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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 4 out of 8,753

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VAERS ID: 1858766 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

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

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

Write-up: Patient received a vaccine after the Moderna vial had been punctured 20 times. Patient was the 24th patient to get vaccinated from the vial. Moderna was contacted and informed of the incident.


VAERS ID: 1858774 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immediate post-injection reaction, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: No medications.
Current Illness: No known illnesses
Preexisting Conditions: No chronic conditions
Allergies: Peanuts
Diagnostic Lab Data: No known medical tests were conducted after adverse event.
CDC Split Type:

Write-up: Pt felt nauseous immediately after vaccination was given. Pt stood up to walk to observation area and stated wanting to throw up. Pt was laid down and v/s were initiated at 1815. BP was 100/80. Pt threw up after 10 min. V/s improved and were within normal limits at 1835. BP improved to 110/80. Pt was in stable condition and left the vaccination site at 1851.


VAERS ID: 1858775 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 7J2CA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Head injury, Loss of consciousness, Urinary incontinence
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), Accidents and injuries (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? 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: SULFA EYE DROPS
Diagnostic Lab Data: none
CDC Split Type:

Write-up: After receiving both vaccines patient was walking around the store with his mom and told her he didn''t feel good. Patient proceeded to pass out and hit his head. Patient peed his pants and felt light-headed until the ambulance arrived and they checked him out.


VAERS ID: 1858779 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

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

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

Write-up: 11/10/21 - 3:35pm Client''s age at time of vaccination is 11 years and 11 months. Client and client''s mom informed vaccinating nurse that client was 12 years old and nurse inadvertently vaccinated client with adult dose of Pfizer not realizing client''s actual age. Client exhibited no s/s of any immediate adverse effects from vaccine. Follow up call placed to client''s mom to check on client. Client''s mom reported that client was doing ok with no issues or concerns. No reports of any headaches, dizziness or lightheadedness.


VAERS ID: 1858784 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C214 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Paraesthesia, Paraesthesia oral, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)

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

Write-up: Pt received vaccine at 1246, experienced tingling of tongue, lips, and eyelids and a sensation of throat tightening at 1257. patient self administered zyrtec 10mg at 1258. At 1345 patient was given 50 mg of benadryl. VSS stable. symptoms improved.


VAERS ID: 1858786 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-29
Onset:2021-11-10
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Rash with booster under arm and breast with booster as like it did with original


VAERS ID: 1858790 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Client received single dose CanSino vaccine in on 08/29/2021. Client requested COVID Pfizer vaccine series. RN submitted a medical consult via text message t, requesting to proceed with the COVID vaccine Pfizer. Per CDC guidance, approval to proceed with COVID vaccine Pfizer was obtained from medical consult team via text message. Client received the 1st dose COVID vaccine (Pfizer, lot#FF8839) at 0450 in the L deltoid.


VAERS ID: 1858794 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-10
Onset:2021-11-10
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Fully vaccinated breakthrough case; inpatient hospital admission.


VAERS ID: 1858797 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Fatigue
SMQs:, Retroperitoneal fibrosis (broad)

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

Write-up: extremely fatigued with back pain


VAERS ID: 1858798 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Gait inability, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Client stated, "I felt dizzy when I started walking to observation room." Vaccinating RN was walking with client from vaccination station to observation room and helped guide patient into a chair. Co Lead RN assessed client to be unable to walk to observation room. Co Lead RN went to bring wheelchair for client and helped transfer client with two nurse standby assist into wheelchair. Client was then transferred from wheelchair into the gravity chair in observation room. At 11:50 AM first vitals taken by observation nurse RN: BP LA 120/79, pulse 68, 110%. Observation RN advised client to take long deep breaths and relax. Client already had water bottle provided but declined crackers. Client stated, "I was just really nervous about the covid shot. It took me a year to finally do it." 11:55 AM second vitals taken: BP LA 126/80 pulse 94 O2 SAT 100%, respirations 18. Client stated, "I had to really try hard to catch my breath. I have a lot of anxiety to the shot. My left hand is tingling." Co Lead RN asked client if they were having trouble swallowing to which client denied having such symptoms. Co Lead RN observed client''s left arm for swelling or hives to which none were observed. Client denied having any itching throughout entire body. Co Lead RN advised client to continue taking long deep breaths. Client does not have any medical conditions and does not take any medications. 12:00 PM next set of vitals: BP RA 129/81, pulse 66, O2SAT 100%. Client stated, "I am breathing better." 12:03 PM client notified her mom via cellphone but she was at work, then client called cousin who was at school. Client stated at 12:05 PM "all my symptoms are gone" and was observed to be A&Ox4. At 12:15 PM last vitals: BP LA 120/86 PULSE 69, O2 SAT 99%. Co Lead RN recommended for client to follow up with PCP within 24 hours, enroll in VSAFE, and the adverse symptoms to call 911 or go to emergency room. At 12:25 client left facility with steady gait as Co Lead RN walked standby assist along side client towards the exit of the facility.


VAERS ID: 1858805 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / -

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

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

Write-up: Client received both 1st and 2nd covid vaccine (Sinovac 1st dose on 03/28/21 lot: G202102005 and Sinovac 2nd dose on 04/24/21 lot: L202103011) and is requesting for Pfizer booster dose. Per pt''s daughter he has Prostate Cancer, has no known allergies and is currently taking Tamsulosin, Bicalutida, Luprorelina and levothyroxine. Per pt''s daugther, no adverse reaction noted after both vaccine administration. Approval obtained for patient to get Pfizer booster. Client received Pfizer Booster Lot:FF8839 exp: 11/29/21. Client completed 15 mins observation with no adverse reactions and left facility at 1646 hours.


VAERS ID: 1858806 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 5 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Formication
SMQs:, Peripheral neuropathy (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: formication 1 hour after vaccination. no signs of rash or redness. no trouble breathing. reported symptoms similiar to patient allergic reaction to sulfa medications


VAERS ID: 1858812 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy
SMQs:, 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: Amlodipine, simvastatin, estradiol, levothyroxine, liothyronine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Very swollen lymph node in the underarm of vaccinated arm


VAERS ID: 1858974 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-08
Onset:2021-11-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MOD 014F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Blothcy, itchy, painful raised welts on upper arm by injection site. Started the afternoon on day 2 after injection (about 24 hours later).


VAERS ID: 1858982 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOXYL 175mcg
Current Illness: Hypothyroidism
Preexisting Conditions: Hypothyroidism
Allergies: NKA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: About 15 minutes after receiving the COVID Moderna booster vaccine (0.25 ML), the patient developed swollen tongue. She took 1 tablet of benadryl 25mg. About 30 minutes after, the swelling got worse and the patient went to the ER. She was started on an drip antihistamine. Her airway was visible.


VAERS ID: 1858992 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: He had a 3 seconds seizure within 15 minutes of Pfizer covid19 vaccine administration.


VAERS ID: 1858993 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

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

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

Write-up: Patient developed small bumps along her left jaw line. Patient did not have swelling of the throat or any difficulty breathing. The patient was treated with 50mg of Benadryl tablets, and sat for observation. Her husband was able to drive her home without any further progression of symptoms. Advised patient to call 911 or go to ER if symptoms progressed, and I assured her that I would follow up with her again in the morning.


VAERS ID: 1859011 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Pallor
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: Within 2 minutes after receiving the vaccine patient passed out for 30 seconds, later woke up and looked really pale. Patient drank orange juice to try to get the blood sugar up and was fine within 15 minutes.


VAERS ID: 1859015 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 LA / IM

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

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

Write-up: Felt dizzy. Orange juice given and encourage fluids (water). Persisted symptom and was sent home. On follow up check at 550pm - she is feeling better and not dizzy anymore. Encouraged to see her doctor if not better.


VAERS ID: 1859022 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-08
Onset:2021-11-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D12A / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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:
CDC Split Type:

Write-up: 3 small rashes on left arm, chills and headache


VAERS ID: 1859024 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Underdose
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: 12-year-old pt. wrongly received the Pfizer vaccine appropriate for ages 5-11 as his first dose of the covid vaccine, as opposed to receiving the vaccine appropriate for ages 12+. Pt was observed for 15 minutes post vaccination and reported feeling fine. Pt left with guardian after vaccine.


VAERS ID: 1859029 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 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: na
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: nka
Diagnostic Lab Data: na
CDC Split Type:

Write-up: fainted for less than one minute


VAERS ID: 1859036 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

Write-up: Patient due for Covid vaccine adult dose and lower dose given (5-11 yr). Dr. informed of the incident. pharmacy was contacted by Dr. to see the follow up or actions we need it to take. Per pharmacist patient doesn''t need to complete the full dose. father informed of the incident and he verbalized understanding.


VAERS ID: 1859037 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0331F21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, 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: Metformin, lisinopril, jardians, aspirin, Prilosec,
Current Illness: NA
Preexisting Conditions: Diabetic
Allergies: NA
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Swollen arm at site of injection. Painful


VAERS ID: 1859039 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Ear discomfort, Paraesthesia, Walking aid user
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Was given oral medication after second pfizer dose at Hospital but does not recall. Symptoms were having difficulty breathing.
Other Medications: Metformin, norco, benazepril HCL, aspirin 81 mg, amlodipine besylate 10 mg, atenolol 25 mg, and atorvastatin.
Current Illness:
Preexisting Conditions: Hypertension, Diabetes type 2, high cholesterol, chronic back pain.
Allergies: Covid-19 vaccine per client statement, and other vaccines in the past.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At 15:28 PM Co Lead RN was alerted by observation nurse RN via walkie talkie that she needed assistance with a client. Client was sitting in 30 minute observation chair with his walking cane between his legs and observation RN standing in front of him. Client stated, "the tip of my ears feel hot and tingly." Co Lead RN recommended to client to take off face mask and take deep breaths. Client A&Ox4. Vitals taken by Observation RN: BP LA 183/121, pulse 92, O2 SAT 98%, respirations 20. Client stated, "yesterday at the doctor''s my blood pressure was like 198/135. They wanted to send me to the emergency room but I told them no. I relaxed for awhile in the office and then it went down a little to 180 something. I also got a new medicine for it." Co Lead RN emphasized to client that he needed to see his PCP regarding his blood pressure. Client then stated, "I already have a cardiology appointment next week." 15:40 PM Client stated, "You have all the information you need. I''ve been here for like an hour I am leaving now. I feel fine." Co Lead RN walked with client as standby assist. Client walked with steady gait.


VAERS ID: 1859043 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient fainted approximately 5 minutes after getting vaccine.


VAERS ID: 1859045 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Fatigue, Headache, Injection site pain, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (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: Verapamil 240mg x 2 daily Trandolapril 4mg x 2 daily Metformin 500mg x 3 daily Aspirin 80mg x daily Atorvastatin 20mg daily Vitamin C, D3, B12 Zinc Tumeric
Current Illness: None
Preexisting Conditions: Hypertension (controlled) Autoimmune Condition - Hashimoto Hearing loss (left auditory nerve damage)
Allergies: None
Diagnostic Lab Data: None at this time, symptoms appear to be consistent with booster vaccine adverse effects for older patients.
CDC Split Type:

Write-up: Right arm pain Fever 102 Aches in legs, back, and neck Headache Increased blood pressure 150/120 Nausea Severe Fatigue


VAERS ID: 1859050 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Fibromyalgia Crohn''s Ehlers Danlos Syndrome Esophageal Webs Arthritis Chronic Migraines Chronic Fatigue Syndrome ADHD
Allergies: IV Dye, Steroids, Latex, Celebrex, plastics, eye make up, lotions
Diagnostic Lab Data: I have not had any to date because I believe this began after my first dose of the J & J covid vaccine.
CDC Split Type:

Write-up: I have fibromyalgia and this pain I have had ever since I woke up this morning is far worse than any fibro pain I have ever experienced. It is in my neck all the way to my lower back, down my legs and the bottoms of my feet. I have taken hydrocodone 10/325mg, morphine 15mg IR and nothing is touching this pain. I am also having extreme thirst (over and above what my medications would have happen).


VAERS ID: 1859051 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Hypertension, Lethargy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: folic acid, B12,
Current Illness:
Preexisting Conditions: Anemia, Disk Bulge, inflammation
Allergies:
Diagnostic Lab Data: blood pressure check and breathing check 11/10
CDC Split Type:

Write-up: Hypertension, headache, muscle ache left side, shoulder and top of neck, Fatigue, lethargy.


VAERS ID: 1859218 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-05
Onset:2021-11-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Amnesia
SMQs:, Dementia (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Diclofenac, Amlodipine, Vitamin D & B, Omeprazole
Current Illness:
Preexisting Conditions: Prostatectomy May 2021
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Short-term memory loss on Wednesday 11/10/2021


VAERS ID: 1859219 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 2 RA / IM

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

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

Write-up: Patient became light headed


VAERS ID: 1859226 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Chest pain in left pectoral area. Shot given in left arm.


VAERS ID: 1859228 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 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: Patient just turned 12 two days ago and received a 5 to 11-year-old Pfizer dose instead of the 12 years and older.


VAERS ID: 1859230 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 3 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Needle issue, Syringe issue, Underdose
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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: none necessary
CDC Split Type:

Write-up: No adverse event occurred. This is the reporting of an administration error. A syringe with a retractable needle was utilized. The vaccine was drawn up properly according to protocol in a 1 mL retractable needle syringe. During vaccination the vaccine was injected with the plunger fully depressed however did not "click" and therefore the needle did not retract into the hub. Therefore there is concern over the full dose not being given because there is a minute amount of vaccine still within the needle itself when un-retracted. The patient was informed of what happened and he was thankful that he was informed and stated he was not concerned about it. He did not ask any further questions and stated no further needs at the time.


VAERS ID: 1859234 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product administration error, Syringe issue
SMQs:, Medication errors (narrow)

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

Write-up: No adverse event occurred. This is the reporting of an administration error. A syringe with a retractable needle was utilized. The vaccine was drawn up properly according to protocol in a 1 mL retractable needle syringe. During vaccination the vaccine was injected with the plunger fully depressed however did not "click" and therefore the needle did not retract into the hub. Therefore there is concern over the full dose not being given because there is a minute amount of vaccine still within the needle itself when un-retracted. The patient was informed of what happened and he was thankful that he was informed and stated he was not concerned about it. He did not ask any further questions and stated no further needs at the time.


VAERS ID: 1859244 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-07
Onset:2021-11-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

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

Write-up: Vomiting and headache on the third day after vaccine. Symptoms disappear by itself after taking a nap.


VAERS ID: 1859415 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Heart rate increased, Oxygen saturation decreased, Respiratory rate decreased, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Infective pneumonia (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: Acetaminophen, Aspirin, Mirapex, Synthroid tablet, Vitamin D tablet, Aspercreme lotion, Debrox solution
Current Illness:
Preexisting Conditions: Hypothyroidism, hypertension, osteoarthritis, chronic kidney disease
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11/10/2021 (at midnight): SOB, chest congestion/tightness, increased pulse, decreased oxygen saturation and increased respiration rate.


VAERS ID: 1859420 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330268D / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Feeling dizzy, light headed with rapid heart rate of 143 less than an hour after shot. Feeling resolved, then returned with HR at 108 BPM 3 hours later at rest.


VAERS ID: 1859423 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest pain, Lethargy, Respiratory rate increased, Vomiting
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: Apixaban, digoxin, duloxetine, gabapentin, latanoprost, senna-docusate sodium tablet, tetrahydrozoline solution, tylenol, vitamin B12, vitamin D3.
Current Illness:
Preexisting Conditions: Atrial fibrillation, osteoporosis, hyperlipidemia, hypertension, chronic obstructive pulmonary disease
Allergies: Aspirin, Fosamax, HMG-COA-R, lisinopril, sulfa antibiotics.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1005 emesis x2. Noon chest pain. 1303 increased respiration rate, using accessory muscles with breathing, lethargy.


VAERS ID: 1859427 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Dizziness, Eczema, Headache, Injection site pain, Injection site rash, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: First and second Moderna doses in March and April 2021. Soreness and muscle aching, no fever or rash.
Other Medications: Synthroid, lexapro, wellbutrin, Claritin, green tea extract, multivitamin, vitamin e, vitamin d, melatonin, probiotic
Current Illness:
Preexisting Conditions: Hashimoto?s hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After 30 minutes soreness in injection site and most muscles in the rest of the body, after an hour headache and dizziness, after 6 hours nausea, vomiting, diarrhea, weakness, as well as an excema-like rash noticed at the injection site, after 8 hours mild fever at 99.4 degrees which gradually reached 100.7 over an hour. Treated nausea with pepto bismol within 30 minutes of nausea which worked in preventing further vomiting and diarrhea, but did not end the general nausea. Tylenol was taken for the headache and fever when the fever was first noticed, after an hour temperature was back to normal and some of the body soreness had dissipated.


VAERS ID: 1860471 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

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

Write-up: Experienced a rash across chest. Was raised and warm feeling. Began 2 hours after receiving vaccine, lasted approximately 4 hours.


VAERS ID: 1860472 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child had syncope


VAERS ID: 1860473 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-11-05
Onset:2021-11-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Cerebrovascular accident, Computerised tomogram, Condition aggravated, Deep vein thrombosis, Electrocardiogram, Facial paresis, Laboratory test
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Immune-mediated/autoimmune 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Prior Covid 11/2020, DVT on xarelto
Preexisting Conditions: Prior Covid 11/2020, DVT on xarelto
Allergies:
Diagnostic Lab Data: ct, ekg, labs
CDC Split Type:

Write-up: CVA, R facial weakness no prior cva or tia. DVT on xarelto.


VAERS ID: 1860475 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: Hour after vaccine patient had vomited, vomited a 2nd time some time later, also feeling very fatigued. Advised family to continue monitoring symptoms and seek medical care if needed.


VAERS ID: 1860476 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Loss of consciousness, Nausea, Pruritus, Urticaria, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: At 5:16pm the patient received 0.2mL of the Pediatric Pfizer vaccine. At 5:20pm the patient lost consciousness. The father grabbed the patient as he was falling to the ground and gently laid him on the ground. The father carried the patient to the cot. The patient reported feeling dizzy and nauseous. The patient denied any pain. The head of the bed was elevated. The patient denied any trouble breathing. At 5:24pm the patient''s BP was 90/62 and HR was 110. At 5:24pm the patient vomited. At 5:24pm EMS was called. At 5:29pm the patient reported that he no longer felt dizzy. The patient was asked if he was itchy anywhere and he reported that his back was itchy. The back was assessed and hives were present across his back. The patient''s parents reported that the patient has a history of breaking out in hives. The patient reported that his back was itchy before receiving the vaccine. At 5:31pm BP was 102/72 and RR 13. The fire department arrived at 5:35pm and assumed care of the patient. At 5:40pm BP was 118/77, HR 74, and O2 Sat 95%. At 5:41pm paramedics arrived on site and assumed care of the patient. At 5:43pm the patient was transported by the paramedics to the emergency room.


VAERS ID: 1860477 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 RA / SYR
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Body aches, mild fever, tiredness, and sore arms
Other Medications: Tylenol Effexor Lipitor
Current Illness: None
Preexisting Conditions: Asthma Diabetes type 2 Colon cancer
Allergies: Contrast iodine Hay fever Alfalfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Mild fever Sore arms Body aches Headaches Congestion Exhausted


VAERS ID: 1860478 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Heart rate increased, Vital signs measurement
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: High heart rate. Can feel pulse around entire body while resting


VAERS ID: 1860487 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site 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: NA
Current Illness: NA
Preexisting Conditions: DIABETES, AUTOIMMUNE DISORDER
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: PATIENT complained that her whole hand was turning NUMB and she was not able to feel anything - but when she pinches herself then she feels it. and she is having tingling sensation in her entire left arm, where she got the vaccine, which did not happen during the 1st two doses that she received.


VAERS ID: 1860496 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-02
Onset:2021-11-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (broad)

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

Write-up: Patient is complaining of pain in the elbow joints after 2 weeks of getting the second dose of Pfizer. Patient has taken ibuprofen or Tylenol which help relieves the pain but doesn''t go away. Consulted patient to f/u with pcp. Per patient will visit pcp soon.


VAERS ID: 1860501 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Electrocardiogram, Fall, Laboratory test, Mobility decreased
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 mg tablet Take 650 mg by mouth every 4 hours as needed for Pain. ? albuterol 90 mcg/puff inhaler Inhale 2 puffs into the lungs every 6 hours as needed for Wheezing or Shortness of Breath. ? bisoprolol (ZEBETA) 5
Current Illness: nothing acute
Preexisting Conditions: Chronic CHF, COPD, HTN, Hyperlipidemia, afib, hypothyroid, all managed
Allergies: penicillin''s, bupropion, doxycycline, and terazosin.
Diagnostic Lab Data: Labs, EKG, CXR - 11/10
CDC Split Type:

Write-up: Pt reports total body generalized weakness for the 6 hours after he got the COVID-19 booster. He then had a ground level fall and was unable to get up. Pt reports that the shot was given on 11/10, however the vaccine registry states it was given on 11/9.


VAERS ID: 1860503 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Seizure, Unresponsive to stimuli, Visual impairment
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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: Johnson and Johnson covid vaccine, patient reported anaphylactic type reaction, though this was not independently verified
Other Medications: unknown, patient does not regularly receive medication from this pharmacy, patient unable to provide details after event / before paramedics arrived
Current Illness: none noted
Preexisting Conditions: none noted on form, nurse administering vaccine said patient indicated she had a tic-like condition i.e. tourette''s syndrome, and had an adverse reaction (anaphylaxis) to Johnson and Johnson Covid Vaccine
Allergies: strawberry, apple, cherry, bee pollen, cat hair
Diagnostic Lab Data: all tests on 11/10/21, vitals including BP, pulse, and breathing were documented every 5-10 mins. BP recorded 111/89 , 112/75, 106/74, pulse recorded at 68, 67 , 67
CDC Split Type:

Write-up: approx 5-10 mins after receiving the vaccine patient reported dizziness, light headedness, and seeing spots. nurse administering had patient lie down with legs up and checked vital signs. patient did not report anaphylactic type reaction so epipen was not given, but held ready in case. about 30 mins after dose, patient reported feeling better and sat up in a chair. after additional 2-5 mins patient was not responding to verbal cues and appeared unable to speak or move despite appearing awake. nurse and NP in store suspected seizure. ambulance was called and all vital signs continued to be monitored


VAERS ID: 1860507 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)

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

Write-up: my menstruation started in the second morning after the third vaccine although normally it should have arrive in around 2 wks. I do use the app for more than 1 Year and I record all the information. My period variation is averaged at 3 days not weeks. Initially I thought that it is spotting but considering the consistency and volume it looks to be period. I did make a doctor appointment today, 11/11 for 12/03 first spot available


VAERS ID: 1860520 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Cardioversion, Electrocardiogram abnormal, Heart rate increased, Supraventricular tachycardia, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol, Eliquis and Rosuvastatin
Current Illness: Cardioblation for right atrial flutter
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG confirmed heart rate of 167. Cardioversion performed on 11/10/2021.
CDC Split Type:

Write-up: SVT/flutter/tachycardia.


VAERS ID: 1860522 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dizziness, Nausea, Syncope, Unresponsive to stimuli
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), 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? 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: Dizziness/Lightheadedness-Mild, Systemic: Fainting/Unresponsive-Mild, Systemic: Nausea-Mild, Additional Details: Patient fainted and unresponsive for about 3 minutes. Upon awakening patient felt dizzy and nauseous. EMS called and patient taken to ER.


VAERS ID: 1860525 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 3 RA / 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 Low-


VAERS ID: 1860526 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), 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 Route (SC, IM, etc.)-


VAERS ID: 1860528 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Tingling (specify: facial area, extemities)-Mild, Additional Details: 15 minutes after immunization, patient reported that she had tingling on the arm and in the fingers after injection. Pt said the tingling got better. I let pt know that it could be temporary due to nerve irratation, which should go away in a couple of days; however, it could also be nerve damage that may last longer and have a more severe impact. Pt will watch out closely for a few days and contact doctor if it gets worse or does not go away after 2-3 days. I will follow up 11/11 and/or 11/12.


VAERS ID: 1860532 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Dizziness / Lightheadness-Mild


VAERS ID: 1860537 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 4 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 Early-


VAERS ID: 1860538 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Erythema, Peripheral swelling, Pyrexia, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lupus
Allergies: Latex and red dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe swelling in arm. Large red welts. Temperature of 103 with fever and chills


VAERS ID: 1860539 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / UNK AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, 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), 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? 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: Fainting / Unresponsive-Medium, Systemic: Nausea-Medium, Additional Details: reporting RPH; immunizer, RN. RN verified pt documentation. previously gotten 2 doses of MODERNA with no side effects reported. when receiving booster pt fainted for several seconds then came too. laid on pharmacy floor while emergency services was called. given water and sat up in chair when ready, still lightheaded. vomited several times. EMT arrived on scene reported pt''s BP and pulse was normal. Pt refused ambulance or medical attention.


VAERS ID: 1860540 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 LA / SYR

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Nausea-Mild


VAERS ID: 1860542 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Stomach ache


VAERS ID: 1860543 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 1 RA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Shakiness-Medium, Additional Details: Patient was seated in store ~5 minutes after dose patient went pale and asked to EMS. He stated he was dizzy and was unresponsive for about 2 minutes. Upon investigation patient states he has has this issue before with blood drawing.


VAERS ID: 1860544 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold
SMQs:

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

Write-up: Systemic: patinet felt cold-Mild, Additional Details: 10 Years old started feeling cool, father asked for Benedryl, patinet was given water. they stayed in obervation area for 30 mins


VAERS ID: 1860545 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: Systemic: Nausea-Medium, Systemic: Vomiting-Medium, Additional Details: Patient complained of severe nausea 15 minutes after his pfizer vaccine and threw up in the bathroom.


VAERS ID: 1860548 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Fever - one day


VAERS ID: 1860550 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium.


VAERS ID: 1860672 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Gait inability, Headache, Insomnia, Pain, Palpitations, Tremor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Headache, severe body aches, joint pain, chills, shaking to the point unable to walk, blurry vision, heart racing, insomnia,


VAERS ID: 1860674 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1860675 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-05
Onset:2021-11-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Inflammatory rash on foot


VAERS ID: 1860676 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

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


VAERS ID: 1860679 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-08
Onset:2021-11-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis, Laboratory test abnormal, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamsulosin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: PVL Venous Exam, 11.10.2021
CDC Split Type:

Write-up: Swollen right calf, experienced within 48 hours of injection, diagnosed as blood clot (DVT), prescribed blood thinner (Equis)


VAERS ID: 1860682 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-13
Onset:2021-11-10
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Laboratory test abnormal
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: Patient tested positive on 11/10/21


VAERS ID: 1860684 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Lymphadenopathy
SMQs:, 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: Birth control pills
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Painful lymphadenopathy in left axilla developed about 18 hours after vaccination


VAERS ID: 1860695 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-08
Onset:2021-11-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

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

Write-up: Patients mother called 2 days after vaccine was given....said patient had redness and swelling at injection site and also had a fever........told patient''s mother to be seen by provider which she agreed.


VAERS ID: 1860704 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-15
Onset:2021-11-10
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer 2/22 and 3/15 and 10/11. Positive on 11/10


VAERS ID: 1860706 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-01
Onset:2021-11-10
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer on 4/3 and 5/1. Postive on 11/10


VAERS ID: 1860745 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-20
Onset:2021-11-10
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -

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

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

Write-up: Tested positive with rapid test during community outbreak


VAERS ID: 1860764 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033P21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: N.A.
CDC Split Type:

Write-up: Fatigue and gastro-intestinal (diarrhea)


VAERS ID: 1860770 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / -

Administered by: School       Purchased by: ?
Symptoms: Injected limb mobility decreased, Pain in extremity, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient reported that she can barley move her arm... Serve pain from her left arm going in her neck... very very sleepy..


VAERS ID: 1860772 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-08
Onset:2021-11-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 34F214 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Injection site induration, Injection site pain, Injection site rash, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna
Other Medications: Synthroid
Current Illness:
Preexisting Conditions: Hypothroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have hard sore bumps below vaccine sight, slight swelling and redness in arm


VAERS ID: 1860781 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025D21A / 1 LA / IM

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

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

Write-up: "Just a heads up that I am sick today, fatigue, body aches and low grade temp (100.5 has been the highest). I have been taking tylenol to help. I plan to be at work tomorrow with the expectation that it is the shot and I should be feeling better."


VAERS ID: 1860786 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-08
Onset:2021-11-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Headache, Injection site pain, Lymph node pain, Lymphadenopathy, Pyrexia, Rash, Rash macular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Swollen, painful lymph nodes in right arm; Pain and tenderness at injection site; Headache; Fever (2 days so far); Splotchy rash on thighs


VAERS ID: 1860789 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-05
Onset:2021-11-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Gastrointestinal pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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: Lipitor, low dose aspirin, multi vitamin, vitamin D supplement, vitamin c supplement, flutacasone nasal spray, zrytec allergy pill
Current Illness: None
Preexisting Conditions: None
Allergies: Neomycin, bacitracin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Lower gastrointestinal bloating and pain. No other associated symptoms. Taking ibruprofen and drinking plenty of fluids. Symptoms have not resolved yet.


VAERS ID: 1860791 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Headache, Illness, Nausea, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fenofribrate, Fish Oil, Vitamin D
Current Illness: None
Preexisting Conditions: Low Plateletts
Allergies: None
Diagnostic Lab Data: None. Wasn''t sick enough for Doctor visit. Just toughed it out at home.
CDC Split Type:

Write-up: Very sick on next day, 11/10. Vomited and nausea. Headache. Developed a rash on my face on my cheeks. Spent most of the day in bed. No appetite. On 11/11 feeling better but still not back to 100%.


VAERS ID: 1860793 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cellulitis, Injection site erythema, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirtazapine, Atorvastatin, Omeprazole, Amlodipine, Fluoxetine, Tramadol, Cyclobenzaprine
Current Illness: None
Preexisting Conditions: HTN, PUD, Cervical disc disease, Anemia, RAD, Dyslipidemia, Depression, OSA, Chronic low back pain, Radicular pain of RLE, CAD, Right hemiparesis, Cervical radiculopathy
Allergies: Sulfa Drugs
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The day after the patient received his Booster shot of Moderna, his left arm became swollen beneath the injection site of the left deltoid all the way down to the elbow. The affected area was red and warm to touch. The patient came to Clinic to see Dr. and was diagnosed with cellulitis. He was prescribed cephalexin 500mg 1 po q12hrs x10 days and returned home.


VAERS ID: 1860798 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Injection site pain, Lymphadenopathy, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: COVID19 (Moderna), 2nd dose, 043B21A, nausea for 24 hours, age 43
Other Medications: N/A
Current Illness: cold
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: fever, pain at injection site, lymph node swelling, nausea


VAERS ID: 1860800 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest discomfort, Cough, Dyspnoea, Pain
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called to report difficulty taking deep breaths (chest felt tight), coughing, pain with deep breaths. Pain was felt mostly in upper back. Urged patient to directly go to ER or urgent care for evaluation and treatment.


VAERS ID: 1860804 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Myocardial infarction, Surgery, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lorazepam, Escitalopram, Donepezil, Calcium carbonate, Vit D
Current Illness: Pharmacy does not have details
Preexisting Conditions: N/A, PCP will have health conditions, pharmacy does have details
Allergies: Peniccillins, Codeine, Sulfa, Tetracylines
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient experienced chest pain, tachycardia, and dizziness around 1 and 1/2 hours after vaccine, she was transported to hospital where she was diagnosed as heart attack and under went procedure.


VAERS ID: 1860809 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Muscle twitching
SMQs:, Taste and smell disorders (narrow), Dyskinesia (broad), Dystonia (broad)

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

Write-up: Metallic taste and pulsating of the base of my tongue that is in the back of my throat.


VAERS ID: 1860815 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-11-01
Onset:2021-11-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 5 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Therapeutic response unexpected
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen, albuterol, finasteride
Current Illness:
Preexisting Conditions: asthma
Allergies: poison ivy, environmental/seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: After each of three (3) injections with the Pfizer vax all the "floaters" within my eyes disappeared almost immediately. While not an "adverse reaction" per se, it was recurrent and unusual enough that I thought it should be reported. I am acutely aware of my "floaters" in daily life and have lived with a physician for many years, so I immediately noticed when they were gone. The "floaters" eventually re-appeared after the first two vaccinations. I attempted to report this reaction through the Pfizer reporting website but could not complete their complex and indecipherable online forms.


VAERS ID: 1860816 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-30
Onset:2021-11-10
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Condition aggravated, Erythema, Extra dose administered, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna covid vaccine 2nd dose. Age 37. Vaccine date: 2/5/21 (lot: 012M20A). Reaction occurred about 1 month later
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Minor food allergy to gluten, egg, casein, soy
Diagnostic Lab Data:
CDC Split Type:

Write-up: With the second dose, I broke out into a full body rash that required a steroid shot to alleviate. It occurred 1 month after the second dose of the moderns vaccine was administered. I wasn?t sure if it was related, so I didn?t report. I just received the booster less than 2 weeks ago and I?m breaking out into a full body rash again. Red, raised welts that are very itchy and burn at certain sites. The rash always begins at my elbows and spreads over my entire body. The reaction from the booster occurred more rapidly and now showing signs on my face which hadn?t happened with the prior shot. The reactions appear to be getting more severe. Within 18 hours of first signs, I have welts over my ankles, face, stomach, elbows, hands, etc


VAERS ID: 1860848 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diltiazem 240mg
Current Illness: none
Preexisting Conditions: HBP
Allergies: no
Diagnostic Lab Data: Vaccine was just yesterday. Called my DR. this morning and was advised to report my issues here.
CDC Split Type:

Write-up: Several hours after injection I experienced lightning like bolts of light flashes in outside corner of left eye. That continued most of the night. In the morning that was gone but I''m currently experiencing what I can best describe as black lines in my eyes. I have never had any problems with my eyes. I had no problems with the first two vaccines.


VAERS ID: 1860874 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chapped lips, Condition aggravated, Extra dose administered, Lip swelling, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 4/6/2021 Janssen 1 dose, lip swelling, hives
Other Medications: Venlafaxine ER 150 mg daily
Current Illness:
Preexisting Conditions:
Allergies: Cipro Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Booster for Janssen Lip swelling Itchy rash Chapped lips


VAERS ID: 1860878 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-17
Onset:2021-11-10
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6296 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 COVID pfizer vaccine given 2/24/21, dose 2 COVID Pfizer vaccine given 3/17/21. Patient hospitalized 11/10/21 with respiratory failure. still hospitalized today 11/11/21, and D/C not expected soon.


VAERS ID: 1860880 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-14
Onset:2021-11-10
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B212A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Mental status changes, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness:
Preexisting Conditions: Alzheimer''s dementia, thrombocytopenia
Allergies:
Diagnostic Lab Data: SARSARS-COV-2 (COVID-19) by NAA, Micro Detected on 11/10/21
CDC Split Type:

Write-up: Patient presented to the Emergency Center with altered mental status and fever. tested positive for COVID on 11/10/21


VAERS ID: 1860885 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Condition aggravated, Insomnia, Muscle strain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever with moderna dose 2
Other Medications: Atorvastatin 80mg Lisinopril 40mg Corvedilol 12.6 mg 2x day Asprin 81mg
Current Illness:
Preexisting Conditions: Heart condition
Allergies: Penicillin Macrobid
Diagnostic Lab Data:
CDC Split Type:

Write-up: 102 degree fever Body aches Pulled muscles due to chills Chills Insomnia


VAERS ID: 1860891 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, Pruritus, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Medication errors (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: Unusual menstrual bleeding, Age 39, 4/7/21, Jannsen/J&J
Other Medications: Supplements: L-tyrosine, L-Theanine, B complex, L-glutamine, D3, K2, 5-HTP, Feminessence Maca Pro Harmony, Vit C
Current Illness: None known
Preexisting Conditions: Previously (over last 5 years) had sub clinical hypothyroidism Previously (over last 5 years) had autoimmune reactions
Allergies: Allergies: None known Sensitive to gluten Sensitive to strong chemicals, perfumes, dyes, etc
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: This was a Pfizer booster after originally receiving the Jansen/J&J shot in April 2021. About 10 hours after the shot, I started feeling very itchy around my palms, forearms, under arms and under my breasts. I treated with some topical anti-itch cream and it subsided. I went to sleep and upon waking at 7:30 the next morning, I noticed some heavy ocular swelling in the upper lids, most especially in my right eye (the side I was sleeping on). My right eye was only able to open about 50-60%. I have previously had a similar reaction after consuming something I?m sensitive to or when having an autoimmune flare up.


VAERS ID: 1860896 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-09
Onset:2021-11-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061EZ1A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Lethargy, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 150mcg Sertraline 75mg daily
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 13 hours after vaccination, I had a 101.5 fever, vomiting and extreme lethargy. I am now 48 hours post vaccine and still have a 99 degree fever and very tired. I am not vomiting anymore. Vomiting only lasted about 5 hours.


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