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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 390 out of 8,010

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VAERS ID: 1633086 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Erythema, Hypoaesthesia, Loss of consciousness, Pallor, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: 3-4 years ago (~20yo); flu vaccine -information unknown; similar event reported
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt stated her hand felt numb, she was sitting up and her face went pale then she folded forward passing out. We sat her up and she convulsed slightly and turned red before stating she was very confused and became pale again. We had her sit for 15 minutes, gave her water and snacks (chips and candy for salt and sugar). She stated she was feeling better after sitting and the color returned to her face.


VAERS ID: 1633089 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness: 0
Preexisting Conditions: 0
Allergies: 0
Diagnostic Lab Data: 0
CDC Split Type:

Write-up: Vial was punctured on 8/16/21 and administered 8/25/21


VAERS ID: 1633093 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dyspnoea, Seizure
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient give Pfizer Covid 19. Patient reported issues breathing. Patient given benadryl. 911 called and instructed to administer epipen. Patient had multiple seizures. Patient transported to hospital by ambulance.


VAERS ID: 1633096 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Loss of consciousness, Nausea, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Brief LOC with nausea, feeling warm, tingling to hands, dizzy, Resolved with rest and po fluids


VAERS ID: 1633104 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Lethargy, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Levothyroxine, Rozerem, Mirtazipine, Cymbalta, Lamotrigine, Testosterone cypionate
Current Illness: None
Preexisting Conditions: None
Allergies: IV iodine dye
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received the COVID vaccine yesterday; fever, chills, body aches, lethargy, nausea/vomitting? feels just like COVID all over again


VAERS ID: 1633106 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / UNK LA / IM

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

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

Write-up: Vial was punctured on 8/16/21 and dose was administered 8/25/21


VAERS ID: 1633110 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Hypoaesthesia, Muscle twitching, Tremor, Vision blurred
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: Tramadol. Mentioned she was allergic to some ingredients on the Jansen and Jansen, doctor prescribed Epipen.
Diagnostic Lab Data: patient was sent to the ED.
CDC Split Type:

Write-up: Blurry Vision, Weakness, Twitching, Numbness on the cheeks, Shakiness. patient was sent to the ED.


VAERS ID: 1633114 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Dyspnoea, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: BIRTH CONTROL
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: ONE 18 YEAR OLD FEMALE THAT ONLY HAD A 15 MINUTE WAIT THAT STATED HAVING ISSUES. WITH CONTROLING HER BREATHING, HER MOTHER STATED SHE HAD BAD ANXIETY ATTACK, AFTER A FWE MOMENT THE YOUNG LADY SHE WAS NAUSEOUS. SHE WAS GIVEN A EMISES BAG AND TRIED TO DO BREATHING EXERCISE THEN SHE STATED SHE HAD TO THROW UP AND SHE DID.


VAERS ID: 1633122 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

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

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

Write-up: Patient fainted, loss of consciousness for about 2 minutes. Checked for pulse and breathing, patient had a strong pulse and steady breath. Patient regained consciousness and was warm and sweaty and disoriented. He was responsive and wanted to call 911. Paramedics came and checked vitals and was taken to hospital for follow up.


VAERS ID: 1633137 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Immediate post-injection reaction, Local reaction, Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient had a localized reaction that almost immediately caused his arm to swell down to his fingers. He also had a tingling sensation in his hands and fingers. He was given 25mg of liquid diphenhydramine orally and the swelling and redness resolved in about 10 minutes. The tingling in his hands did remain.


VAERS ID: 1633145 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (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: birth control medication
Current Illness: None
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Within 1 minute of receiving vaccine patient fainted and fell from the chair onto the floor. She regained consciousness within a few seconds. She drank water and had a snack and symptoms quickly improved. Patient left on her own about 30 minutes after vaccine. I spoke with patient approximately 3 hours later and she said she was feeling OK.


VAERS ID: 1633148 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Feeling hot, Nausea, Thirst
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data: Pt was monitored for blood pressure and on EKG.
CDC Split Type:

Write-up: Few minutes after vaccination pt was feeling lightheaded and nausea, a bit hot and thirsty. Parent insisted on calling EMS. Pt was sitting down, told to lie down and elevate legs. Put damp towel on forehead and had a sip of water. EMS came in just over 5 minutes and evaluated and treated her, like checked blood pressure.


VAERS ID: 1633151 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: dizziness with 1st dose Moderna, but has a history of fainting as a child
Other Medications: not known
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the vaccine the patient was seated in a chair for observation and within 5 minutes the patient started to feel dizzy and laid down on the floor and sweat profusely. He had a good pulse, was severely nauseous and felt like throwing up. We monitored the patient and gave him an ice pack. The patient felt better for a few seconds and then back to feeling nauseous. He did not lose consciousness. But because he was going back and forth between feeling better and getting dizzy, we called 911. (Patient insisted waiting 2 minutes before calling 911) They took care of the patient from there.


VAERS ID: 1633155 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Cold sweat, Dizziness, Hyperhidrosis, Pallor, Yellow skin
SMQs:, Cholestasis and jaundice of hepatic origin (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: ADHD
Allergies: unknown
Diagnostic Lab Data: blood sugar 101
CDC Split Type:

Write-up: 1410 - Pt approached table reporting feeling dizzy and requested for water. RN approaches pt. Client appeared pale. Head nodded downward. RN guided client safely to the ground and propped legs on top of chair. No injuries sustained. Called EMS. 1411 ? Instantaneously woke up and insisted he was okay. Pt wanted to sit up and informed pt to remain laying. NP, site director, & EMS approached. NP assessed client. Pt diaphoretic, pale, denies nausea, denies chest pain, denies blurry vision, no SOB. Hx of ADHD, no hx of DM, reports smoked marijuana before arrival, denies taking medications. Last meal was breakfast consisting of oatmeal, coffee, and green tea. 1413 ? Pulse ox 98% HR 64. Diaphoretic, clammy, yellow pale. Says, ?feeling fine. I feel somewhat better.? In laying position 1417 ? BS 101, pt reports weighs 155lbs, 6 ft tall, bp 99/64 laying, pulse ox 100% hr 61 1420 ? Pt sat up on ground with assistance. Given fluids. No dizziness reported. When asked how he is feeling reports, ?I am 98%?. 1421 - VS 99% ox saturation, p 64, bp 122/80 while seated on ground 1422 ? seated in chair, color returning 1425 ? VS 115/81 HR 92 pulse ox 100% seated in chair, denied weakness 1430 ? Vs BP 106/80 hr 89 ox sat 99% 1432 ? VS BP 103/75 HR 84 standing o2 sat 100%, per NP negative orthostatic hypotension, no diaphoresis, denies chest pain, no SOB, dizziness subsided, denies blurry vision. Client stayed for another 12 minutes. 1447 ? NP okayed client to leave, escorted to car with RN


VAERS ID: 1633158 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Headache, Nausea, Pain
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: Kirkland AllerClear Kirkland Adult Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Body aches, headache, nausea - all mild to moderate


VAERS ID: 1633314 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril-hctz 20-25
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had received Moderna vaccine for his first dose and received Pfizer vaccine for second dose


VAERS ID: 1633315 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3080 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Malaise, Nervousness, Pallor, Respiratory rate increased
SMQs:, Neuroleptic malignant syndrome (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: psoriasis
Allergies: nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: A few minutes after vaccine administration pts companion came to tell the pharmacy that she was not feeling well. the pt was seating in the waiting area and was pale, sweaty, and breathing fast. Her father stated that she was very nervous about getting the vaccine. she was given water and some saltine crackers. they stayed and was monitored until pt felt better.


VAERS ID: 1633318 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-30
Onset:2021-08-25
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 LA / IM

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

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

Write-up: Vaccine error, patient had Pfizer 1st dose December 2020 and 2nd dose January 2021. Patient had asked for her 2nd shingles shot that was due. Patient isn''t immunocompromised so she just got 3rd dose early and it was Moderna instead of Pfizer. Patient did not have any adverse event with the immunization.


VAERS ID: 1633319 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose decreased, Fall, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: Hydroxyzine, sertraline
Current Illness: none
Preexisting Conditions: anxiety and depression
Allergies: NKDA, NKFA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient deals with intense anxiety and stated he does have a fear of needles. After giving him a few moments to calm down until he was ready, the vaccine was administered and the patient seemed fine and was even joking with his girlfriend in the clinical services room. Had the patient take a seat and moments after his girlfriend told us he fell off the bench. I ensured his airways were clear and the patient was starting to sit up and was responding. No Epipen or Benadryl needed. He was pale and sweating profusely. I gave the patient some cold water to help cool him down. He did not want us to call the ambulance because he knew he would get better. I determined the patient had not yet eaten today so his blood sugar was already low and his fear of needles only intensified the situation. I gave him a bag of fruit snacks to get some sugar into his system. He was perking up just fine and normal breathing . After about 5 to 10 more minutes of observation the patient left feeling fine. Recommended some Tylenol and Advil.


VAERS ID: 1633324 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide-Lisinopril 25 mg
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated she had not been vaccinated . She was given Moderna vaccine. Patient came back after lunch and brought vaccination card that she had been vaccinated with Pfizer on 05/18/2021 and 06/10/2021. She stated she forgot she was vaccinated.


VAERS ID: 1633326 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK RA / IM

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

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

Write-up: The patient experienced syncope about 5 minutes after receiving vaccine. The patient was conscious again in about 30 seconds. A physician examined the patient and monitored blood pressure for about 30 minutes. The patient recovered and his father drove him home.


VAERS ID: 1633327 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-21
Onset:2021-08-25
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

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

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

Write-up: Not an adverse event but patient received Pfizer for her first dose and inadvertently received Moderna for her second dose.


VAERS ID: 1633333 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 RA / IM

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

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

Write-up: Pt received the second dose at an interval of 25 days instead of the recommended 28 days


VAERS ID: 1633336 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Hypoaesthesia, Influenza like illness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: unknown at this time--called patient''s OB/GYN md and left message as to what pt had told us
CDC Split Type:

Write-up: Patient called stating that she was feeling like she had the flu--which is normal side effect but was also having some numbing / tingling on the right side of her face. Pt is pregnant 13 weeks, child number 7, delivery date unknown


VAERS ID: 1633337 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure systolic increased, Body temperature increased, Feeling hot
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 5 min after pt received Moderna 1st dose, pt complained about hot, temp checked 100.4 F. BP and HR checked, BP 192/110 and HR 106. No SOB. pt drank water and felt better. Rechecked vitals after 5 min, SBP down to 180s and HR down to 90s. pt drank more water, rechecked after 5 min, SBP down to 160s and temp down to 99 F. Pt sat for 5 min and said symptoms coming back. Rechecked, SBP up to 170s. Pt said she doesn''t need an ambulance. pt has a friend with her and was instructed to go to urgent care or ER to have more monitoring. Pt agreed.


VAERS ID: 1633340 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: 2 min after the injection patient started to sweat and fainted for a few seconds, then 1 min later she passed out 2nd time for a few seconds and woke up again. Patient then disclosed she has had passed out in the past with blood drawing, but didn''t mention about vaccine issue. She said she hasn''t gotten the same issue for a long time and so didn''t report on consent form. Patient was fully recovered by the time paramedics arrived. They checked on her and said everything was within normal condition.


VAERS ID: 1633351 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Menstruation irregular, Neck pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Fertility disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Sore neck, sharp pain on the left side elbow and upper left side chest and back. My cycle was late by 8 days after the 1st shot. Will find out if it?ll effect my next cycle. Fever of 100.3


VAERS ID: 1633359 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 got dizzy and passed out about 5 minutes after the shot


VAERS ID: 1633372 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3184 / 1 LA / IM

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

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

Write-up: Client reported already receiving 2 doses of Sinovac only after Pfizer vaccine was administered.


VAERS ID: 1633375 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia oral, Pruritus
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient was given the Moderna COVID-19 vaccine. About 15 minutes into her wait time her tongue started to feel numb and her neck was itching. We gave Benadryl and recommended going to an Urgent Care. She didn''t want to go when we suggested and wanted to wait to see if the Benadryl would help. We kept here for another 30 minutes to watch her to make sure it didn''t progress. Went to check on her again and she stated that she was feeling better. We told her that if it got any worse to go the the ER or an Urgent care and she agreed that she would.


VAERS ID: 1633377 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-01
Onset:2021-08-25
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: Positive for COVID 19 on 8/25/21
CDC Split Type:

Write-up: Employee tested positive for COVID 19 and is fully vaccinated.


VAERS ID: 1633381 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Dizziness, Headache, Hypoaesthesia, Immediate post-injection reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine
Other Medications: none on file
Current Illness: None reported
Preexisting Conditions: None known
Allergies: Ciprofloxacin, Flu vaccine, iodine tincture, norflex, and sumatriptan
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Covid-19 vaccination on 8/25/21. A few moments after administration of vaccine, patient complained of dizziness, numbness down her arm, tingling of fingers, headache, and back ache. The local EMS squad was called, and they responded within minutes. Patient was still conscious, and was taken to nearest hospital to be examined.


VAERS ID: 1633382 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Chills, Cooling therapy, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: Light headed, chills, increased blood pressure, nausea. Cold compress, Patient advised to lie on floor and elevate legs, sips of apple juice, blood pressure taken with patient sitting upright x3. Blood pressure remained elevated so we called EMT assistance. They arrived and took her to their ambulance to further monitor her blood pressure. Patient stated that she did not experience this following the first vaccination. She also said she had covid-19 several months ago and was quite sick for 3 weeks.


VAERS ID: 1633560 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received COVID booster dose, Requested Moderna. Patient stated he lost his vaccine card and asked if we could fill out the card info for the first two vaccines. Upon checking FL Shots it was discovered that he received Pfizer for his first two vaccines.


VAERS ID: 1633568 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: Patient reported anxiety and feeling faint post vaccine.


VAERS ID: 1633570 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: Patient reports she got up to get a get a drink because she felt thirsty so she went to get a drink and while she went to the self check out she passed out. Someone picked her up and walked her back to the clinic. Patient reports she is diabetic and didn''t really eat a lot prior to coming in, and that she did have an anxiety prior to getting the vaccine. Patient sat in the lobby for about 30 mins after drinking a coke and eating some chips. HR 64, Blood pressure 108/68, RR 18 prior to leaving


VAERS ID: 1633575 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 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: hydrocortisone 2.5 % cream, coreg, Lasix, diclofenac 1% gel, simvastatin, metolazone, tizanidine, ibu, clotramizole 1 % cream, omeprazole and lisinopril
Current Illness: HTN, morbid obesity, splenomegaly, DM, chronic diastolic heart failure, acute on chronic kidney injury, sleep apnea, hypoxemia, dyslipidemia
Preexisting Conditions: See above
Allergies: penicillin, amlodipine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Reconstituted Pfizer with 0.18 ml of normal saline instead of 1.8 ml of normal saline. Provider notified. She feels patient will be fine. Manager to be notified in am as it is evening clinic now. Patient to be notified after nurse manager notified of event and further instructions provided.


VAERS ID: 1633581 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

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

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

Write-up: patient felt dizzy and fell to the floor from his chair


VAERS ID: 1633583 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pharyngeal paraesthesia
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: none reported prior to admin - post admin, ibuprofen (anaphylaxis), ACE inhibitors (unknown)
Diagnostic Lab Data:
CDC Split Type:

Write-up: approximately 5 min post administration - pt complained of tingling sensation in her throat, administered 25mg oral benadryl, called EMS, she left with them once they arrived


VAERS ID: 1633585 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Feeling cold, Headache, Injection site erythema, Injection site swelling, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Wellbutrin, Klonopin, Adderall
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Woke up cold chills and shivering, full body aches, shooting pains in legs, headache, unable to move both arms without excruciating pain, redness and swollen injection site. Wet cold washcloth on injection site, 600 mg ibuprofen, icepack on head for throb, added covering to bed for chills. Multiple hours later, chills and shooting pains subsided. Still have headache and swollen injection site, body aches continue but are minor.


VAERS ID: 1633592 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Heart rate increased, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Immediately after the shot was given patient experienced very fast heart beat and chest tightness. The heart rate calmed down shortly thereafter but the chest discomfort lasted about and hour 15 min before resolving.


VAERS ID: 1633595 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Presyncope, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT EXPERIENCED VASOVAGAL SYMPTOMS, PRINCIPALLY THAT OF VERTIGO, NAUSEA, & HEADACHE.


VAERS ID: 1633597 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Epistaxis, Haemoptysis
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: patient took ibuprofen and Tylenol over the counter
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt states she started coughing up blood and her nose was bleeding. Occurred some time in the evening. States her chest does not feel "right." Advised pt to go to ED.


VAERS ID: 1633598 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

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

Write-up: Pt came in on 8/18 for a covid shot and stated that they had the Pfizer shot. Pt was given 2nd shot and told to come back with the card and we could fill it out. Pt brought back the card and 1st shot given was Moderna.


VAERS ID: 1633601 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: AMOXICILLIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: While patient was waiting patient had nausea, sweating and lost consciousness for few seconds. We called 911 and let patient lie down on the back with leg lifted on a chair. patient felt ok and EMT checked him out.


VAERS ID: 1633606 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam, Prednisone, Enbrel, Folic Acid, Pantoprazole, Vitamin C, D, Zinc, Magnesium, Calcium
Current Illness: none
Preexisting Conditions: psoriatic arthritis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: sore throat


VAERS ID: 1633615 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pertussis when she was a baby
Other Medications: sertraline, diazepam, birth control.
Current Illness: none known
Preexisting Conditions: none known
Allergies: pertussis vaccine.
Diagnostic Lab Data: Bp was 120/75. HR was 65
CDC Split Type:

Write-up: pt was feeling nausea, dizziness and lightheadedness, 5 minutes after receiving vaccine. Bp was 120/75. HR was 65 . Pt waited for 25 minutes for nausea to resolve and was able to leave the store in good health.


VAERS ID: 1633616 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK RA / IM

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

Write-up: patient felt nauseas after getting her covid shot, kept monitoring the patient , and then she said she felt much better.


VAERS ID: 1633618 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / UNK LA / IM

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

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

Write-up: PT REPORTED SHORTNESS OF BREATH THAT RESOLVED THEN SHE BROKE OUT IN HIVES


VAERS ID: 1633767 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Hyperhidrosis, Immediate post-injection reaction, Pallor, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: patient received Pfizer covid 19 vaccine and immediately began complaining of tingling feeling in body, lightheadedness, and feeling like she was going to pass out. She was pale, and began sweating. We gave her a cool cloth and ice pack, checked her BP (which was high) then called for EMS and a code white. She left via ambulance to be checked out at the local hospital


VAERS ID: 1633768 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / UNK - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose normal, Blood pressure increased, Heart rate increased, Hyperventilation, Hypoaesthesia, Muscular weakness, Panic attack
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Eosinophilic pneumonia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient c/o numbness in Bilateral hands after vaccination. Patient stated he did not eat before receiving vaccine. Patient''s blood pressure was 149/100 (@12:51pm). Patient can not open his hands (bilateral). EMS was called due to hyperventilating. EMS was given report. EMS checked blood pressure (152/92). Patient stated he does have panic attack to EMS. Blood sugar (114) Heart rate check: 1st time (127), 2nd time at 12:53pm (96). Blood press checked by EMS was 148/90. Patient was given orange juice and some snacks. EMS had stated patient did not need to go the ER at all. Patient was allowed to rest at the site until 01:30pm, and left on his own.


VAERS ID: 1633777 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site reaction, Injection site warmth, Lethargy, Rash papular
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo Loestrin, Sertraline, ibuprofen, aspirin
Current Illness: None
Preexisting Conditions: Plaque psoriasis
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site rash, ~3 inches long and ~1 inch tall. It is warm to the touch and slightly raised. Rash not present after first injection. Slightly lethargic, no body aches, arm is not tender. Started this morning, 8/25.


VAERS ID: 1633779 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-23
Onset:2021-08-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain
SMQs:, Anaphylactic reaction (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: Sulfa
Diagnostic Lab Data: None done at Clinic, ER for cardiac r/o
CDC Split Type:

Write-up: Patient presented non emergent to Clinic for chest tightness. Stated pain hours before but that had subsided. VSS, no distress. Due to complaint, patient sent to ER for further cardiac evaluation unavailable at Clinic location.


VAERS ID: 1633796 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

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

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

Write-up: Mom lied to us about daughters age. Pfizer covid is only approved for 12 and older. Mom lied saying daughter was 12, but we figured out daughter was only 11 years old.


VAERS ID: 1633804 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FAC3182 / 1 LA / IM

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

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

Write-up: Patient passed out after vaccination. Blacked out for a moment and very sweaty then came back to consciousness. They had stated that they have passed out before when donating blood and that they had not eaten anything for breakfast today before hand.


VAERS ID: 1633809 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: PATIENT CAME IN TO RECEIVE 3RD COVID VACCINE AND FILL OUT PAPERWORK. REGISTRATION DESK ENSURED THAT MODERNA WAS WRITTEN ON THE PAPERWORK AND VACCINE CARD WAS GIVEN. VERBAL COMMUNICATION WAS ALSO ALERTED WHEN PAPERWORK WAS HANDED OFF TO PHARMACIST THAT IT WAS A MODERNA DOSE. PHARMACIST VERBALLY VERIFIED MODERNA DOSE WITH PATIENT BUT ACCIDENTLY GAVE PFIZER. DRAWN MODERNA DOSES ARE KEPT IN THE COOLER SEPARATE FROM THE PFIZER DOSES TO AVOID VACCINATION ERRORS. PATIENT WAS OKAY AFTER MONITORING PERIOD AND LEFT.


VAERS ID: 1633981 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-17
Onset:2021-08-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939893 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site induration, Injection site nodule, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Swelling and itching and a hard knot at injection site. 7days after shot


VAERS ID: 1633983 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-27
Onset:2021-08-25
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 UN / UN

Administered by: Public       Purchased by: ?
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received once dose of Moderna. Developed pneumonia (non-COIVD)


VAERS ID: 1633985 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Dyskinesia, Fatigue, Feeling abnormal, Feeling hot, Hypoacusis, Memory impairment, Nasopharyngitis, Nausea, Seizure, Staring, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Gardasil vaccine received 07/10/2020; I ran a fever for weeks after receiving the first round. I have 2 more to go but I have no
Other Medications: I took the following medications at 06:00 AM on 08/24/2021; Xyzol 10mg, Prenatal Vitamins, AMOX-CLAV 875-125 MG TABL, and Mucinex-D 600 mg tablet.
Current Illness: N/A
Preexisting Conditions: Recently found out I have a fatty liver.
Allergies: Slight allergy to shrimp.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: On 08/24/2021 I felt bad within the hour after getting the COVID-19 1st dose at 3:45 pm; very fatigued and cold. On 08/25/2021 I woke up at 6:30 am and felt bad; nausea, fatigue, and weakness. On 08/25/2021 at 10:00 pm, I started feeling light-headed. I brushed it off and started to get hot, dizzy, at moments I could not hear. I sat there for about 10 minutes and got up to go to bed took about 5 steps, and had to immediately sit back down. After that, I do not remember anything but waking up on the floor and jerking and could not hear anything my fiance was in front of me crying and histairicle. I had no recollection of what just happen. When I came completely too my fiance preceded to tell me what happen he said, "I sat back down and was looking down and suddenly raised my head up and gave him a blank stare and jumped up out of the chair, locked up and started to convulse and fell over and continued to convulse and kick my legs vigorously. I suspect I had a seizure.


VAERS ID: 1633987 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Patient got dizziness and sweating and headache while sitting at the waiting after the shot. Pharmacy staff gave her gatorate to drink. Pharmacist and walked by OB doctor helped her laying down on the floor and gave her one chewable benadryl. Paramedics team arrived check her pulse and pressure.


VAERS ID: 1633990 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Heart palpitations with first dose of Pfizer COVID vaccine, 12 hours post-immunization on 7/29/21. Patient was same age, 35 year
Other Medications: melatonin at bedtime for sleep, no other meds
Current Illness: None were reported by the patient
Preexisting Conditions: None were reported by patient
Allergies: No known allergies
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Immunizing pharmacist spoke with patient prior to vaccine. Patient said after her first dose, she did experience chest palpitations for a few seconds, 12 hours after her first dose on 7/29/21. The patient said the palpitations did not occur again - it was just that one time. Pharmacist told her there have been reports of myocarditis/pericarditis after the vaccines, but nothing that Pharmacist could see relating to palpitations. Pharmacist did tell her it''s her body, so it''s up to her if she wants to receive the vaccine - there are always risks. She confirmed that she did want the second dose. After administering the second dose, Pharmacist told her to wait in the pharmacy for 15 minutes after the dose like last time. Pharmacist believes she only waited 5 minutes, then proceeded up to health and beauty to shop. About 10 minutes post vaccine, she came right back stating she felt like she was going to faint and was having heart palpitations. We sat her down and took her blood pressure and heartrate. 5:14pm it was 153/97 and HR 129, at 5:17pm it was 126/93 HR 95, at 5:21pm it was 121/91 HR 85. We told her to stay sitting for a while because she said she still felt dizzy, like she could faint. at 5:30pm she grabbed our attention again and said her palpitations were back. I asked if she wanted us to call an ambulance and she said yes. I called an ambulance and relayed all of the information to the paramedics. Patient did receive about 3-4 ounces of water at 5:15ish. Paramedics arrived at 5:38 pm and the patient''s vitals were taken, prior to being escorted out by them to where they were awaiting the arrival of the ambulance. She was able to walk out of the store with the paramedics on her own. I tried calling the patient at 8:44pm on 8/25/21 to check on her and see how she is doing, but there was no answer and I had to leave a voicemail.


VAERS ID: 1633995 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Chest discomfort, Dizziness, Flank pain, Hyperhidrosis, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: About 15 minutes after pateint received the vaccine he began to feel a pressure in the area of the sterum and medial pectoral muscles, worse when he took a deep breath. He had no SOB< left sided chest pain, pain radiating to left arm or next, sweating, or dizziness. On exam HR 92 and regular, 2+ radial pulse b/l with brisk cap refill, heart normal S1, S2, no m/g/r, lungs CTA B with good aeration throughout, no wheezing, normal resp effort. +tenderness to palpation of the chest wall and along b/l edge of the sterum. Patient was observed for about 30 minutes. Symptoms still present but no progression and no new symptoms. He felt he could go back to work. Instructed him and supervisor that he should not do any streunuous activity. Shoudl he experience any worsening symptoms, any new symptoms such as chest pain or SOB then he should be evaluated right away. He may take ibuprofen or acetaminophen in needed for the chest wall discomfort.


VAERS ID: 1633996 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Erythema, Headache, Heart rate increased, Hypoaesthesia, Pharyngeal swelling, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None known of.
Allergies: Corn, amoxycillin
Diagnostic Lab Data: Taken to ER in the building, 25 mg Benadryl. Steroid in buttcheek and more benedryl given and observation for 1 hour for steroid to take effect.
CDC Split Type:

Write-up: 30 minutes after: redness across neck, arms, chest and legs. Trouble catching breath, throat swelling. Itching, heart rate spike, numbness in feet, throbbing in head.


VAERS ID: 1634179 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: Pt arrived for Pfizer COVID vaccine around 8pm 8/25/21. Directly after giving vaccine, pt fainted forward, was caught (did not hit the floor), pt was feeling nauseous, and slightly throwing up. No EpiPen was administered, ambulance was consulted but felt no need in coming as pt was communicating and breathing normally. Gave water, supervised pt for 15-25 min, felt comfortable enoguht to walk on his own.


VAERS ID: 1634183 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haemorrhage, Head injury, Memory impairment, Syncope, Tinnitus
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known.
Current Illness: Patient reported none.
Preexisting Conditions: Not known.
Allergies: Patient reported no known allergy.
Diagnostic Lab Data: BP 114/67 on lying position.
CDC Split Type:

Write-up: Patient received first dose Pfizer and left waiting room ~10 min after vaccination, although instructed to stay for 15 min. He said his ears were ringing while in the waiting room, but he did not remember leaving the room. Other customers said he collapsed while exiting the waiting room, got up and stumbled across the aisle and collapsed again on the floor, hitting his head on the floor. He bled quite a bit and BP was 114/67 on lying position. He was conscious when I checked on him. No other sx reported besides ringing ears. Store employee gave him some water and he took a sip, I stopped him and instructed NPO. Paramedic arrived while I was checking BP. Paramedic said they will take him to the Hospital.


VAERS ID: 1634193 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Bone pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, muscular & bone pain


VAERS ID: 1634196 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E W 0202 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Erythema, Hypoaesthesia, Muscular weakness, Pain, Paraesthesia, Peripheral swelling, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms 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: Wellbutrin Fish oil Magnesium Omeprazole Probiotic
Current Illness: None
Preexisting Conditions: Anxiety controlled with meds Depression controlled with meds
Allergies: Sulfa Floxin
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Right arm tingling finger numb, right arm swollen, red, hot to touch from shoulder to elbow. Severe pain with movement in elbow. Feels strained unable to lift any heavy items. Ibuprofen 800 MG taken and ice applied at home.


VAERS ID: 1634201 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / IM

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

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

Write-up: Headache, body aches, L arm sore


VAERS ID: 1634203 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: My injection site is very swollen and hard to the touch. It is also very itchy, warm, and red. I have just been cleaning it and taking Tylenol and it has not effected the reaction.


VAERS ID: 1634213 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Extra dose administered, Headache, Malaise
SMQs:, Arthritis (broad), Medication errors (narrow)

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

Write-up: I went to the Pharmacy to get the seasonal Flu vaccine required for nursing school. I paid for it and filled the forms required by the pharmacy prior vaccine administration. The pharmacist failed to follow the five rights of medication administration and administered me a third dose of COVID vaccine. Once she realized her mistake, she administered me the Flu vaccine on the other arm, which was the vaccine that I was requesting since the beginning. I was very concern because I had my two dosis of COVID vaccine with Moderna (1st Moderna dose 3/5/2021 ; 2nd Moderna dose 4/6/2021) and the pharmacist said that is ok to have the 3rd dose with a different type of vaccine. Starting at 8:45pm the same day, I started with severe headache, malaise, and shoulder pain.


VAERS ID: 1634216 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Injection site pain, Muscular weakness, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Vomiting, nausea, fever, muscle weakness, pain at injection site, back pain


VAERS ID: 1635567 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-24
Onset:2021-08-25
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cellulitis
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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt hospitalized on 8/26/2021 for cellulitis and tested positive on admit (asymptomatic)


VAERS ID: 1636123 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Tinnitus-Medium


VAERS ID: 1636125 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Confusional state, Dizziness, Fatigue, Headache, Lethargy, Pain, Syncope, Unresponsive to stimuli, Vomiting
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), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Abdominal Pain-Severe, Systemic: Body Aches Generalized-Severe, Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Headache-Severe, Systemic: Vomiting-Severe, Systemic: Weakness-Severe


VAERS ID: 1636127 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Severe


VAERS ID: 1636154 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1636156 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

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

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

Write-up: Error: Booster Given Too Late-


VAERS ID: 1636162 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1636165 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Seizure-Mild, Systemic: Shakiness-Mild, Additional Details: patient indicated prior to vaccination that she ususally faints when given shots. we discussed what to expect from vaccination and that i would be right in front w her. I administered the vaccine and she seemed relieved that it was painless. i had her sit down in front of the pharmacy and about 5 min later she alerted me that she felt faint. i stood in front of her and aked her to put her head down when she collapsed in my arms , was sweating, pale and began to shake, possiby a seizure


VAERS ID: 1636168 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Medium


VAERS ID: 1636173 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1636178 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1636180 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Immediate post-injection reaction, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Allergic: Anaphylaxis-Mild, Systemic: swellling and hot to touch at injection site-Mild, Additional Details: Patient stated that when she received the 1st injection she experienced a rash on her arm. As soon as this shot was injection she experienced swelling and the injection site was hot to the touch. Patient was given Benadryl and an ice pack was placed on her arm. I sat and monitored the patient until her parents arrived. She confirmed that she was not light headed or was not experiencing anymore side effects.


VAERS ID: 1636181 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-20
Onset:2021-08-25
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM

Administered by: Private       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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization (non-ICU) dose #1 on 3/16/21 dose #2 on 4/20/21


VAERS ID: 1636182 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

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

Write-up: Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Breathing-Severe


VAERS ID: 1636184 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Approximately 2 minutes after injection of JnJ vaccine patient fainted.... patient recovered after approximately 30 seconds


VAERS ID: 1636185 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-08-25
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 RA / IM

Administered by: Private       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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization (non-ICU)


VAERS ID: 1636191 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-08-25
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private       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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization (non-ICU)


VAERS ID: 1636195 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-11
Onset:2021-08-25
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 RA / IM

Administered by: Private       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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization (non-ICU)


VAERS ID: 1636349 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-24
Onset:2021-08-25
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dizziness, Nausea, Respiratory tract congestion, SARS-CoV-2 test positive, Vaccine breakthrough infection, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: arthritis, BPH, DVT, diabetes
Allergies: NKDA
Diagnostic Lab Data: 8/25 SARS-CoV-2 detected
CDC Split Type:

Write-up: Breakthrough COVID admission in fully vaccinated patient. Presented with dizziness, nausea, vomiting, 2 week history of cough and congestion. SpO2 96% on room air


VAERS ID: 1636350 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-20
Onset:2021-08-25
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Deep vein thrombosis, Echocardiogram, Heart rate increased, Oedema peripheral, Skin warm, Tenderness, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: losartan
Current Illness:
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data: Venous doppler and echocardiogram - August 25, 2021
CDC Split Type:

Write-up: Patient received one dose of Moderna COVID-19 vaccine on July 20, 2021. Diagnosed with DVT on August 25, 2021 via venous doppler. Patient sought medical care after experiencing left lower extremity edema, warmth, tenderness, and elevated heart rate. Patient is unsure exactly when symptoms began.


VAERS ID: 1636352 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling hot, Hypoaesthesia, Paraesthesia
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: ADDERALL
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: KIWI FRUIT (ANAPHYLAXIS)
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: ABOUT 30 MINUTES AFTER MY SECOND VACCINE THE LEFT SIDE OF MY BODY STARTED TO FEEL NUMB, TINGLY, AND WARM. SENSATION IS STILL PRESENT THE NEXT DAY WITHOUT IMPROVEMENT


VAERS ID: 1636356 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Shortness of breath,. Patient, with history of allergies and asthma, said ""my PCP approved me receiving the Pfizer vaccine and I took 2 Benadryl per advise at 7:30 A.M. (Pfizer vaccine administered around 8:47) 9:13 AM Patient reported feeling some shortness of breath and chest tightness and took 2 puffs of her Albuterol inhaler. Pulse ox- 99%, Pulse-99, BP 128/74 Lungs clear. 9:20 reports ""SOB and chest tightness ""dissipating, but feels jittery."" She reports that she has been having to use her Albuterol inhaler more frequently during the past 2 weeks due to seasonal allergies. Observed, symptoms improved 9:42 discharged in stable condition and advised to speak with her MD prior to 2nd vaccine.


VAERS ID: 1636365 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-28
Onset:2021-08-25
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Breast Cancer
Preexisting Conditions: Breast Cancer
Allergies: Unknow
Diagnostic Lab Data: Rapid Covid test positive on 8/25/2021
CDC Split Type:

Write-up: Patient is currently in the hospital. Unknown for treatment


VAERS ID: 1636371 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: Patient under age to receive COVID vaccine.


VAERS ID: 1636378 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: The mother said that he has fainted before as a child getting vaccines
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient fainted about 10 min after taking vaccine. The patient woke up a few seconds later. An ambulance came to check vitals but the patient seemed fine and left on his own power. I checked on the patient about 3 hours later and he was fine.


VAERS ID: 1636379 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Muscle twitching, Posture abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ER visit 8/25/21
CDC Split Type:

Write-up: syncope reaction, head drooped backwards, eyes rolls in back of head, arm and leg twitched


VAERS ID: 1636382 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-08-25
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient was vaccinated for COVID and then contracted COVID.


VAERS ID: 1636388 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site pain, Insomnia, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: Symbicort, fluticasone
Current Illness: None
Preexisting Conditions: Asthma
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at injection site, sleeplessness, fever (101.2), body aches.


VAERS ID: 1636393 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hyperhidrosis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: The patient started to sweat and feel week about 15 min or so after vaccine. The patient began to feel nauseated and then proceeded to vomit for about 10 min off and on. An ambulance came to check his vitals. The paramedic did not get a good read of vitals and the patient decided to be brought to the ER to be checked out. I checked on the patient about 3 hours later and he said he was home and feeling fine.


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