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

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



Case Details (Reverse Sorted by Onset Date)

This is page 403 out of 8,010

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VAERS ID: 1628303 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Retching, 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: Tylenol
Current Illness: None
Preexisting Conditions: Hashimoto?s thyroiditis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting, dry heaving


VAERS ID: 1628313 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: BP 122/88 SP 98% 85P
CDC Split Type:

Write-up: Patient complained about having a fast heart rate. He asked if someone could check it as he had concerns. Patient was checked..


VAERS ID: 1628317 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Product preparation issue, 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: None per patient
Current Illness: None per patient
Preexisting Conditions: None per patient
Allergies: None per patient
Diagnostic Lab Data:
CDC Split Type:

Write-up: Due to reconstitution error patient was given less than half of required dosage. Patient was notified and returned to clinic to receive the appropriate dose the same day.


VAERS ID: 1628323 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety
SMQs:, 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: AFTER 10 OF OBSERVATION, THE PATIENT COMPLAINED OF ANXIETY FROM THE VACCINE. PATIENT STATED HE HADN''T EATEN, AND USUALLY DOESN''T EAT UNTIL 12:00. VITALS WERE GOOD WHEN CHECKED B/P 120/68, PULSE 60, AND HE WAS CLEARED.


VAERS ID: 1628330 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-22
Onset:2021-08-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

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

Write-up: 2 days after taking the vaccine, he felt chest pain. He can''t lie down as he will feel the pain, but sitting in the chair is ok.


VAERS ID: 1628331 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Patient fainted approximately 1 minute after receiving vaccination. Patient reported a history of fainting in response to "needles" prior to vaccination. Patient reported feeling warm just after vaccination and moved to lie on the floor under her own power until she was assisted by reporter and partner who accompanied her. She lost consciousness for <30 seconds. Patient continued to breath and pulse was present. Patient was observed after regaining consciousness for 30 minutes. Patient reported resolution of symptoms and felt "normal" at departure from pharmacy.


VAERS ID: 1628332 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 LA / IM

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

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

Write-up: Due to reconstitution error patient was given less than half of required dosage. Awaiting further guidance from regarding third dose for an immunocompromised patient.


VAERS ID: 1628333 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Dysgeusia, Dyspnoea, Headache, Immediate post-injection reaction, Pharyngeal swelling, Tachycardia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: pacemaker since 2010
Allergies: self-reported: aspirin, atenolol, demerol, dilaudid, laritrex, toradol, mobic, morphine, oxycodone, pennicillin, phenergan, primaquine, quine, contrast dye
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: At 1112, the first dose of Pfizer vaccine was administered. Patient stated that they could taste the vaccine immediately after it was administered. Within 10 minutes, they reported a headache, dizziness, lightheadedness and throat tightness. The sense of swelling in their throat worsened and she became tachycardic. At 1135, Epi was administered. This helped initially, and then the throat tightness worsened and she started having difficulty breathing. EMS was called and took her for transport to the hospital at 1200.


VAERS ID: 1628339 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Conjunctival haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Conjunctival disorders (narrow)

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

Write-up: EYE SUB CONJUCTEVAL HEMORRHAGE


VAERS ID: 1628345 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pharyngeal swelling, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt entered the clinic at approx.12:15 inquiring about the initial dose of the Pfizer per her primary care providers instruction. Pt reported a Hx of "her throat closing" s/p flu vaccination administration. No epi-pen administered at the time for that reaction. Pt was educated about the COVID-19 vaccine and received the first dose at 12:29 PM. Pt was instructed to wait in observation for 30 minutes. Shortly after COVID-19 vaccine administration pt stated that she "feels like her throat was getting scratchy", then proceeded to state "my throat is swelling"; "who even knows what is in these vaccines?". This RN did not observe any signs of angioedema upon examination. Pt was brought to ED for further evaluation per Nurse Manager. During transportation to the ED, Pt asked both RNs present "does this mean that I do not need a second dose of the vaccine? Who would authorize this?" Pt appeared stable during hand-off to ED triage RN.


VAERS ID: 1628353 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
SMQs:, Medication errors (narrow)

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

Write-up: No adverse effects reported at this time. Patient received Pfizer COVID-19 vaccine with insufficient diluent, leading to multiple doses administered. Patient informed of error and advised to monitor for side effects per CDC guidance, and contact clinic if questions or concerns.


VAERS ID: 1628372 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Fall, Head injury, Limb injury, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not Available
Current Illness: Not Available
Preexisting Conditions: Not Available
Allergies: Not Available
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was holding hand of his spouse after getting his shot and he pass out while holding his spouse''s hand and fall on display and then on the floor. He came back to sense in about 30 seconds. He scratched his hands and bumped his head on the floor. His scratch was cleaned with antiseptic wipes and applied antibiotic ointment. He had redness on his head from collapse but his refluxes were completely normal. They both went to shopping after 15 minutes of monitoring.


VAERS ID: 1628392 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-02-16
Onset:2021-08-24
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, 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: sleep apnea, ulcerative colitis, hx of smoking, asthma, arthritis, DM 2, congestive heart failure, GERD, hypertension
Allergies: albuterol, furosemide, ibp, metoprolol, montelukast, pantopraz
Diagnostic Lab Data:
CDC Split Type:

Write-up: 01/21/2021- FIRST DOSE OF MODERNA 02/16/2021- 2ND DOSE OF MODERNA 08/19/2021- SYMPTOM ONSET. SHE WAS EXPOSED TO RELATIVE WHO TESTED POSITIVE. 08/24/2021- PATIENT TESTED POSITIVE FOR COVID WITH RAPID PCR TEST.


VAERS ID: 1628401 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-08-24
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 RA / IM

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

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

Write-up: hospitalization.


VAERS ID: 1628415 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-01-20
Onset:2021-08-24
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient is not here to provide this information
Current Illness: The person is not here to provide this information
Preexisting Conditions: The person is not here to provide this information.
Allergies: Patient is not here to provide this information
Diagnostic Lab Data:
CDC Split Type:

Write-up: This person has been fully vaccinated and had a break-through positive case with symptoms. She has congestion and headache. She has had symptoms for one week and tested negative on 08/16/21 and 08/18/2021. She tested positive on 08/23/2021


VAERS ID: 1628424 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3281 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Injection site erythema
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Redness at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Medium


VAERS ID: 1628427 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen lymph nodes.


VAERS ID: 1628429 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / IM

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

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

Write-up: 9 minutes after receiving Janseen vaccine pt reported feeling lightheaded. He was asked to lay down on exam table for 10 minutes and this feeling resolved.


VAERS ID: 1628430 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Condition aggravated
SMQs:, 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: yes
Current Illness:
Preexisting Conditions: Panic, Anxiety, Seizures, High Blood pressure
Allergies: yes
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anxiety


VAERS ID: 1628435 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Wrong 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: prozac, baby aspirin, multivitamin, tylenol
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received pfizer as her 1st covid-19 vaccine dose. She was given moderna in our clinic as her 2nd dose.


VAERS ID: 1628436 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Muscle tightness, Palatal swelling, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dystonia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Pneumoccal vaccine, 2 years ago per pt where she developed same symptoms while in the clinic and received "benadryl and steroids
Other Medications: unknown
Current Illness: none
Preexisting Conditions: Fibromyalgia Asthma upper airway resistance syndrome
Allergies: artificial sweetener, cipro, clavulanic acid, doxycycline, iodine, keflex, notriptyline Hcl, pneumococcal 23-val p-sac vaccine, shellfish derived products, spironolactone, sulfa (sulfonomide antibiotics), sulfasalazine, sulfa (not sulfonomides)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 minutes post vaccination, pt reported the roof of her mouth swelling and then swelling to her throat and tightness to her face and neck. Benadryl 50mg IM given to R arm.


VAERS ID: 1628440 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: Patient came into the pharmacy for the Johnson and Johnson covid-19 vaccine. Patient filled out the registration and consent form. This form has a question asking if the patient has received any of the covid-19 vaccines to date. The patient checked "no." After the clinic the vaccinator (RN) went to document vaccination in system and noticed that the patient has a documented vaccination of Moderna from the health department 4 days prior to receiving the Johnson and Johnson vaccine. Pharmacy unable to reach patient at provided phone number.


VAERS ID: 1628447 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 3 RA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1628448 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Heart palpitations within 12 hours of vaccine


VAERS ID: 1628454 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8488 / 3 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1628461 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bradycardia, Fall, Injection site bruising, Injury, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Site: Bruising at Injection Site-Mild, Systemic: Fainting / Unresponsive-Medium, Additional Details: BRADYCARDIA, RECOVERED IN 30-40 MINUTES. PATIENT FAINTED AND GOT INJURED BECAUSE OF THE FALL


VAERS ID: 1628462 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Headache, Injection site pain, Loss of consciousness, Nausea, Paranasal sinus discomfort
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (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: Tri-Lo-Marzia Xyxol
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness 5 minutes post shot, blacked out/ fainted 5 minutes post shot, injection pain, headache, sinus pressure, flushed skin, nasua


VAERS ID: 1628463 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris
SMQs:, Other ischaemic heart disease (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: Humira, daily vitamins, fluoxetine
Current Illness: Non-radiographic axial spyroandipital arthritis
Preexisting Conditions: Non-radiographic axial spyroandipital arthritis (taking Humira)
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up day after vaccine booster shot with pain around heart/chest


VAERS ID: 1628465 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-16
Onset:2021-08-24
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: redness and swelling at injection site


VAERS ID: 1628471 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Pallor, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient complained of dizziness was sweating, clammy, shaking, and pale. Vitals were taken; BP 70/43, O2 97%, respiration 12, temp 96.8. Cold compression was placed with LVN by his side. Patient ate breakfast bar and orange juice. EMS was called due to possible hypoglycemic event. Upon EMS arrival; RN reported patients condition. EMS assessed, vitals were back to normal, patient felt better. EMS cleared patient; no other treatment needed per EMS. RN advised patient to eat and stay hydrated, see PCP, go to ER if symptoms persist.


VAERS ID: 1628480 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Rash, Rash morbilliform
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: hydroxyzine, docusate, lisinopril, loperamide, Vit D, insulin, prednisone
Current Illness:
Preexisting Conditions: DM, hepatitis, renal cell carcinoma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: morbilliform rash to face and upper torso


VAERS ID: 1628505 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered
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: -ezetimibe 10mg QD -alendronate 70mg QW -pravastatin 10mg QD -tolteridine ER 2mg QD
Current Illness: none
Preexisting Conditions: none other than those being treated with medications indicated (elevated cholesterol namely)
Allergies: nkda
Diagnostic Lab Data: none
CDC Split Type:

Write-up: My intent was to give patient both a 2nd dose Pfizer covid vaccine and a shingrix vaccine, but inadvertently gave her 2 Pfizer covid vaccines (followed by the Shingrix vaccine)


VAERS ID: 1628515 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: losartan 25 mg tablet
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was mistakenly given Moderna Vaccine as her 2nd dose, Her 1st dose was Pfizer


VAERS ID: 1628534 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Limb discomfort
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: Unknown
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: BP and HR was normal
CDC Split Type:

Write-up: Arm felt heavy after injection and began sweating profusely and feeling lightheaded within 2 minutes of injection.


VAERS ID: 1628569 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unable to assess; this person came through our covid drive through for testing only. They are not an established patient.
Current Illness: Unable to assess
Preexisting Conditions: Unable to assess
Allergies: Unable to assess
Diagnostic Lab Data:
CDC Split Type:

Write-up: This person was not vaccinated at this clinic so we do not know the dates he received his two doses of vaccine. He came through our drive through testing clinic and is not an established patient so there is no history on him. He is fully vaccinated and tested positive today with c/o cough, congestion, runny nose and sore throat


VAERS ID: 1628595 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Malaise, Neck pain, Pain in extremity, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is suffering with sore arm, neck,coughing/sneezing and sick feeling. Recommended taking a tylenol 325mg if needed


VAERS ID: 1628608 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (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: Patient started feeling dizzy with blurred vision 4 minutes after vaccine. Vitals were taken; BP 142/72, Pulse 68, O2 99%, temp 97.2, respiration 16. Patient observed for 15 minutes. Patient stated he felt better and his vision improving. Advised to eat, drink, and get rest. Advised to see his PCP or go to ER if symptoms persist.


VAERS ID: 1628614 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hypertension, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Hypertension (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: Pfizer COVID-19 vaccine - Pt had a mild anaphylactic reaction about 40 minutes post administration
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Zpack, shellfish, Pfizer COVID-19 vaccine
Diagnostic Lab Data: Taken to ED and evaluated by ED staff.
CDC Split Type:

Write-up: Patient had adverse reaction several weekes ago to Pfizer vaccine. Per MD instructions, she was to get 2nd shot of J&J. Within 10 minutes patient reported mild lightheadedness. Given a bottle of water to drink and about 15 minutes post injection, patient reported blurry vision in her right eye. Discussed situation and Hx with other staff on site and it was decided the best course of action would be to take patient to ED for further evaluation. Patient was escorted by 2 RNs to the ED where SBAR was given to triage staff. at about 10:00am. Patient and her daughter returned about an hour later to thank us and let us know her symptoms had resolved and that her BP in the ED was "a little high".


VAERS ID: 1628627 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pulmonary meds for cystic fibrosis Hydrocortisone for secondary adrenal insuficiency Promethazine Oxycodone Sertraline Lorazepam
Current Illness: cystic fibrosis secondary adrenal insufficiency low blood sugar issues - uncontrolled
Preexisting Conditions: cystic fibrosis secondary adrenal insufficiency low blood sugar issues - uncontrolled
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: vomiting stomach pain nausea


VAERS ID: 1628634 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-22
Onset:2021-08-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypoaesthesia, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol patch, low dose aspirin, levothyroxine
Current Illness: Auto immune disease
Preexisting Conditions: Auto immune disease
Allergies: Opioid analgesics
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Rapid onset of symmetrical upper body tingling, numbness in extremities, neck and face and intense tremors in hands. Symptoms appear to have predominately resolved within approximately 45 minutes with some residual weakness and mild paresthesias ongoing at time of this report.


VAERS ID: 1628641 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-22
Onset:2021-08-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK LA / 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Progesterone 10mg one tablet daily x10 days
Current Illness: Endometriosis, surgery on 7/27, miscarriage May 2021
Preexisting Conditions: Endometriosis
Allergies: Allergy to flagyl
Diagnostic Lab Data: Er visit
CDC Split Type:

Write-up: Chest pain


VAERS ID: 1628648 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Immediate post-injection reaction, Nausea, Pallor, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: had similar reaction after first dose of pfizer covid vaccine
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient experienced nausea, sweating, paleness immediately after injection. shortly afterward he had tingling in arms and legs. blood pressure 108/73 pulse 56, after about 5 minutes blood pressure 123/74 pulse 72, given ice pack on back of neck, apple juice, monitored for 30 plus minutes, released to parent after symptoms resolved


VAERS ID: 1628654 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Provider listened to pt''s lungs and breathing, also checked pt''s throat .
CDC Split Type:

Write-up: After 13 minutes of recieving her first Moderna vaccine pt complained of throat tightness and issues swallowing, no issues breathing. Epipen 0.3 administered to pt, after 1 minute pt experienced relief. Pt monitored for additional 45 minutes. Medical Director of our practice Dr. examined pt and pt seemed to be fine. Pt monitored for additional time then felt well enough to leave.


VAERS ID: 1628686 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 RA / IM

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

Write-up: C/O scratchy throat similar to when she eats watermelon. BP 116/70 HR 74 O2 Sat 98% No signs of difficulty breathing, speaking, or swelling. Benadryl offered; patient declined. Patient approximately 40 minutes and stated she felt fine and left facility. Advised to consult allergist prior to receiving 2nd COVID vaccine.


VAERS ID: 1628698 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: Dizziness, lightheaded starting approximately 5 minutes after shot


VAERS ID: 1628706 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: No symptoms, no signs noted of adverse event. Patient waited 30 mins before leaving


VAERS ID: 1628709 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-04
Onset:2021-08-24
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram, Heart rate increased, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: EKG 8/23/2021
CDC Split Type:

Write-up: rapid heart beat of 110 BPM for about 30 minutes on 8/5/2021 rapid heart beat of 110 BPM for about 30 minutes on 8/6/2021 continued rapid heart beat and high blood pressure


VAERS ID: 1628715 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Dyspnoea, Nausea, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Administered Pfizer vaccine, about 7 minutes post vaccination, patient presented with feeling faint and clammy; approximately 2 minutes later patient began wheezing and feeling short of breath. RXT called 911, I administered 1 Epipen in right thigh (through patient''s clothing). She began feeling as though she needed to use the restroom and/or vomit (she didn''t vomit, but I accompanied her to the bathroom). Wheezing resolved after a few minutes, patient left with EMS via ambulance to be checked out at hospital. She was awake and alert and was able to answer all questions EMS asked her


VAERS ID: 1628720 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure decreased, Hyperhidrosis, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), 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), 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became non responsive, sweaty, glance look and decreased bp. did not faint. took approximately 2 minutes and last 4-5 minutes.


VAERS ID: 1628721 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Patient lost consciousness, nystagmus, and twitching of body. Head jerked back. Patient sneezed and returned to consciousness. Unconsciousness lasted <1min. EMS called, patient determined to be okay to go home instead of hospital. Recommended he follow up with his primary care provider. He remained seated for about 15min before leaving the premises.


VAERS ID: 1628724 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diplegia, Dysstasia, Gait inability, Hypoaesthesia, Laboratory test, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 35 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ammoninium lactate 12% lotion 225g - Celecoxib 200 Mg capsule - Emerita Pro-Gest progesterone cream 1 patch once per week - Esomeprazole Magnesium Dr 40 Mg - Estradiol 0.0375 MG DIS ALV patch - Gabapentin 300 MG capsule 3 capsules per day -
Current Illness: None
Preexisting Conditions: Diagnosed with Hashimoto''s Disease 07/2018 - Asthma since birth
Allergies: Tylenol with Codeine - Biaxin - Sulpha Drugs and cream - Statin Drugs - Lipitor/Provocol - Some shellfish - Tussionex Ext-el Sus cough syrup
Diagnostic Lab Data: A lot of test that began on Thursday, August 12 until present and beyond. I do not know the names or the tests or the dates. The hospital has a record of that.
CDC Split Type:

Write-up: On August 11, 2021, I noticed that my legs were becoming numb. By the next morning, I could not walk or stand up. I was paralyzed from my belly button to my tippy toes My legs and feet felt like pins and needles! I was in excruciating pain. I was rushed to Hospital where I am now presently in the Inpatient Rehabilitation Center.


VAERS ID: 1628727 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APPLE CIDER VINEGAR CAPSULES, CALTRATE, RAINBOW LIGHT WOMEN''S MULTI-VITAMIN, ASHAGAWANDA ROOT CAPSULES, ANCIENT NUTRITION WOMEN''S SBO+PROBIOTIC, MEMBER''S MARK ALLER-ZYR, YOUTHEORY: IMMUNE+ DAILY WELLNESS
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: PENICILLIN
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Period started within 24 hours of getting vaccine. Initially very heavy. My period was due for another 12 days.


VAERS ID: 1628730 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: ADMINISTRATION ERROR : Pt received 1st dose Phizer 08/03/2021, then received 2nd dose Moderna 08/24/2021. No noted symptoms/ No noted Primary visit.


VAERS ID: 1628748 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PASSED OUT, TURNED PALE
Other Medications: N/A, Pharmacy is not her regular pharmacy
Current Illness: N/A, Pharmacy is not her regular pharmacy
Preexisting Conditions: N/A, Pharmacy is not her regular pharmacy
Allergies: N/A, Pharmacy is not her regular pharmacy
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient stated that she was dizzy and passed out when the first Pfizer vaccine was administered. She received the second dose of the Pfizer vaccine on 8/24/21. I told her to take a seat after I administered the vaccine. She turned red and fell down on her knees while still seated in the chair. I asked her if she can still breath and she said yes. I gave her a pillow to lay on. Five minutes later, the EMT workers arrived and took her blood pressure and vital signs. They asked her more questions and the EMT workers left. She thanked me for calling 911 and walked out the store..


VAERS ID: 1628753 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adapalene Topical 0.1% Gel Topically
Current Illness: None.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was inadvertently given an unreconstituted dose of the vaccine. Due to human error the vial was not reconstituted and I gave her the 0.3ml dose. The error was caught by staff administering the next vaccine. Patient was called and advised of error and told to watch out for worsening symptoms. At the time of notification patient had no side effects or symptoms at all. Patient was told to go to Emergency Department if any severe symptoms develop and she was advised in detail what common symptoms to look for. She was also told to let her employer know if she develops mild symptoms. Patient expressed understanding.


VAERS ID: 1628766 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Exposure during pregnancy, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever (100.8), severe chills (convulsions), headache, diarrhea Currently 31 weeks pregnant.


VAERS ID: 1628768 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine, topiramate, vitamin D2 50,000 units, citalopram. Patient smokes cigarettes and drinks coffee also
Current Illness: none
Preexisting Conditions: epilepsy
Allergies: Latex, Corn, carbemazapine, iron
Diagnostic Lab Data: none
CDC Split Type:

Write-up: About 10 minutes after patient recieved the vaccine , she said her face and arm and legs felt itchy . She asked for benadryl. She took one tablet of benadryl. She waited another 20 minutes after taking the benadryl and said she felt fine then.


VAERS ID: 1628776 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: mild tightness around sternum, pain/discomfort. NP addressed patient and cleared him with no future eval neccessary unless pt feels discomfort later. Pt stated he feels fine


VAERS ID: 1628777 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Hypotension, Presyncope
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient had a vasovagal response in father''s truck. He was diaphoretic and had low blood pressure 93/46. Father informed me that son had not eaten all day. Ambulance was called to have him checked out. He was fine. Blood pressure went up to normal and he refused to go to the hospital.


VAERS ID: 1628778 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Extra dose administered, Headache, Hyperhidrosis, Loss of consciousness, Pyrexia, Sleep disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient received 3rd dose of Moderna vaccine 8/23/21 at 10:16AM. Her mother called 8/24/21, stating that she had an adverse reaction to the vaccine and wanted to report it. Patient was in the background of the call and gave permission for her mother to speak on her behalf. She states that on 8/24/21 at approximately 3am she experienced sever fever/chills/sweating. This woke her up and she got out of bed to turn on the air-conditioner and passed-out (fainted) in the hallway. She was passed-out for 15 minutes and then got up and went back to bed. At the time of the phone call on 8/24/21 at 3pm, she was experiencing only a mild headache and mild chills. Patient states that she is taking Mavenclad for Multiple Sclerosis.


VAERS ID: 1628780 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Muscle spasms, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: - Fever - Aches - Fatigue - Muscle Cramping - Soreness at injection site


VAERS ID: 1628793 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry throat, Headache, Tongue pruritus
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Dehydration (broad)

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

Write-up: headache within 5 minutes, dryness of throat/claimed itch of tongue 5-10 minutes post vaccination, to which patient was given a chair to sit, a glass of water and 25mg of liquid diphenhydramine and observed for appx additional 15-20 minutes. Patient then claimed to be feeling better and she and her mother left pharmacy.


VAERS ID: 1628794 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oral pruritus, 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: oxycodone/apap 5/325mg, verapamil er 240mg, gabapentin 800mg, np thyroid 120mg, vitamin d 50,000 units,
Current Illness:
Preexisting Conditions:
Allergies: latex, levothyroxine, iron, relpax, cherries, blueberries
Diagnostic Lab Data:
CDC Split Type:

Write-up: severe itching in throat and mouth diphenhydramine 50mg patient declined calling 911, mother picked patient up to take home for observation


VAERS ID: 1628796 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypertension, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: anxiety attacks
Other Medications: gabapentin and buspirone for anxiety
Current Illness: Heightened anxiety after the first shot of Pfizer COVID vaccine
Preexisting Conditions: Generalized anxiety
Allergies: aspirin
Diagnostic Lab Data: 12:45pm 153/84 12:59pm 152/93 1:20pm 136/97 HR 75
CDC Split Type:

Write-up: Patient complained of palpitation and hypertension ~20minutes post 2nd Pfizer COVID vaccine.


VAERS ID: 1628800 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Chest discomfort, Feeling hot, Pruritus, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Hypertension (narrow), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 112mcg?s 1 daily Paxil 10mg 1 daily
Current Illness: None
Preexisting Conditions: Hashimoto?s Hypothyroidism
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blurry Vision 5 minutes after shot administered. Warming sensation spread throughout my chest. It felt like a chain reaction within the muscle layer of my chest. It traveled outward and into my left arm and up towards my neck. Face became a little itchy. The sensation last for about 1 to 2 minutes then it subsided. After and an additional 5 minutes the warming sensation began again from the same locations. A traveling warming sensation began to spread in my chest. At that point the decision was made to call 911 for further evaluation. The paramedics assessed that my blood pressure was elevated, abut that oxygen vitals were good. It was determined I would not need further intervention and to go home and rest and take some Benadryl as a precaution. On the way home, I got the warming sensation again this time on my abdomen. And it passed after a few minutes.


VAERS ID: 1628801 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Patient was seated for two minutes after the injection and fainted for several seconds. EMTs were called at the request of the mother. She had low blood pressure when they arrived but quickly recovered after laying with her feet elevated. The patient remained seated at the pharmacy for an additional 45 minutes before leaving under her own power.


VAERS ID: 1628806 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 043A21A / 1 LA / IM

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

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

Write-up: Patient presented to the Health Department for a J&J Janssen vaccine. An on-site nurse administer the vaccine and brought the patient to the waiting area for a 30 minute observation to monitor for side effects. After 25 minutes of sitting, the patient stated she was having substernal chest pain which had begun five minutes prior to notifying the paramedic. Patient denied any other symptoms. The patient stated her only medical history was rheumatoid arthritis and an allergy to penicillin. Patient stated she has never had chest pain before. Vital signs were stable. Patient was advised that this could be a serious problem and she should be transported to the ER by ambulance. Patient declined transport. Patient stated she would be taken to the ER by her husband.


VAERS ID: 1628810 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Condition aggravated
SMQs:, Hypoglycaemia (broad)

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

Write-up: Pt c/o of anxiety 3 minutes after vaccination, encouraged to take full deep breaths, "gets anxiety everytime with vaccinations, just like recent flu shot, also going through alot" V/S 138/82, 71, 18, O2 stat-99% on RA. Obs pt til 5pm, stated "she feels much better" Educated pt to seek urgent care/ER if anything else arises post clearance.


VAERS ID: 1628815 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product substitution
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: diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse event occurred, but there was an administration error. This was the patient''s second dose, and Moderna was supposed to be administered. The patient was given Pfizer by mistake.


VAERS ID: 1628825 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: Patient is 16 years of age and was given the Moderna vaccine in error. No adverse reaction.


VAERS ID: 1628831 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Headache, Nausea, Nervousness
SMQs:, Acute pancreatitis (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown none identified on vaccination consent form.
Allergies: None on vaccination consent form
Diagnostic Lab Data:
CDC Split Type:

Write-up: After about 6 minutes of receiving second does of Pfizer, she complained of nausea, being lightheaded, dizzy, and had a headache. She also was cool and clammy. Patient nervous about getting second vaccine. After ask her some questions we found out she had not eaten. Gave her some Gatorade and a snack and she started feeling better. She left facility at about 10:45. After lunch her mother was called and she is doing good.


VAERS ID: 1628832 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / IM

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

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

Write-up: Patient states felt dizziness and nauseous about 1 hour after getting 2nd vaccination.


VAERS ID: 1628837 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Impaired driving ability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Moderate to severe fever (reaching at least 100.4 degrees F) debilitating headache resulting in inability to drive or perform basic motor functions well


VAERS ID: 1628838 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Injection site pain, Injection site swelling, Joint range of motion decreased, Musculoskeletal stiffness, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), 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:
Current Illness: hypertension and anemia
Preexisting Conditions: hypertension and anemia
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: unable to lift my right arm above head. swelling and stiff muscle near injection site. muscle pain in areas near injection site (shoulder, upper back, chest, arm)


VAERS ID: 1628839 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anxiety, Dizziness, Pain in jaw, Retching, Trismus
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dystonia (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vestibular disorders (broad), Osteonecrosis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: first vaccine shot area became extremely hot and injection site she had a red big bubble, dizzy and headache
Other Medications: multi vit, biotin
Current Illness: no
Preexisting Conditions: asthma, blood clots in both lungs
Allergies: blue dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: became lightheaded feel a little off, dizziness, jaw starting to lock and hurt, started dry heaving, feeling of anxiety, has no taste


VAERS ID: 1628840 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, 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: Patient received COVID Pfizer vaccine 1st dose. During 15 minute period post vaccination, patient remained seated and started feeling lightheaded. He came over to the consultation window to let us know approximately 5 minutes after seated.
Current Illness: None. He did report after gaining consciousness that he had COVID 4 months ago in April.
Preexisting Conditions: None. Patient has no health conditions and healthy
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Past out and appeared to may have had mild seizure with eyes rolled back and perspiration. Patient was unconscious for approximately 30sec-1min.


VAERS ID: 1628846 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: No testing by pharmacist
CDC Split Type:

Write-up: Patient felt hot,sweaty and like she may faint


VAERS ID: 1628851 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: 1430- patient reported feeling lightheaded, patient appeared pale and diaphoretic, NP and EMS radioed at this time. Assisted patient to floor with lower extremities elevated with assistance of another RN. Vital signs monitored, provided alcohol pads to smell, patient states its helped him the past, states he has had similar episodes in the past with injections, blood draws, vaccines. Patient observed for approximately 20 minutes, provided water and Gatorade, reports he felt better. Cleared by NP, patient ambulated without complaints to car with girlfriend. Vital Signs: 1434- 97% 69 130/81 symptoms improving as per patient 1436- 99% 74 1438- 98% 71 128/85 1443- 99% 75 133/90 patient assisted to sitting position, tolerated well 1445-98% 86 138/82 1450- 124/82 patient sitting in chair 1454- patient cleared by NP.


VAERS ID: 1628867 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: N/A


VAERS ID: 1628870 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: After 5 minutes post injection of dose 2 , patient became nauseous,gagging and then vomited. No treatment initiated at pharmacy. Patient left to her car where her driver was waiting for her with water and nausea medication. She anticipated this would happen and ran out in a hurry.


VAERS ID: 1628873 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-17
Onset:2021-08-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none that patient stated
Current Illness: not given
Preexisting Conditions: not given
Allergies: no drug allergies listed
Diagnostic Lab Data: not given
CDC Split Type:

Write-up: had headache for a few days, then starting on 8/24 had rash all over body from head to toe


VAERS ID: 1629064 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: R/O nausea post vaccination. Assessed by EMS and released for stable condition.


VAERS ID: 1629072 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Dysmenorrhoea, Injection site pain, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil, multivitamin, fish oil, vitamin D
Current Illness: None
Preexisting Conditions: Endometriosis SI chronic joint pain
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Spotting 7 days in advance of start of menstrual cycle. Light cramping too. I called my OBGYN to report it and they recommended that I report it. Advil to treat cramping. No other symptoms other than soreness at site of injection.


VAERS ID: 1629083 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

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

Write-up: Reporting feeling nauseous, dizzy and temporary loss of hearing after vaccination. Assessed by EMS released due to stable condition.


VAERS ID: 1629084 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial pain, Muscle tightness, Pain in jaw, Trismus
SMQs:, Dystonia (narrow), Glaucoma (broad), Osteonecrosis (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: IBS
Allergies: Lots of food and medication allergies none in the covid vaccine that I was made aware of
Diagnostic Lab Data:
CDC Split Type:

Write-up: Facial/jaw pain tightness and spasms


VAERS ID: 1629096 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-21
Onset:2021-08-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamins
Current Illness: none
Preexisting Conditions:
Allergies: nubain
Diagnostic Lab Data: induction will occur 08/25
CDC Split Type:

Write-up: Heartbeat unable to obtain of 14 week fetus Due date February 20, 2022


VAERS ID: 1629098 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Malaise
SMQs:

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

Write-up: Client''s father alerted staff that the client was not feeling well around 2:52 PM. Client reported having a headache after completing the 15 minute observation period. Assisted client to anti-gravity chair. Vitals obtained at 2:55 PM were as follow: BP 118/76, O2 99%, HR 72. Client was alert and oriented to person, place, time, and situation (AOx4). Client is sitting upright in anti-gravity chair, denied shortness of breath. Client reports headache pain is rated a 5/10 on a 10 point scale 0 being no pain and 10 being extreme pain. HA is located on right side of head on temple area. Pain comes and goes. Client denies aggravating factors. The client stated that her pain became more tolerable after she sat down. Client denies significant past medical history and denies use of medications. Offered the client water, the client denied. The client states she has consumed water and eaten today. Offered the client a juice and the client denied. Vitals obtained at 3:00 PM were as follows: BP 117/72, O2 98%, HR 70, AOx4. The client reports 3/10 pain. Denies any other symptoms. Vitals obtained at 3:10 PM were as follows: BP 118/72, O2 98%, HR 64, AOx4 Client reports 4/10 pain. Denies any other symptoms. Educated client and her father on ED precautions, when to seek EMS, signs of respiratory distress, and s/s of anaphylaxis. Vitals obtained 3:25 PM were as follows: BP112/73, O2 98%, HR 70, AOx4. Client reports 0/10 pain. Denies any symptoms. Client left the observation area with her father. Client left facility under no apparent distress unassisted with a steady gait.


VAERS ID: 1629103 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / SYR

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

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

Write-up: Extreme headache and extreme itching all over my upper body front and back. Triggered my eczema.


VAERS ID: 1629104 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hot flush, Hyperhidrosis, Injection site pain, Nausea, Skin warm
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: BLOOD PRESSURED WAS MEASURED ABOUT 5-10 MINUTES AFTER THE ONSET OF SYMPTOMS AND WAS WITHING RANGE 120/69.
CDC Split Type:

Write-up: PATIENT SAID ABOUT 30 SECONDS AFTER GETTING THE VACCINE, HIS LEFT ARM STARTED HURTING FROM THE SHOULDER TO THE ELBOW. THEN, HE GOT A HEADACHE AND FELT REALLY NAUSEOUS AND SO DIZZY. HE SAID HE FELT LIKE GETTING A HOT FLASH, HIS SKIN FELT REALLY HOT, AND HE SWEAT A LOT. AFTER SITTING DOWN, DRINKING WATER AND REST FOR ABOUT 15 MINUTES, HE FELT BETTER. AFTER 30 MINUTES, HE SAID HE FELT NORMAL LIKE BEFORE GETTING THE IMMUNIZATION WITH NO SYMPTOMS.


VAERS ID: 1629106 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, 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: passed out from needle before surgery
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was waiting the required 15 minutes after time was up went to leave felt clammy and cold fainted-pt states didnt eat today and has passed out from needles in the past on empty stomach


VAERS ID: 1629283 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dry throat
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient stated she had persistent cough, and post nasal drip
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Ibuprofen, zofran, omeprazole, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second dose pfizer. Within 25 minutes patient started to clear throat, cough, and complained of throat dryness.


VAERS ID: 1629293 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor XR, Omeprazole, plaquenil, tinzanidine, gabapentin, rosuvastatin, nurtec, pilocarpine, celebrex
Current Illness:
Preexisting Conditions: Sjogren?s
Allergies: PCN, Sulfa, Pepto Bismol, Citrus, raspberries, seafood, shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives, so far on feet, back, shoulders


VAERS ID: 1629297 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: Patient was given Monderna Vaccine first dose on 7/27/2021 at Pharmacy, today on 8/24/21 he came in to Pharmacy store to get his second dose. However, he was administered Pfizer for his second dose.


VAERS ID: 1629299 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206421A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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? Yes
Hospitalized? No
Previous Vaccinations: Flu shot per patient interview
Other Medications: unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Flu shot, Penicillin. Tdap
Diagnostic Lab Data: BP: 80/63mmHg
CDC Split Type:

Write-up: Pt explained he had a history of poor reactions to vaccines historically (flu-like symptoms with Tdap and trigger if seizures with flu shot). Explained to pt potential risk may occur d/t poor history but decided to vaccinate d/t no previous history of covid vaccine. After administration. pt started to feel light headed and dizzy. Started to sweat, have hand tremors, and stated he felt intense tinglines all over hands. Took BP reading, was 80/63mmHg. Administered 0.3mg of Epi-pen into right-thigh hand called 911. Paramedics came and took patient to Emergency room.


VAERS ID: 1629301 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Bradycardia, Condition aggravated, Dizziness, Fall, Hyperhidrosis, Hypotension, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient fell out of observation chair and become diaphoretic, weak, dizzy, and nauseated post vaccination. Assisted to chair and assessed blood pressure of being hypotensive at 74/40 and bradycardic at 54. Gave Zofran ODT and Benadryl PO w/ resolve to condition after monitoring for approx 30 min. Discharged to self under supervision of family member.


VAERS ID: 1629303 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-19
Onset:2021-08-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer covid dose 1
Other Medications: Ibuprofen, morphine-ER, omeprazol, claritin-D
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: Eggs, tomatoes, pollen, dust mites, pines, detergents
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Red itchy hives over entire body.


VAERS ID: 1629306 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was walking around the store after the vaccine and had felt lightheaded and passed out. He fell into a display. The pharmacy staff called 911 immediately and tended to him. He was sitting up and talking just stated that he felt lightheaded. He remained seated until the EMS arrived and took over from there.


VAERS ID: 1629314 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer Covid Vaccine
Other Medications: unknown
Current Illness:
Preexisting Conditions: unknown
Allergies: has history of dizziness with vaccinations
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient in for her 2nd Pfizer covid vaccine dose, has history of dizziness with vaccinations, assisted to immunization room, given vaccine in supine position. 2 mins after vaccination, patient reported feeling dizzy. 3:50pm BP 105/69 HR 63 O2Sat 99%, remains alert and responsive. Advised to conitnue deep breathing and try to relax. 3:55 PM patient states she feels a little better BP 108/73 HR 65 Sat 100%. Advised patient to remain in supine position. 4PM, patient denies dizziness, BP 103/67 HR 59 Sat 98%. BP rechecked at 4:3pm 107/71, assisted in a sitting position (legs still up in the exma table/bed) 4:05pm BP 100/75 HR 71, Sat 100%. Denies diziness. 4:10PM sitting with leg dangling BP 104/72 HR 79 Sat 99%. Patient states she feels better, assisted into standing position 4:15PM BP 106/71 HR 66 Sat 99%, no dizziness, Patient to be discharged, assisted by NP to patient;s vehicle. Advised to contact primary MD if any other symptoms arise.


VAERS ID: 1629318 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Gait disturbance, Nausea, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxygen use only at night 2 liters Ursodiol Tab 250 mg - 1 tablet, 2x/day Dexilant 60 mg - 1x/day Ezetimibe Tab 10 mg - 1x/day CBD Oil 1500 mg - 1ml 2x/day Stool Softener Docusatesodium 100mg - 1 tablet, 2x/day Albuterol, as needed Cyanocoba
Current Illness: Cancer in abdomen, origin unknown, treating as colon cancer Scarring in lung from cancer surgery
Preexisting Conditions: Cirrhosis of the liver High cholesterol Acid reflux
Allergies: Omega 3
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Room spinning out of control, dizziness, lightheadness, naseau, vomiting, vertigo, unsteady on feet


VAERS ID: 1629511 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-18
Onset:2021-08-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Red rash and hives developing on torso, thighs, neck and arms. Accompanied by minor itching.


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