostic Lab Data: EMTs took EKG, heart rate, and blood pressure. All were within normal ranges.
CDC Split Type:

Write-up: Patient received vaccine at seemed ok initially. No history of adverse reaction to vaccines previously and felt ok after injection, so went to pick up prescriptions and was asked to stay in store for monitoring for 15 minutes. While checking out at counter after approximately 3 to 5 minutes, patient tensed up and passed out, falling backward and hitting her head on the floor. Patient came to within 15 to 30 seconds, but complained of being hot, slightly nauseated, and was very pale. Patient was brought back into private health room with her mother and monitored by pharmacist and RXOM, and ambulance was called. Patient showed improvement and after EMT vitals came back normal, patient declined ambulance ride but was advised by pharmacy staff to contact PCP in regards to her reaction. Patient chose to leave after a few more minutes saying she felt ok.


VAERS ID: 1467746 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Hypotonia, Loss of consciousness, Muscular weakness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), 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: Patient has passed out with every vaccine and blood draw
Other Medications: Not available
Current Illness: Not available
Preexisting Conditions: Anemia (past condition)
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately after receiving the injection, the patient passed out. She was already in the proper sitting position, and I ( immunizer) saw that she was passing out. I had just placed the syringe in the sharps container and was about to place her bandage on, when her head went slack and I saw her eyes roll. I immediately leaned one arm over her to keep her from falling out of the chair, while using my other hand to steady her neck and head. The patients mother was in the room with us, and was talking to her daughter, trying to revive her. I informed the patients mother that I would be unable to leave her daughter, and gave her the name of my pharmacist on duty and asked her to step out and go to the consult window and have him come back to the immunization room. Pharmacist and the patients mother returned in short order and pharmacist verified what I had already checked that she was showing signs of breathing, chest was rising and falling. He helped support her head and asked the mother to gently rub her face to try to wake the patient back up. He stepped out briefly while I was continuing to support the patient and came back with some wet paper towels to place on the back of the patients neck and forehead. After approx. 10 minutes the patient came to and was able to stand and walk under her own power. She sat in the waiting room for an additional 15 minutes before leaving.


VAERS ID: 1467751 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

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

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

Write-up: patient stated that she was itching in both arms/wrists/hands - she was given 5ml of bendaryl 15 minutes later - pt stated that she felt fine but still had the itching feeling. no sign of difficulty of breathing - I called the patient later tonight to check on her and she was doing fine


VAERS ID: 1467754 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK LA / IM

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

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

Write-up: Pt came in and asked to get covid vaccine. He said he hasn''t received it and also checked "not received" on consent form. Later on same day, his daughter called and told us Pt received both Pfizer vaccine at different location on Feb 2021. She said his father just don''t remember that he received already. She understands that he received 3rd dose of Pfizer and let us know if there is any other concern.


VAERS ID: 1467756 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Dyspnoea, Loss of consciousness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: within about 30seconds to 1min after administering Pfizer covid vaccine, 12 year old patient passed out....went from talking, laughing to sagging off his chair, I grabbed him and slowly lowered him to the floor....he was having difficulty breathing, focusing , etc.....talked to him, focus him on breathing, gave him water to drink, wet cloth to forehead, face and neck...he came out of it and said he felt ok....he got up and walked to the waiting area with his mom...appeared to be fine, was talking and laughing again, when all of a sudden he was just sitting there, eyes wide open, but not aware. Another customer was there and she noticed him and immediately got him to focus, breathe, popped an ammonia inhalant, applied instant ice pack to his back and neck which brought him out of it.....asked mom and we called 911, EMT''s responded and transported Patient to the hospital to be checked.


VAERS ID: 1467762 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None that we were made aware of.
Current Illness: None reported.
Preexisting Conditions: None reported. He stated after the incident that he has fainted in the past when getting bloodwork done and during a tattoo, but only stated this after the incident.
Allergies: No allergies he is aware of.
Diagnostic Lab Data: EMT''s checked his blood pressure and heart rate and did an EKG. (07/13/21)
CDC Split Type:

Write-up: Patient fainted while sitting in a chair in our waiting area. He slowly fell forward, lightly hit his head of the blood pressure machine, and went to the ground. He was out for only 5-10 seconds and able to speak with me right after waking up. We called 911, he stated he felt light headed until the EMT''s arrived and they did an EKG and blood pressure/heart rate reading and decided to take him to the hospital just to be safe.


VAERS ID: 1467765 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-07
Onset:2021-07-13
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysmenorrhoea, Fatigue, Heavy menstrual bleeding, Menstruation delayed, Ovarian cyst, Pain, Polymenorrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Heavier period, earlier period, ?nstense cramps that won?t go away with pain killers or heating pads. Pfizer Vaccine. 1st dose -
Other Medications: Ibuprofen 600mg X2 gel form for period cramps
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: The yellow tide breaks me out in hives
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Nothing was wrong with me after my first dose, my period came a day late which is normal for me to get it later and it was like any other period I had this year. I then got the second dose of the Pfizer vaccine on 06/28/2021 meaning in 07/12/2021 I would be deemed fully vaccinated. Just a day after, today 07/13/2021 I got my period 3 days earlier when that has NEVER happened to me in my 10 years of having a period, its always like I said a day to a week (max) late. My period came in like a fully opened faucet, making me change my pads every hour, my cramps are so intense I feel dizzy, fatigued, on the verge of passing out from the pain and if I could afford a hospital bill I would?ve been there hours ago getting help. I can?t even stand or move too much without breaking down in pain. These cramps are NO joke. I took 2 ibuprofen 600 mg an hour apart from each other and it?s been 4 hours singed and I have no improvement. I do have ovarian cysts in both ovaries and usually have bad periods with stronger cramps than what other healthy women experience but this is completely different. I?m listening to my body and it?s telling me something is wrong.


VAERS ID: 1467779 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-13
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWU202 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Headache, Migraine, Retinal migraine, Vision blurred, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flixotide (Long term treatment for Asthma. It is authorized in )
Current Illness: NA
Preexisting Conditions: Asthma
Allergies: Aspirin
Diagnostic Lab Data: Self reporting of the symptom
CDC Split Type:

Write-up: I have got a retinal migraine this day. It started by some difficulty to see and focus the vision (15-30 min). Then I got the headache. It was moderate for 1 hr and then relatively low the next hours. I have not had any migraine in the last 3 years. But I got some before in other countries (on or two max per year).


VAERS ID: 1467964 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-12
Onset:2021-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dizziness, Headache, Nausea, Pain in jaw, Paraesthesia, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Osteonecrosis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B12
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms within 24 hours after injection: headache, nausea, jaw pain, chills, tightness in chest Symptoms between 24-48 hours after injection: tingling in left hand, blurry vision, light-headed


VAERS ID: 1467973 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

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

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

Write-up: Patient fainted after the shot, but quickly became responsive.


VAERS ID: 1467980 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cooling therapy, Depressed level of consciousness, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), 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: NOT CURRENTLY TAKING ANY MEDICATION
Current Illness: PERSON WITH HER MENTIONED SHE WAS MENSTRATING BUT NO OTHER ILLNESSES OR HEALTH RELATED ISSUES
Preexisting Conditions: NO OTHER HEALTH CONDITIONS
Allergies: NO ALLERGIES
Diagnostic Lab Data: no tests
CDC Split Type:

Write-up: pt started to faint and was nauseous. She never lost full consciousness -- she closed eyes but with cold compress and touching her face she regained consciousness. We did call EMS jus in case but pt regained full consciousness and was able to stand on her own before they arrived and did not want to wait.


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