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From the 9/3/2021 release of VAERS data:

Found 661,087 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 4 out of 6,611

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VAERS ID: 1655971 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-27
Onset:2021-08-29
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

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

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

Write-up: Difficulty breathing, hospitalization.


VAERS ID: 1656002 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-27
Onset:2021-08-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Hypersensitivity, Nausea, Pain in extremity, Pruritus, Pyrexia, Rash, Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol succ er 25mg
Current Illness: none known
Preexisting Conditions: none known...maybe mild blood pressure
Allergies: none known
Diagnostic Lab Data: none so far... saw local doctor and he prescribed famotidine 20mg and allegra 60mg twice a day...recommended her to see an allergist before next shot to take in 24 or so days
CDC Split Type:

Write-up: normal adverse reaction to moderna--mild fever and chills,,mild headache,sore arm,some nausea...but developed a rash from day after shot-Saturday into sunday and Monday...allergic reaction rash over both arms and upper torso,,some itching..somewhat raised red rash similar to an antibiotic allergic reaction...breathing ok,,,no swelling in lips or lungs,,.


VAERS ID: 1656071 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-28
Onset:2021-08-29
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: Type 2 DM
Allergies: nkda
Diagnostic Lab Data: Inpatient hospitalization
CDC Split Type:

Write-up: Breakthrough case


VAERS ID: 1656157 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-29
Onset:2021-08-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypotension, Musculoskeletal stiffness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Fainting / Unresponsive-Mild, Additional Details: fainted, muscles in arms went stiff. Called 911, retrieved epipen in case she stopped breathing. She spontaneously woke up after about 60 seconds unaware of what had happened. Paramedics arrived, checked her bp and ekg. bp was low, 95/55. ekg was normal. Father refused transport to hospital.


VAERS ID: 1656209 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-17
Onset:2021-08-29
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Hospital 8/29/21. Received 2nd Pfizer COVID shot 7/31/21


VAERS ID: 1656212 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / SYR

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

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

Write-up: Rash, much like shingles.


VAERS ID: 1656246 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-28
Onset:2021-08-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (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: MULTIVITAMIN
Current Illness: LAST MONTH A LITTLE COLD
Preexisting Conditions: NONE
Allergies: PENICILLIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: swollen LYMPH NODE UNDER THE LEFT ARMPIT. NOT PAINFUL


VAERS ID: 1656374 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-27
Onset:2021-08-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen 200mg I was experiencing a headache before I went to get the vaccine. I took 3 200mg ibuprofen before I left. About 1 hour before I received the shot.
Current Illness: None
Preexisting Conditions: None I have no past health conditions
Allergies: NKDA
Diagnostic Lab Data: This just started last night. I have reached out to my doctor to come in for an appointment. I know Guillain Barre syndrome is linked to the Johnson and Johnson vaccine, I am going to ask my doctor if this is what I am experiencing.
CDC Split Type:

Write-up: I received the vaccine on Friday afternoon, by Sunday night I have been experiencing numbness and tingling in my feet and hands. I feel like I?m having a hard time getting circulation to my hands. They keep feeling as though they are ?falling asleep?. It''s now Monday afternoon, and they symptoms have not gone away.


VAERS ID: 1656413 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-08-01
Onset:2021-08-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Corneal reflex decreased, Cranial nerve disorder, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Corneal disorders (narrow), Hearing impairment (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: bells palsy type symptoms, blinkiking left eye right sided facial droop


VAERS ID: 1658375 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-06
Onset:2021-08-29
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Confusional state, Decreased appetite, Hypersomnia, Nausea, Pain, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

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

Write-up: Weakness body aches, confused, weak and groggy, nausea vomiting, decreased appetite with increased sleep.


VAERS ID: 1658383 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-27
Onset:2021-08-29
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH RN6208 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, COVID-19, Fall, SARS-CoV-2 test positive
SMQs:, Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient brought to ED for generalized weakness and falls, found to be in afib and also COVID positive. Patient still in hospital for treatment.


VAERS ID: 1658424 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-01
Onset:2021-08-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Headache, Pain, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Mom called the following day to report vomiting, fever, lack of air, body pain and headache. Mom gave her acetaminophen and the girl improved.


VAERS ID: 1658542 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-26
Onset:2021-08-29
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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: Moderna on 2/26 and 3/26. Positive on 8/29 admitted 8/29 to current


VAERS ID: 1658546 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-08
Onset:2021-08-29
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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: Janssen on 4/8. Positive on 8/29 admitted on 8/29-current


VAERS ID: 1658563 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-03-04
Onset:2021-08-29
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Hypoxia, Myalgia, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)

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

Write-up: Patient presented to ED with a 5 day history of cough, rhinorrhea, muscle aches, and chills. Patient was hypoxic and initially required 2 L of oxygen by nasal cannula.


VAERS ID: 1658584 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-29
Onset:2021-08-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, 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: None
Current Illness: None
Preexisting Conditions: Osteo-Arthritis (knees)
Allergies: Penicillin Vancomycin Bactrim
Diagnostic Lab Data: None
CDC Split Type:

Write-up: In addition to side effects previously reported for this lot number.......at about 10:30pm sudden onset of elevated body fever and chills which lasted through the rest of the night. Benadryl taken to assist with sleep. Upon wakeup the next morning, elevated fever was gone.


VAERS ID: 1658613 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-08-29
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043AZ1A / UNK - / -

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

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

Write-up: positive covid test and symptoms


VAERS ID: 1658790 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-29
Onset:2021-08-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: fractured ankle, infected bone of ankle, substance abuse
Preexisting Conditions: depression, asthma,
Allergies: lidocaine, sulfa and morphine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received the first dose of Moderna on 2/3/21 but never received the second dose. When patient reported to the ED for a infected ankle MD wanted to administer the second dose of COVID vaccine. MD accidentally ordered Janssen vaccine instead of Moderna. Error was not caught by pharmacy nor nursing. No patient harm reported.


VAERS ID: 1658838 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-10
Onset:2021-08-29
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Leukocytosis, Pneumonia viral, SARS-CoV-2 antibody test, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 40 mg Tablet Directions: 1 tablet oral daily at bedtime (Active) cefdinir 300 mg Capsule Directions: 1 capsule oral twice a day (Active) cyproheptadine 4 mg Tablet Directions: 1 tablet oral three times a day (Active) doxy
Current Illness:
Preexisting Conditions: Hypothyroidism Peptic ulcer disease Hyperlipidemia
Allergies: Penicillins
Diagnostic Lab Data: 8/29/2021 - SARS-CoV-2 Antigen and PCR both (++) 8/30/2021 SARS-CoV-2 IgG - 5.75; IgM 0.56 8/30/2021 SARS-CoV IgI2 QT-SPIKE< ++++ $g50,000
CDC Split Type:

Write-up: Hospitalized on 8/29/2021 with COVID19+, viral pneumonia and leukocytosis.


VAERS ID: 1658993 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-08-29
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Confusional state, Fall, 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), Accidents and injuries (narrow), Arthritis (broad), Hypoglycaemia (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:
Allergies:
Diagnostic Lab Data: Defer to MD
CDC Split Type:

Write-up: Pt was given the Pfizer vaccine on 2/4/21 and 2/25/21. She was admitted to the hospital on 8/29/21 due to a fall and hip pain. Pt was dx with COVID 19+ a week prior to hospital admit per chart review. No significant symptoms noted by OT during today''s short session, though she was confused. uncertain if that is due to HOH, language barrier, her baseline cognitive level, vs Impact of COVID.


VAERS ID: 1659140 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-17
Onset:2021-08-29
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 RA / IM

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

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

Write-up: Vaccinated patient hospitalized with COVID-19.


VAERS ID: 1659172 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-21
Onset:2021-08-29
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, COVID-19 pneumonia, Intensive care, SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Severe COVID-19 pneumonia requiring bipap and ICU admission


VAERS ID: 1659178 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-08-29
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: PMH of TBI, paraplegia
Allergies:
Diagnostic Lab Data: POSITIVE SARS-COV-2 BY PCR FROM SPECIMEN COLLECTED 8/29/21
CDC Split Type:

Write-up: INCREASED SOB


VAERS ID: 1659286 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-01
Onset:2021-08-29
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Magnetic resonance imaging, Thrombosis, Transient ischaemic attack
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT scan, MRI
CDC Split Type:

Write-up: Blood clots causing small stroke


VAERS ID: 1659333 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-28
Onset:2021-08-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Renal pain
SMQs:

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

Write-up: I woke up the next day after the vaccine with horrible pain in the left kidney, I already have 3 days with the pain and it does not go away or decrease anything. I was feeling good before the vaccine.


VAERS ID: 1662297 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-27
Onset:2021-08-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest pain, Chills, Echocardiogram normal, Fatigue, Myocarditis, Pain, Pyrexia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: Troponin - 8/30 0931 = 0.891, 8/30 1230 = 1.123, 8/30 1531 = 1.932, 8/31 0352 = 3.363 Echo 8/30 - no noted abnormalities Cardiac cath 8/31 - no angiographic abnormalities
CDC Split Type:

Write-up: Following 2nd dose of COVID vaccine on 8/27, patient had low-grade fever, body aches, chills, and fatigue. Starting 8/30 in the morning, he began having burning chest pain, described as being like he "just ran a long time in cold weather". He came to the hospital and was noted to have elevated troponins (8/30 0931 = 0.891, 8/30 1230 = 1.123, 8/30 1531 = 1.932, 8/31 0352 = 3.363). An echo was also completed and was unremarkable. He was admitted to the hospital with suspected myocarditis. Further cardiac workup was done and patient had a cardiac cath on 8/31 which showed normal coronary angiography.


VAERS ID: 1662422 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-01-27
Onset:2021-08-29
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M204 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed and admitted to hospital with COVID 19.


VAERS ID: 1662552 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-29
Onset:2021-08-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 - / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NICOTINE PRODUCTS
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT FELT DIZZY 5 MINS AFTER GETTING THE VACCINE HE STATED IT TYPICALLY HAPPENS TO HIM EVERY TIME HE GETS A VACCINE


VAERS ID: 1662620 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-24
Onset:2021-08-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiovascular symptom, Electrocardiogram, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, omeprazole, cardiem, hydrochlorthiazide , zetia , tricor ,atacand, flomax
Current Illness: none
Preexisting Conditions: asthma
Allergies: penicillin, benacar, beta blockers
Diagnostic Lab Data: ekg 8/31 and 9/1 bp dr check 8/31 and 9/1
CDC Split Type:

Write-up: Heart attack symptoms, extremely high blood pressure when able to check


VAERS ID: 1662631 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-08-29
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Alcohol poisoning, Aspartate aminotransferase increased, Asthenia, Benzodiazepine drug level increased, Blood culture, COVID-19, COVID-19 pneumonia, Computerised tomogram head normal, Computerised tomogram thorax abnormal, Drug screen positive, Dyspnoea, Electrocardiogram QT interval, Endotracheal intubation, Glomerular filtration rate normal, Intensive care, Lung consolidation, Lung infiltration, Mechanical ventilation, Obstructive airways disorder, Pulmonary mass, Respiratory distress, Respiratory failure, SARS-CoV-2 test positive, Seizure, Serum ferritin increased, Tracheal aspirate culture, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Convulsions (narrow), Drug abuse and dependence (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (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: seizure, not maintaining airway, COVID positive History of Present Illness Patient is currently being evaluated in intensive care unit-patient is on ventilator on sedation. Information is obtained from the medical record and is noted below from the ER notes: The patient presents with difficulty breathing. The course/duration of symptoms is constant. Degree at onset moderate. Degree at present moderate. The Exacerbating factors is none. The Relieving factors is none. Risk factors consist of none. Prior episodes: none. Therapy today: none. Associated symptoms: none. Additional history: 63-year-old female presents today in respiratory distress. Patient reportedly had a seizure earlier. Patient known COVID-19 positive. EMS attempted to intubate numerous times were unsuccessful. Presently patient being bagged.. T: 99.2 ?F(Oral) TMIN: 97.1 ?F(Oral) TMAX: 99.2 ?F(Oral) HR: 40 RR: 18 BP: 125/71 SpO2: 98% WT: 69.5 kg On Dexamethasone, Ceftriaxone & Azithromycin (QTc: 403 mS). PLAN: -agree with steroids -will add Remdesivir. Will follow her transaminases on this medication (see 3 below) -OK with above abx. Following the blood cx 2. Respiratory failure requiring intubation J96.90 See above. As per Pulm
CDC Split Type:

Write-up: . Pneumonia due to COVID-19 virus U07.1 This is a 63 year old female with ETOH abuse, whom we are consulted for COVID-19 pneumonia. She was initially seen in this ER on 8/25, with reported generalized weakness. At that time, she was diagnosed with COVID-19. She was recommended to receive Regeneron. She was discharged in stable condition on 8/26. She then re-presented to the ER on 8/29 with difficulty breathing. Of note, she is s/p the Pfizer COVID vaccine previously. When she arrived in the ER, she was in respiratory distress. She reportedly had a seizure earlier. EMS attempted to intubate her numerous times en route, but were unsuccessful. She was intubated in the ER. Afebrile. WBC 13.9K. GFR 93. SGOT/SGPT: 144/88. CRP 3.9, Ferritin 454. COVID-19 PCR positive 8/25 & 8/29. UDS: benzos & THC. Blood cx from 8/29 pending. ETT aspirate cx from today is pending. CT brain today without acute findings. CT chest PE today: no PE, diffuse GGO infiltrates, bilateral upper nodular consolidations.


VAERS ID: 1663240 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-29
Onset:2021-08-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dyspnoea, Impaired work ability, Myalgia, Pain in extremity, Pruritus, Pyrexia, Throat tightness, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Pfizer,- April 2021 hives & swelling, Influenza- 2008
Other Medications: Losartan; ZYRTEC OTC; NASONEX; zolpidem; famciclovir (stopped taking prior to vaccine)
Current Illness: No
Preexisting Conditions: Seasonal allergies
Allergies: Many antibiotics; penicillin; azithromycin; codeine; Sudafed; Topamax; DM (cough medicine); strawberries; avocados
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I pretreated with 50 mg of Benadryl and Tylenol at 12:15. I got the injection at 01:41pm and at approx. 02:20 pm on my way home I developed hives and my throat started close up. I was taken to the ER. I was given .3 of epinephrine and then 60 mg of prednisone and 50 mg of Benadryl. Shortly after, about an hour later, my throat closed up again and I could not breathe. I was given an additional .3 of epi and more Benadryl and an IV was put in. I was discharged that evening with a 10mg taper of prednisone and 2 epi pens, I was directed to take Benadryl every 4-6 hours as needed. I have also had joint and muscle pain, a fever, sore arm. I am still itching, mostly in my face and left palm and left bottom of my foot. I am unable to work, will have to stay home for a week to make sure this is resolved.


VAERS ID: 1663406 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-28
Onset:2021-08-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevat
CDC Split Type:

Write-up: chest pain


VAERS ID: 1666077 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-28
Onset:2021-08-29
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 06B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Malaise, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (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: acetaminophen 325 mg oral tablet, 650 mg= 2 TAB, PO, Q4H (Every 4 hours), PRN albuterol 2.5 mg/3 mL (0.083%) inhalation solution, 2.5 mg= 3 mL, NEB, 4 times a day, PRN allopurinol 100 mg oral tablet, 100 mg= 1 TAB, PO, Daily furosemide 4
Current Illness:
Preexisting Conditions: COPD, BPH, PACEMAKER, AFIB, HTN, HC, OSTEOARTHRITIS,
Allergies: LOSARTAN, ATORVASTATIN, PREDNISONE, ROCEPHIN, SULFA DRUGS, LISINOPRIL, LEVOFLOXACIN
Diagnostic Lab Data: POSITIVE COVID TEST
CDC Split Type:

Write-up: pt reports he has been sick since 8/20 and tested postive for covid a couple days ago, sob and o2 level was low


VAERS ID: 1666095 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-21
Onset:2021-08-29
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / N/A - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, COVID-19, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: AMLODIPINE
Current Illness:
Preexisting Conditions: Anxiety Apnea CPAP treatment Depression Hypertension Sleep apnea
Allergies: NKA
Diagnostic Lab Data: POSITIVE COVID TEST 08/29
CDC Split Type:

Write-up: arrived via EMS from home, c/o SOB, Fever, loss of taste, Was COVID NEG on Monday, not getting any better, When EMS arrive pt O2sat @ 60''s in RA


VAERS ID: 1666155 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-05
Onset:2021-08-29
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EN29N3 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Lethargy, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: allopurinol 300 mg oral tablet, 300 mg= 1 TAB, PO, Daily, Aspirin Enteric Coated 81 mg oral delayed release tablet, 81 mg= 1 TAB, PO, Daily, atorvastatin 20 mg oral tablet, 20 mg= 1 TAB, PO, QHS (At bedtime), finasteride 5 mg oral ta
Current Illness:
Preexisting Conditions: Adenoidectomy Anemia... Appendectomy Benign prostatic hyperplasia CHF (congestive heart failure)... COPD Cellulitis Cirrhosis of liver Depression Diabetes mellitus Fracture Glaucoma... Gout Hypercholesterolemia Hypertension Implantation of cardiac pacemaker Inguinal hernia LASIK Pancytopenia
Allergies: NKA
Diagnostic Lab Data: POSITIVE COVID TEST 08/29/2021
CDC Split Type:

Write-up: patient c/o fever, lethargy, sob


VAERS ID: 1666182 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-27
Onset:2021-08-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Back pain, Balance disorder, Burning sensation, Diarrhoea, Dyspnoea, Feeling abnormal, Headache, Muscular weakness, Myalgia, Paraesthesia, Pruritus, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), 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? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cuvitru IGG Immuno therapy
Current Illness: None
Preexisting Conditions: Lyme disease 2017, hypogammaglobulinemia, primary immune deficiency
Allergies: NKDA
Diagnostic Lab Data: Lyme specialist appointment for Tuesday 9/7/21.
CDC Split Type:

Write-up: Burning in hands, hands falling asleep. Brain fog, Feeling of falling, loss of balance, Leg and arm weakness, joint pain, muscle pain, stabbing pains in abdomen and back shortness of breath headache diarrhea. On the 6th day after receiving vaccine I woke up with a rash and extreme itching all over


VAERS ID: 1666214 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-08-29
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dyspnoea, Fatigue, Hypoxia, Nasal congestion
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
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 was evaluated in the clinic by his PCP on 9/1/2021 for cough, fatigue, chills, shortness of breath and nasal congestion that had an onset 3-4 days prior. His pulse oximeter was 68-72% on room air, advised to the ER for further evaluation. Upon arrival to the ER he was hypoxic to the mid 80s and placed on supplemental oxygen. Admitted to the hospital for further treatment of COVID infection. No prior COVID infections.


VAERS ID: 1666266 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-26
Onset:2021-08-29
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Decreased appetite, Gait disturbance, Hypotension, Respiratory tract congestion, SARS-CoV-2 test positive, Seizure
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (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: Acetaminophen, allopurinol, amoxicillion, atorvastatin, cholecalciferol, famotidine, fluticasone propionate, flucosam sul Na/chondr, losartan, meclizine, metoprolol sussinate, prednisone, rivaroxaban, senna-docusate, tamoxifen, torsemide
Current Illness:
Preexisting Conditions:
Allergies: Steri-strip [Adhesive Tape], Diflucan [Fluconazole], Flagyl [Metronidazole], Hydrochlorothiazide, Citalopram, Doxycycline, Nitrofurantoin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted as inpatient on 8/29 due to COVID-19. Patient was tested for COVID-19 and was positive on 8/29. Since Friday (8/27)patient states she has been having low blood pressures while at home. With this she has been having a cough seizing feeling congested having a decreased appetite. She states that she has been stumbling a little bit as well.


VAERS ID: 1666313 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-12
Onset:2021-08-29
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Oxygen saturation decreased
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D2 50,000 intl units (1.25 mg) oral capsule 50,000 Milk of Magnesia 30 mL PO at bedtime PRN as needed for constipation Bisac-Evac 10 mg PO q6h PRN as needed for constipation melatonin 3 mg oral tablet 3 mg PO at bedtime PRN
Current Illness:
Preexisting Conditions: Alzheimer''s
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/29/21: Patient arrived at the ER from facility with decreased O2 saturations. Patient currently on 70 L O2 of heated high flow, patient transferred to inpatient hospice. Please note: Patient received first dose Pfizer vaccine on 12/22/2020 Lot # EL0140 and the second dose on 1/12/2021 Lot # EL1284


VAERS ID: 1666347 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-27
Onset:2021-08-29
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Diarrhoea, Oropharyngeal pain, Pyrexia, Tachycardia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None - She recently discontinued the use of Tofacitinib prior to vaccination
Current Illness: None
Preexisting Conditions: Psoriasis, Sjogren''s syndrome
Allergies: None
Diagnostic Lab Data: Dates of tests: 9/2/2021 - elevated troponin 0.20. Pending echocardiogram.
CDC Split Type:

Write-up: This patient presented to the emergency department 2 days in a row for chest pain fever. Shira of tachycardic with chest pain. She also complained of sore throat and diarrhea. She was admitted to the hospital with Cardiology for further evaluation and treatment of possible myocarditis given her elevated troponin and chest pain in the setting of recent vaccination.


VAERS ID: 1666702 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-08-15
Onset:2021-08-29
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute myocardial infarction, Angioplasty, Catheterisation cardiac, Chest X-ray normal, Chest pain, Electrocardiogram normal, Pain, Pain in extremity, Troponin increased
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D, folic acid, vitamin B6, levothyroxine, potassium chloride
Current Illness: None
Preexisting Conditions: History of left breast cancer (2017 , triple negative, s/p lumpectomy and chemo)
Allergies: Codeine
Diagnostic Lab Data: Elevated troponin of 63, repeat 1120. Question of possible mild anterior ST-elevation on initial EKG, repeat showed no ST elevation. Chest x-ray normal.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 07/23/2021 and 2nd dose on 08/15/2021 at Pharmacy . Patient presented to Hospital ER early on 08/29/2021 at 1:52 a.m. with complaints of chest pain for an hour and half, left chest radiating down the left arm, was talking on the phone when chest pain started. Was evaluated in the ER, initial troponin 63, repeat 1120. Transfer to Hospital and underwent cardiac catheterization, had angioplasty to the diagonal artery with no stent placement. Patient was started on Plavix, aspirin, Lipitor 80 mg, metoprolol succinate and discharged home. Ultimately diagnosed with NSTEMI.


VAERS ID: 1662584 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-28
Onset:2021-08-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Started 2nd day post vaccination. I had high fever, chills, tiredness and pain muscle and joint. I got better but even today I still have the same symptoms, although mild and with some headache.


VAERS ID: 1641355 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-08-28
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Anxiety, Blood test, Chills, Differential white blood cell count normal, Dizziness, Ear discomfort, Ear infection, Facial pain, Fatigue, Feeling abnormal, Full blood count normal, Heart rate irregular, Helicobacter test, Inflammation, Lymph node pain, Metabolic function test normal, Muscle spasms, Muscle tightness, Muscular weakness, Musculoskeletal stiffness, Pain, Pain in jaw, Palpitations, Panic attack, Parosmia, Sensation of blood flow, Taste disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Osteonecrosis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo Estrine Xyxal
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: Monday I was tested for H Pylori, Metabolic Panel, and CBC with differential. Everything came back fine. I have to go do bloodwork today for vitamins.
CDC Split Type:

Write-up: I started having random shooting pains the day after my shot. I felt really fatigued and had random chills through my body. It was not until a week after my vaccine that I really started feeling weird. My anxiety really set it and I had several panic attacks. My ears have felt clogged and are continuously having to be popped, jaw pain, hurting lymph nodes in the necks, tight neck and shoulders, random muscle spasms throughout my body, blood rushing to head when standing, dizziness, random strong heartbeats, and heart palpitations, stomach problems, muscle weakness, for a day I had what felt like sciatica in my face, and though I can smell and taste, somethings smell different and taste different. I went to the doctor yesterday and they gave me a z pack and steroids for and ear infections. The doctor said it sounds like I have a lot of inflammation in my body right now. I have a neurology appointment next month. I also started on Prilosec.


VAERS ID: 1641824 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-25
Onset:2021-08-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysstasia, Gait disturbance, Headache, Musculoskeletal stiffness, Vertigo
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (narrow), Arthritis (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: Metoprolol, furosemide, pantoprazole, Tramadol, Topamax, Singulair, ibuprofen, diphenhydramine, fish oil, budesonide, Symbi-Cort, Spiriva Respi-mat,
Current Illness: Chronic kidney disease, non-Hodgkin''s lymphoma, lumbar radiculopathy, benign hypertension, atrial fibrillation, SVTs, osteopenia.
Preexisting Conditions: Same as Item 11.
Allergies: Tetracycline, amoxicillin, benzalkonium chloride, chlorhexidine gluconate, Xopenex HFA.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Severe vertigo - unable to stand or walk. Occurred about 2am on 8/26/2021 when getting up to go to bathroom. Room spinning. Crawled back to bed and lay down. By 8am of 8/26/2021 ertigo was gone. Was left with very bad headache and stiff neck the remainder of the day, even though I alternated taking tylenol and ibuprofen all day. When I woke 7am 8/27/2021, headache was very mild. No more vertigo since original incident.


VAERS ID: 1642875 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-27
Onset:2021-08-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspepsia, Exposure during pregnancy, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Zoloft (5mg) Prenatals Omega fish oil Vitamin C
Current Illness: None
Preexisting Conditions: PCOS
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 21 weeks pregnant via IVF. Estimated date of delivery = dec 28th. Around 11:45pm, developed fever and severe chills with bad indigestion. Proceeded to vomit multiple times.


VAERS ID: 1645941 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-25
Onset:2021-08-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Period started 7 days early, after second vaccine. My period is extremely regular. I had my first covid vaccine 12 weeks ago and it started early then too and then went back to being regular.


VAERS ID: 1651217 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-01
Onset:2021-08-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Red area on arm at injection site with distinct borders, hot to the touch. Approx 5 inches by 4 inches at time of report. Area is painful and itchy.


VAERS ID: 1651224 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 50 mg zinc daily
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient was kind of nervous before receiving the vaccine. He felt lightheaded while waiting his 15 minutes after receiving the vaccine. He began to feel nauseous and then vomited once. Blood pressure was 106/61, heart rate was 87, O2 was 99. Patient was cooled with an ice pack and give water to sip. After 30 minutes he began to cool down and the nausea went away. He was also given 1 25 mg tablet of diphenhydramine.


VAERS ID: 1651233 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-20
Onset:2021-08-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 53E21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site pruritus, Injection site reaction, Injection site swelling, Injection site warmth, Rash erythematous
SMQs:, Anaphylactic reaction (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: Vitamin D, Lipitor, Fenofibrate
Current Illness: None
Preexisting Conditions: High cholesterol
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red rash on my upper right arm near where shot was administered. Swollen as well. Feels hot, slightly itchy, and sore. Rash measures about one inch by one inch.


VAERS ID: 1651246 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: Patient fainted, was out for about 10-15 seconds. When she came to she knew where she was as well as the day. She appeared sweating and pale at first, a few minutes later after have some water and gatorade her appearance was back to normal


VAERS ID: 1651259 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-01
Onset:2021-08-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Severe tinnitus in right ear. I have no history of this. It occurred three days after my second Pfizer shot.


VAERS ID: 1651260 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-08-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Chills, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Busiperone 10mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, muscle aches, bone pain, headache


VAERS ID: 1651271 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-13
Onset:2021-08-28
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Condition aggravated, Dizziness, Fatigue, Hypoaesthesia, Injection site pain, Injection site swelling, Pain, Pain in extremity, Spider vein
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: Vitamin D, Vitamin C, Vitamin B12, Zinc
Current Illness: None
Preexisting Conditions: Underactive thyroid
Allergies: None
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Dizziness 15 minutes post vaccination, soreness & swelling at site for 2 hours, severe exhaustion after 3 hours, achiness all over body after 4 hours, chills after 8 hours, leg & back pain between shoulder blades as well as ankles and right wrist for 48 hours with continued exhaustion. Intermittent hand numbness for 72 hours. 15 days post vaccine new spider veins in legs as well as worsening pre existing spider veins with moderate leg pain.


VAERS ID: 1651282 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-08-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site warmth, Myalgia, Pain, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Arm soreness and general feeling of unwell after first Moderna dose
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm and heat radiating from injection site only a few hours after vaccination. Full body muscle aches and pains as well as uncontrollable shivering during the night. Fever in the morning and continued pain the next day.


VAERS ID: 1651294 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-27
Onset:2021-08-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Influenza like illness, Myalgia, Oropharyngeal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 30mg XR, belsomra 20mg, lamotragine 25mg daily
Current Illness: None
Preexisting Conditions: Depression, adhd, insomnia
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu like symptoms, myalgia, arthralgia, fatigue, sore throught


VAERS ID: 1651306 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Hyperhidrosis, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: not sure which vaccines, but parents reported has happened in the past
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: blood glucose and pulse oximetry
CDC Split Type:

Write-up: customer became pale, unable to respond to external stimuli, diaphoretic while sitting in waiting area directly after being given vaccine


VAERS ID: 1651307 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-27
Onset:2021-08-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra for allergies
Current Illness: Mild swelling at the injection site and arm pain
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pfizer-bioNTech Covid-19 Vaccine EUA


VAERS ID: 1651309 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 3 LA / IM

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

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

Write-up: vaccine was administered 20 hours after the vial was initially punctured. it should be administered within 12 hours.


VAERS ID: 1651310 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: none
CDC Split Type:

Write-up: patient had felt sweaty and nauseated and light headed. patient called ambulance not transported to er


VAERS ID: 1651311 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC2588 / 1 RA / IM

Administered by: Other       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: NO
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: BP: 100/66 Resp.: 16 Pulse: 112 O2 Sat: 95%
CDC Split Type:

Write-up: Patient felt nauseous and vomited a little only once. She felt fine after evaluation. BP: 100/66 Resp.: 16 Pulse: 112 O2 Sat: 95%


VAERS ID: 1651316 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: Not known
Diagnostic Lab Data: None or aware
CDC Split Type:

Write-up: After the shot patient was doing okay as soon as they got out of immunization area family member notices that patient was pale and getting dizzy. We had the patient sit down again. Gave him water and ensure to drink. Patient mention that he did not eat breakfast and had hard day of work previously. Family member gave food also and waited about 25 minutes before going home.


VAERS ID: 1651318 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: KNM
Current Illness: Parents stated she had had some fainting spells at school. Did not document this on Vaccine Admin. Form or notify pharmacy of this condition prior to vaccine administration.
Preexisting Conditions:
Allergies: KNDA
Diagnostic Lab Data: EMTs came and checked vitals. Parents denied to go to hospital with them.
CDC Split Type:

Write-up: Patient received vaccine at 11:15 ten minutes later she passed out in a sweat, hot, dizzy, nauseous.


VAERS ID: 1651323 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Her and her father were shopping in front of the pharmacy and she fainted about 5 minutes after administration. She regained consciousness in about 30 seconds, slowly. EMS came to scene, assessed her, and she refused further treatment.


VAERS ID: 1651326 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-08-06
Onset:2021-08-28
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FR0809 / 1 LA / IM

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

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

Write-up: Paramedic reports patient feeling dizzy and sweaty. VS are manually taken with values BP 97/70, P-62 and o2-99. Patient lies down and legs are raised. Doctor R. is notified. He''s left in observation. Patient responds to treatment, VS are retaken BP 112/80, P-75, o2-99. Patient leaves the clinic with his wife oriented X3.


VAERS ID: 1651328 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Crying, Dizziness, Feeling abnormal, Feeling hot, Heart rate increased, Hyperhidrosis, Hypoacusis, Malaise, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient started to feel light headed and hot 3-5min after vaccination. She was in transition from consult room to waiting room for 15m waiting period. Patient was observed starting to look pale so was asked to be seated. Upon sitting she stated she was very anxious from the vaccine and starting to feel ''sick''. Patient was upset and crying also stated her hearing seemed muted-she continued to say she was over heated and was visibly sweating. I attempted to get cool cloths for her-while mom stood in front of her chair in case she lost consciousness. Within the next 5min period patient vomited 1-2 x and had increased pulse rate. She was given cool cloths and ice pack and water over the next 15minutes. Her pulse began to normalize and she stopped crying and sweating. Her color returned to normal and she stated she was feeling better after getting sick and did not feel light headed any longer. We had her wait for another 15minutes until she stated she was feeling more normal, she had no signs of reaction on her arm or other symptoms. She did state that she had not ate or drank anything prior to the vaccine and had a big fear of needles. Patient went home with both parents, will follow up later today to ensure no issues.


VAERS ID: 1651337 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Magnesium. Allergic reactions to vaccines in the past.
Diagnostic Lab Data: Allergic reactions to vaccines in the past
CDC Split Type:

Write-up: Vaccine was administered and within 2 minutes the patient was having a anaphylactic reaction. Unable to breath and red on the trunk. Epipen was administered at 1:15 and 911 was called.


VAERS ID: 1651340 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0369 / 3 LA / IM

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

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

Write-up: Patient was given an expired vaccine which expired at 2:45pm--there was no date just a time left in the basket they were stored in. Patient was still in the store when we discovered the dose was expired and we asked him to remain in the store while we called Pfizer to determine how to proceed. Per Pfizer, there medical department was not open to advise on what procedure to follow until the following Monday 8-30-2021 8am-8pm Eastern. Patient was notified we would contact him Monday after contacting Pfizer''s medical team.


VAERS ID: 1651342 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-08-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Facial pain, Pain, Sleep disorder, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (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: No
Current Illness: Had covid around 7/28-8-6
Preexisting Conditions: Asthma
Allergies: Not that I know of
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Today on 8/28 I woke up to a swollen face on my right side. It hurt to touch and to even blink or squint. I had to call into work due to the circumstances. I couldn?t sleep very well because even the ear in that side of the face felt swollen as well. I put a cold compress on it twice then went to sleep and woke up to the swelling going down. Then I took Tylenol to help with the pain which hasn?t fully worked. My face is still swollen.


VAERS ID: 1651345 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: Severe lower back pain for over 24 hours


VAERS ID: 1651346 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium


VAERS ID: 1651353 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-31
Onset:2021-08-28
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN RS-AD26 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Demyelination, Facial paralysis, Hypoaesthesia, Myelitis transverse, Neurological symptom, Specialist consultation
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Hearing impairment (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Prostate cancer S/P prostatectomy, Hypertension, Hyperlipidemia, GERD, Osteoarthritis,
Allergies: NKDA
Diagnostic Lab Data: MRI ordered 8/25/21, Consult to neurology includes impression of transverse myelitis with etiology yet to be determined.
CDC Split Type:

Write-up: Patient now admitted to Hospital. At direction of the Provider currently taking care of patient I am entering this report. Per providers note and conversation - patient is experiencing facial droop, numbness and migrating neurologic symptoms severe enough to present to emergency room and then be admitted to Hospital floor for further monitor and testing. Demyelinating disease with possible transverse myelitis is suspected.


VAERS ID: 1651354 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 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: 1651356 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0127 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Heart rate increased, Hyperhidrosis, Hypertension, Syncope, Tachycardia, Tongue biting, Tongue haemorrhage, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypertension-Medium, Systemic: Tachycardia-Medium, Additional Details: Patient fainted after receiving 1st Pfizer COVID 19 vaccine. Paramedics were called and patient came to fairly quickly. He did bite his tongue and had some bleeding. Heart rate and pulse were elevated.


VAERS ID: 1651357 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-22
Onset:2021-08-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Celexa 20mg, bupropion 150mg sr,
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillan
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately one week after receiving my first shot I woke up with vertigo. I have never had a bought of vertigo in my life. The dizziness and spinning room sensation has been happening for about 8 hours now.


VAERS ID: 1651359 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Malaise, Nervousness, Palpitations, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), 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: Anti-Anxiety meds, no other information
Current Illness: Hx of Anxiety
Preexisting Conditions: Unknown
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became anxious after receiving the dose. He stated he has a hx of anxiety and takes medication. He said he had taken his medication this am but had not eaten. He then complained of racing heart, arm tingling, heart palpitations. and became shaky. BP 180/90 and HR= 90. Patient was given water and a protein bar. He still complained of not feeling well and at that time EMS was alerted. They arrived within 15min. and took over this patient.


VAERS ID: 1651362 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 5 minutes post administration, patient came back and reported throwing up one time and feeling short of breath. He did not report any itching or show any signs of generalized allergic reaction. I had him sit down and focus on slow, deep breathing. I had him put a cold, wet cloth on his head and gave him some water. I observed him for about 10 minutes. I asked if he felt any itching or tingling or had trouble breathing. He denied any of these symptoms. He said he was feeling better and left the store.


VAERS ID: 1651364 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cognitive disorder, Dizziness, Ear discomfort, Exercise tolerance decreased, Fatigue, Headache, Heart rate increased, Muscular weakness, Nausea, Orthostatic intolerance, Tinnitus, Tremor, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Hypoglycaemia (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:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Debilitating fatigue, muscle weakness, muscle shaking, pressure and ringing in ears, vertigo, dizziness, nausea, increased heart rate, increased orthostatic intolerance, exercise intolerance, headache, cognitive impairment


VAERS ID: 1651366 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head discomfort, Nausea
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: NAUSEA, HEAVINESS IN TONGUE. GIVEN MECLIZINE FELT BETTER AFTER.


VAERS ID: 1651372 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)

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

Write-up: itching throat immediately after vaccination


VAERS ID: 1651373 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: he had a seizure 5 minutes after shot and frozed up in chair. Called EMS and ambulance came and vitals good but when he got up from lying down, he had another seizure so he went to the hospital.


VAERS ID: 1651381 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Hypoglycaemia
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 50mg caps
Current Illness: ADHD
Preexisting Conditions: ADHD
Allergies: none known
Diagnostic Lab Data: BP - normal, around 120/90 Pulse ox - normal 98%
CDC Split Type:

Write-up: 10 minutes after pt got the Pfizer COVID-19 vaccine she reported feeling light headed and dizzy. Pt was offered some soda to treat suspected hypoglycemia. After drinking some pt stated they felt chest tightness and SOB. EMS was called. About 5 minutes after calling EMS pt said she felt better (no SOB and no chest tightness). When EMS arrived pts BP and O2 sat where within normal limits. Pt denied additional care from EMS. Pt declined EMS offer to transport to hospital. Pt exited the pharmacy about 5 minutes after EMS left.


VAERS ID: 1651382 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / SYR

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

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

Write-up: Approximately 5 mins following the administration of the patient''s second Pfizer COVID 19 vaccination, the patient, momentarily lost consciousness in the waiting area chair. Patient''s eyes widened and rolled into his head and he started to sweat profusely. Seconds later, patient regained consciousness and alertness and straightened up in his seat. He was provided water and Kleenex in order to mop his sweat. After approximately 20-25 mins he was able to leave the pharmacy under his own power with his female companion.


VAERS ID: 1651385 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: Patient experienced hives/rash breaking out on face, chest, and stomach. Also experienced a scratchy throat and scratchy eyes. All this began approximately 30 minutes after receiving the vaccine shot.


VAERS ID: 1651386 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: Pt got the Pfizer vaccine and passed out at the consultation window. I saw she was not feeling well with her head rested on the glass divider. When out to her and she was out for 5 secs. She woke up shaking and was very dizzy. She felt mostly better within 10 mins after the event.


VAERS ID: 1651392 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: He had a slight seizure and frozed up on the chair 5 minutes after administering his Moderna vaccine. Called ambulance and his vitals checked out fine and he did not have to go to the hospital . After about 15-20 min. he left on his own.


VAERS ID: 1651397 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: PT FELT DIZZY 5 MINUTES AFTER RECEIVNG HIS FIRST PFIZER COVID SHOT , HE WAS SWEATING AND GET SEATED AND WE OFFERED HIM WATER AND JUICE SINCE HE SAIS HE ONLY HAS COFFEE IN THE MORNING THEN WE CALLED 911 WHO INSTRUCTED US TO HOLD ANY FLUIDS UNTIL THE PYRAMEDICS ARRIVED . PT STAYED COHERENT BUT KEPT HIS EYES CLOSED AND HE WAS TALKING TO 2 TEAM MEMBERS IN SPANISH AND THE PHARMACIST ON DUTY.


VAERS ID: 1651398 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fainting


VAERS ID: 1651408 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Patient became clamy and lightheaded and sweaty. Eye had significant dilation and he said he couldn''t see well. We determined he just passed out due to anxiety about getting a shot. 911 was called and an ambulance crew allowed him to leave and go home with his mother after the symptoms resolved.


VAERS ID: 1651414 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-08-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Migraine, Pain
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: Fainting age 16, gardasil
Other Medications: Vyvanse, naltrexone, vitamin d and b12
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Migraine, body aches


VAERS ID: 1651420 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

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

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

Write-up: pt got the pfizer vaccine at age 11. no adverse events or treatment known.


VAERS ID: 1651422 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 AR / IM

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

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

Write-up: Pt states states they had itching after and are on blood thinners, anxious before shot. Vaccinated patient with J&J. In observation area they began to feel unwell, we supported them and lowered them to ground with pillow supporting head and knees up for comfort. They regained consciousness. Medical personnel applied a cold pack, washcloth, and cooling fan. O2 sat 99 and pulse approx 100 by pulse ox. Pt family brought to their side to comfort them. Pt began feeling better. Pt sat upright. Color improving. Pt now sitting and talking. O2 100 and pulse 86 by pulse ox. Pt feeling much better now seated back in chair within observation area accompanied by family at 1240. Seemed to recover fully, patient accompanied by family when leaving.


VAERS ID: 1651428 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tdap: flu like sx
Other Medications: wellbutrin
Current Illness:
Preexisting Conditions: PCOS
Allergies: penicillin, pea protein, Diflucan
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the Janssen COVID vaccine (lot 205A21A, exp 9/21/2021) at approximately 1210. At 1219, patient reported to PHN and Paramedic that she felt lightheaded and sweaty. Patient transferred unassisted to zero-gravity chair, placed supine, and given juice. Vital signs: respirations 18l, blood pressure 150/96, pulse 88. Patient reported feeling anxious about vaccination. Patient reported allergies to penicillin, pea protein, and Diflucan. Patient takes Wellbutrin. Medical condition includes polycystic ovarian syndrome. Patient reported eating prior to vaccination. PHN encouraged patient to follow up with provider, when to call 911, and to stay for monitoring for 30min after report of symptoms. PHN offered patient Benadryl, patient declined. At 1223, patient reported no prior similar reaction. At 1230, vital signs: blood pressure 154/98, pulse 84, respirations 16. Patient reported symptoms had resolved and she wanted to leave against medical advice. PHN and Paramedic assisted patient to seated position at 1231, and monitored as patient stood without assistance at 1232. Patient continued to report symptoms had resolved. At 1232, patient left walking with steady gait.


VAERS ID: 1651433 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Malaise, Pallor, Visual impairment, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: VS 99/63, 82, 20, O2 stat-100% on RA, Pt c/o of "not feeling well, can''t really see (vision change), abdominal cramping (Abd BS presentx4 quadrants), pale, vomitx1. Pt only had cookies for breakfast, gave 1 slice of orange, EMS activated and arrived within 10 minutes, reported to EMS and transferred care. Pt''s mom by side, pt transferred to hospital.


VAERS ID: 1651435 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: Pt. Reported swimmers ear, sweating, and felt faint approximate three minutes in observation. Vitals were taken. Bp 112/74, temp 97.6. Pt was cleared.


VAERS ID: 1651439 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Pt came in and stated that she wanted to get her 1st dose of COVID vaccine and wanted to get Moderna. After administration the pt let the pharmacist know that she had actually previously gotten both doses of Pfizer but had recently gotten a stem cell transplant and her doctor told her to redo all vaccinations and specifically to get Moderna.


VAERS ID: 1651440 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: FOOD, ANIMAL FECES, ETC
Diagnostic Lab Data:
CDC Split Type:

Write-up: 15 MINUTES AFTER VACCINE, PATIENT''S MOM REPORTED BUMPS APPEARED ON PATIENTS ARM. PATIENT WAITED 15 MORE MINUTES AND THERE WAS NO CHANGE. WHEN ASKED, PATIENT STATED THERE WAS NO DIZZINESS, NO NAUSEA, NO SHORTNESS OF BREATH, NO PAIN, NO ITCHING, NO OTHER SIDE EFFECTS. PATIENT WAS REFFERED TO FOLLOW UP WITH PEDIATRICIAN.


VAERS ID: 1651442 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Dizziness, Dysstasia, Feeling hot, Pain, Paraesthesia, Renal pain, Visual impairment
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Other ischaemic heart disease (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: 10 minutes after the patient received the vaccine he experienced severe sharp shooting pain in both of his kidneys as well as his heart and both sides of his body. He also became very dizzy, he could not stand, he was hot, he was experiencing black out spots in his vision and he stated his whole body was tingling. 911 was called and he was taken to the Hospital


VAERS ID: 1651443 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient said he started sweating about 2 minutes after dose


VAERS ID: 1651446 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Patient experienced itching, sensation of the throat. Benadryl 0.5 was administered. Patient felt better. Vitals temp 97.3, BP 120/82, O2 99%, Pulse 80. Patient was cleared.


VAERS ID: 1651453 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-17
Onset:2021-08-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazodone, Lexapro, Bupropion ER/SR, Levothyroxine, Estradiol, D3 50,000
Current Illness: Unknown
Preexisting Conditions: Thyroid, depression
Allergies: NKA
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: day of vaccine painful at site of injection, 10 days post vaccine itching, area is red, feels hot and burning sensation with red streak about 2.5-3 inches in length form vaccine site towards elbow


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