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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 416 out of 8,010

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VAERS ID: 1771323 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATJNJFOC20211013278

Write-up: VACCINATION FAILURE; SARS-COV-2 INFECTION; This spontaneous report received from a physician via a Regulatory authority (regulatory authority, AT-BASGAGES-2021-046832) on 07-OCT-2021 and concerned a 31 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XD985 expiry: UNKNOWN) dose was not reported, 1 total administered on 09-JUN-2021 for an unspecified indication. No concomitant medications were reported. On 24-AUG-2021, the patient experienced vaccination failure and sars-cov-2 infection. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccination failure and sars-cov-2 infection was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint.


VAERS ID: 1771324 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATJNJFOC20211013524

Write-up: SARS-COV-2 INFECTION; VACCINATION FAILURE; This spontaneous report received from a physician via a Regulatory Authority (regulatory authority, AT-BASGAGES-2021-046836) on 07-OCT-2021 and concerned a 43 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 21C10-03 expiry: UNKNOWN) dose was not reported, 1 total administered on 21-MAY-2021 for an unspecified indication. No concomitant medications were reported. On 24-AUG-2021, the patient experienced sars-cov-2 infection and vaccination failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the sars-cov-2 infection and vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint.


VAERS ID: 1771325 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATJNJFOC20211013094

Write-up: VACCINATION FAILURE; SARS-COV-2 INFECTION; This spontaneous report received from a physician via a Regulatory Authority (regulatory authority, AT-BASGAGES-2021-046838) was received on 07-OCT-2021 concerned a 44 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 21C10-03 expiry: unknown) dose was not reported, 1 total administered on 21-MAY-2021 for unknown indication. No concomitant medications were reported. On 24-AUG-2021, the patient had sars-cov-2 infection and vaccination failure The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccination failure and sars-cov-2 infection was not reported. This report was serious (Other Medically Important Condition). This case is associated with product quality complaint.


VAERS ID: 1771326 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATJNJFOC20211013086

Write-up: VACCINATION FAILURE; SARS-COV-2 INFECTION; This spontaneous report received from a physician via Regulatory Authority (regulatory authority, AT-BASGAGES-2021-046846) on 07-OCT-2021 and concerned a 45 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XD975 expiry: UNKNOWN) dose was not reported, 1 total, administered on 10-JUN-2021 for an unspecified indication. No concomitant medications were reported. On 24-AUG-2021, the patient experienced vaccination failure, sars-cov-2 infection. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccination failure and sars-cov-2 infection was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint.


VAERS ID: 1784779 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATJNJFOC20211013796

Write-up: SARS-COV-2 INFECTION; VACCINATION FAILURE; This spontaneous report received from a physician via a Regulatory Authority (regulatory authority, AT-BASGAGES-2021-046815) on 07-OCT-2021 concerned a 62 year old male patient. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 21C16-04 expiry: unknown) dose was not reported, 01 total (first dose), administered on 12-JUL-2021 for unknown indication. No concomitant medications were reported. On 24-AUG-2021, the patient experienced severe acute respiratory syndrome coronavirus 2 (sars-cov-2) infection and had vaccination failure. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the sars-cov-2 infection and vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint: 90000196826.


VAERS ID: 1784780 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATJNJFOC20211024415

Write-up: SARS-COV-2 INFECTION; VACCINATION FAILURE; This spontaneous report received from a physician via Regulatory Authority (regulatory authority, AT-BASGAGES-2021-046851) on 12-OCT-2021 concerned a 52 year old female. The patient''s height, and weight were not reported. No past medical history and concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XD974 and expiry: unknown) dose was not reported, 1 total administered on 30-JUN-2021 for product used for unknown indication. No concomitant medications were reported. On 24-AUG-2021, the patient experienced SARS-CoV (severe acute respiratory syndrome coronavirus)-2 infection and vaccination failure. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the SARS-CoV (severe acute respiratory syndrome coronavirus)-2 infection and vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint.


VAERS ID: 1785812 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATJNJFOC20211024419

Write-up: SARS-COV-2 INFECTION; VACCINATION FAILURE; This spontaneous report received from a physician via a Regulatory Authority (regulatory authority, AT-BASGAGES-2021-046854) on 12-OCT-2021 concerned a 28 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XD985 and expiry: Unknown) dose was not reported, 1 total administered on 05-JUL-2021 for an unknown indication. No concomitant medications were reported. On 24-AUG-2021, the patient experienced sars-cov-2 (Severe acute respiratory syndrome coronavirus 2) infection and vaccination failure. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the sars-cov-2 infection and vaccination failure was not reported. This report was serious (Other Medically Important Condition).


VAERS ID: 1786131 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESMODERNATX, INC.MOD20213

Write-up: Seizure; This case was received via Regulatory Agency (Reference number: ES-AEMPS-983387) on 06-Oct-2021 and was forwarded to Moderna on 06-Oct-2021. This regulatory authority case was reported by a physician and describes the occurrence of in a 12-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. No Medical History information was reported. On 23-Aug-2021, the patient received dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. For mRNA-1273 (Spikevax) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided. Company Comment: This case concerns a 12-year-old, female patient with no relevant medical history, who experienced the unexpected event of seizure. The event seizure occurred 1 day after the unknown dose of mRNA-1273 vaccine administration. The rechallenge was not applicable since the only information disclosed was with this unknown dose number. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. The RA SD captured the onset latency and onset from the last dose of the event seizure as 2 days instead of 1 day. The dose number as well as the dosage route was not given. (23 August 2021 patient received 1 dose of unknown dose number of mRNA-1273 through unknown dosage route, 24 August the patient experienced adverse event of seizure). RA SD coding was captured and maintained. Most recent FOLLOW-UP information incorporated above includes: On 06-Oct-2021: Translation received on 08-Oct-2021, included anatomical location of suspect product was added.; Sender''s Comments: This case concerns a 12-year-old, female patient with no relevant medical history, who experienced the unexpected event of seizure. The event seizure occurred 1 day after the unknown dose of mRNA-1273 vaccine administration. The rechallenge was not applicable since the only information disclosed was with this unknown dose number. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. The RA SD captured the onset latency and onset from the last dose of the event seizure as 2 days instead of 1 day. The dose number as well as the dosage route was not given. (23 August 2021 patient received 1 dose of unknown dose number of mRNA-1273 through unknown dosage route, 24 August the patient experienced adverse event of seizure). RA SD coding was captured and maintained.


VAERS ID: 1593183 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-20
Onset:2021-08-23
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Rash presented on left arm (but not directly at the injection site). It was raised, warm, painful, and sometimes itchy. It was about 4 inches in diameter. The rash presented for about 2 weeks before disappearing.


VAERS ID: 1602815 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-21
Onset:2021-08-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Cystitis, Decreased appetite, Dysarthria, Fatigue, Heart rate increased, Muscle spasms, Palpitations, Pulse abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingles & Hep B
Other Medications: Gabapentin, Prozasin, Xyzal, Buspherion, Progesterone, Mirtazapine, Cyclobenzaprine, mutli-vitamin, probiotics, digestive enzymes, MSM, Biotin, mushroom immunity complex, Vitamin D & K, Selenium, Electrolytes
Current Illness: None
Preexisting Conditions: Asthma, anxiety, PTSD
Allergies: Gluten & Dairy
Diagnostic Lab Data: None
CDC Split Type:

Write-up: heart palpitations and a fast thready pulse, bladder infection within 24 hours of the shot, intestinal distress, severe cramping in my feet and legs, slurred speech this morning but that seems to be improving, loss of appetite, fatigue


VAERS ID: 1622734 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-22
Onset:2021-08-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / -

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

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

Write-up: Headache fever muscle aches


VAERS ID: 1623270 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: moderna. she just stated that she had a severe reaction to the vaccine
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: moderna covid shot
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated after the fact that she had a severe reaction to the Moderna shot, did not get the 2nd shot and her Dr. instructed her to get a different vaccination to see if that one would work. This does not follow the guidelines and the shot was given by mistake. No reaction occurred while in the store with the new vaccination.


VAERS ID: 1623281 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-20
Onset:2021-08-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: My menstrual cycle has started 13 days early! I just had a week long cycle Aug 9th.


VAERS ID: 1623332 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-23
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Headache, Musculoskeletal stiffness, Pain in jaw
SMQs:, Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Arthritis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xeljanz XR, Florinef, Claritin, Celexa, Wellbutrin, Famvir
Current Illness: none
Preexisting Conditions: RA, Myalgic Encephalomyelitis/CFS, Fibromialgia
Allergies: Sulfa and Iodine cause hives
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache on left front side of head, left side of jaw pain, muscle stiffness, Diarrhea.


VAERS ID: 1623355 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-15
Onset:2021-08-23
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Hip arthroplasty
SMQs:, Osteoporosis/osteopenia (broad), Osteonecrosis (broad), Arthritis (broad)

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

Write-up: Customer stated he had shoulder pain that ran down to his hip. Counseled to speak with his doctor.


VAERS ID: 1623369 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-08-23
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray, Chronic kidney disease, Confusional state, Cough, Decreased appetite, Fatigue, Hypoxia, Pyrexia, Renal failure, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol 100 mg oral tablet, 100 mg= 1 TAB, PO, Daily Alta, allopurinol 100 mg oral tablet, 100 mg= 1 TAB, PO, Daily, Altace 10 mg oral capsule, 10 mg, PO, Daily, Coreg CR 80 mg oral capsule, extended release, 80 mg= 1 CAP, PO, QAM (Eve
Current Illness:
Preexisting Conditions: coronary artery diseascoronary artery disease, possible sarcoidosis, Barrett''s esophagus, diabetes, hyperlipidemia, BPH, insomnia, anxiety, chronic kidney disease stage 3 e, possible sarcoidosis, Barrett''s esophagus, diabetes, hyperlipidemia, BPH, insomnia, anxiety,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a 79-year-old male with a past medical history of coronary artery disease, possible sarcoidosis, Barrett''s esophagus, diabetes, hyperlipidemia, BPH, insomnia, anxiety, chronic kidney disease stage 3 who presents to the emergency room when his wife found him leaning over a sink in the bathroom feeling weak and confused. In the emergency room patient was febrile and his O2 sat was 90% but he was not in any respiratory distress. Has been intermittently confused in the emergency room. He is oriented to person and place but not to the year. Other times he seems to answer questions appropriately and accurately. We do not have recent records on him or prior labs. In the emergency room he was in acute versus. This is a 79-year-old male with a past medical history of coronary artery disease, possible sarcoidosis, Barrett''s esophagus, diabetes, hyperlipidemia, BPH, insomnia, anxiety, chronic kidney disease stage 3 who presents to the emergency room when his wife found him leaning over a sink in the bathroom feeling weak and confused. In the emergency room patient was febrile and his O2 sat was 90% but he was not in any respiratory distress. Has been intermittently confused in the emergency room. He is oriented to person and place but not to the year. Other times he seems to answer questions appropriately and accurately. We do not have recent records on him or prior labs. In the emergency room he was in acute versus chronic kidney disease, hypoxia, COVID positive and worsening renal failure. Chest x-ray was also concerning for possible pneumonia. Patient states he has had a cough and fatigue along with decreased appetite recently. He states he did get the COVID vaccines with Moderna. Patient denies any chills, rhinorrhea, sore throat, chest pain, shortness of breath, palpitations, orthopnea, paroxysmal nocturnal dyspnea, nausea, vomiting, diarrhea, constipation, hematuria, dysuria, frequency, melena, hematochezia or focal neurological complaints Surgical history: Cardiac catheterization with 3 stents, vats, neck and cholecystectomy Social history: He states he quit smoking 25 years ago, rare use of alcohol, no illicit drugs. He is married


VAERS ID: 1623374 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-08-23
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Hospitalized 8/23/21, COVID positive.


VAERS ID: 1623378 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-22
Onset:2021-08-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

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

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

Write-up: Vomited at 11:35am day after vaccine


VAERS ID: 1623385 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 LA / SYR

Administered by: Other       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:
CDC Split Type:

Write-up: Inadvertently provided 2nd dose early. 2nd dose should have been administered 8/26 but administered 8/23. Patient was monitored for 30 minutes (rather than 15 minutes) with no issues. (English was not the patient''s first language which contributed to error.)


VAERS ID: 1623410 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 50 mcg, citalopram 20 mg
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came in to get her 2nd Moderna vaccine; dose was administered by my tech. 15-min timer goes off then I went to check on the pt and pt stated that she was dizzy and about to throw up. Pt collapsed and threw up. I asked her if she wanted a some water, she said yes. Pt did not want us to call 911. After about 10 min, pt stated that her lungs ''were on fire.'' I advised her that I think it is in her best interest to seek medical attention and my tech called 911. Paramedics took pt''s vitals and BP was 130/80 and O2 sat was 99. Paramedics took pt to Health facility.


VAERS ID: 1623414 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: The patient received the Pfizer vaccine at age 11. The mother filled out the consent form online with an incorrect birthdate. The administering pharmacist confirmed the birthdate before immunization. Another agency contacted the pharmacy after immunization advising of the actual patient date of birth. The pharmacist subsequently called patient''s father who confirmed the birthdate given by the agency is correct.


VAERS ID: 1623428 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: patient felt dizzy and nauseous after immunization. did not show any signs of allergic reaction. had patient sit with a cold compress on neck for 30 minutes after which patient felt normal and was ready to leave.


VAERS ID: 1623436 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

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

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

Write-up: AFTER RECEIVING VACCINE CLERICAL STAFF CHECKED MEDICAL RECORD AND DISCOVERED PATIENT''S FIRST DOSE WAS OF MODERNA, AND PFIZER WAS ADMINISTERED AT THIS VISIT BECAUSE CLIENT REPORTED TO CLERICAL STAFF THAT SHE WAS HERE FOR HER SECOND DOSE OF PFIZER. PATIENT TOLERATED DOSE FINE AND WAS INFORMED THAT THE SERIES WAS CONSIDERED COMPLETE AND DOSE SHOULD NOT BE REPEATED PER CDC INTERIM CLINICAL CONSIDERATIONS.


VAERS ID: 1623444 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-08-23
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Patient received J+J vaccine 3/8/2021. Patient then received Pfizer vaccine as listed here on 7/30/2021.


VAERS ID: 1623448 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate decreased, Hypophagia, Hypotension, 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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient passed in chair a couple minutes after receiving pfizer dose number 2. Patient was responsive to rph. Did not have this reaction with first dose. Patient reports not eating or drinking that morning and did not eat dinner the night prior. Was given water, gatorade, and a couple cookies. 911 was called and she was taken out to ambulance. Had low blood pressure and heart rate (number unknown).


VAERS ID: 1623462 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure decreased, Heart rate increased, Loss of consciousness, Syncope
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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: 21 yo Mwith no PMHX accompanied by mother for single dose J&J vaccine at approximately 11:50am. Approximately 30 seconds after vaccine administration, patient experienced syncopal episode with persistent orthostatic vital sign changes. Brief LOC witnessed, patient did not fall over. When patient moved from sitting to laying position, BP dropped and HR elevated slightly. Patient denies n/v, HA, dizziness, visual changes, tinnitus. Patient denies allergies or previous episode of syncope. Condition improved with time. Vitals laying BP 100/61, Pulse 53, O2 91%, RR 12, sitting up BP 100/50, Pulse 70, O2 98%, RR12. EMS called and pt transferred to ER for medical eval.


VAERS ID: 1623470 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-18
Onset:2021-08-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: 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:
Other Medications: NA
Current Illness: SORE THROAT
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type: 21057

Write-up: Slept in air conditioning beside dog and woke up with welts all over from waist down both legs to feet. Extremely itchy. Not red or open sores. "Looks like mosquito bites." None above waist. Typically sleeps with dog without issues; no new clothing/laundry detergents, etc. lotions, or medications. Guardian given diphenhydramine and had her soak in cool Aveno bath. Plans to take to PCP if symptoms do not subside by 1600 today.


VAERS ID: 1623475 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

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

Write-up: Pt Felt tightness of chest and tightness of throat


VAERS ID: 1623477 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-23
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 3 LA / IM

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

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

Write-up: Patient completed Pfizer COVID vaccine series on 6/14/2021 and 7/5/2021 from different vendor. Patient received 3rd dose of Pfizer at our event as listed on this report. No patient issues reported on site.


VAERS ID: 1623490 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-22
Onset:2021-08-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Menstruation irregular
SMQs:, Termination of pregnancy and risk of abortion (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Early period or miscarriage


VAERS ID: 1623563 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-05
Onset:2021-08-23
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole, Saw Palmetto
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Lots and Lots Please contact hospital.
CDC Split Type:

Write-up: Pericarditis, CHest pain. Treated with anti-Inflammatorys


VAERS ID: 1623578 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Fatigue, Hypoaesthesia oral
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Metallic taste in mouth, fatigue, tongue numbness


VAERS ID: 1623677 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD4884 / 3 RA / IM

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

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

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


VAERS ID: 1623683 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-07-26
Onset:2021-08-23
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 spelt their first name without the ''h'' in their first name on their paperwork and was put into our pharmacy system without the ''h''. The technician who gave the vaccine noticed the name was different after seeing the patients license and changed their profile to be correct. The paperwork that was filled out was overlooked and the fact that it said they had already gotten a COVID vaccine was missed, however it did not indicate what vaccine they had received. The patient had received Johnson and Johnson on 4/8/21 then received Moderna first dose on 7/26/21. They were due for their second dose of Moderna today and we checked data base and noticed they had received Johnson and Johnson back in April. Unfortunately, checking data base was not part of our daily routine at the time of their first dose but with the spelling of their name it wouldn''t have shown. They were notified and will not be receiving their second dose of Moderna.


VAERS ID: 1623692 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: Systemic: Chills-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium


VAERS ID: 1623717 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 AR / SYR

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1623735 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-19
Onset:2021-08-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / -

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

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

Write-up: patien took moderna on 8/19/21 then came took pfizer shot on 8/23/21


VAERS ID: 1623762 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-07-31
Onset:2021-08-23
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 3 LA / IM

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

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

Write-up: Patient completed Pfizer COVID vaccine series 4/15/2021 and 5/10/2021. Patient received 3rd dose of Pfizer vaccine on 7/31/2021 as documented on this report.


VAERS ID: 1623768 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-01
Onset:2021-08-23
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Aspirin & jalape?o
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, body aches, Nauseous, headache


VAERS ID: 1623772 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWOC171 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Client was initially vaccinated with Pfizer vaccine at 04/29/2021. Patient agreed to mix vaccines and receive a Moderna as 2nd shot. Patient was offered appointment at another facility for the second shot with Pfizer but preferred to take the Moderna 2nd shot at our clinic. Client is over 42 days from first shot.


VAERS ID: 1623775 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / IM

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

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

Write-up: Patient under 18 years old was given Moderna COVID vaccine. No reaction occurred.


VAERS ID: 1623777 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

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

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

Write-up: not enough diluent was put in vaccine bottle and vaccine was pulled out of this bottle.


VAERS ID: 1623784 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-21
Onset:2021-08-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Hypoaesthesia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Woke up ~30 hours after vaccine with lt sided facial swelling and numbness, also had a headache upon waking up and took Excedrin but the swelling and numbness persisted, was seen in my office ~6 hours later and the swelling had resolved but the numbness and tingling of lt side of face persist.


VAERS ID: 1623828 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-18
Onset:2021-08-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram abnormal, Myocardial strain, Pulmonary endarterectomy, Thrombectomy
SMQs:, Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Pulmonary hypertension (narrow)

Life Threatening? Yes
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: zanaflex 4mg, xanax .5mg, lexapro 20mg, adderall, synthroid 75mg
Current Illness: none reported
Preexisting Conditions: hypothyroidism
Allergies: none
Diagnostic Lab Data: CTA - as above 8/23/2021
CDC Split Type:

Write-up: Extensive Bilateral PTE with moderate heart strain requiring thrombectomy


VAERS ID: 1623835 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Feeling hot, Flushing, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (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: Adderall 30mg
Current Illness: N/A
Preexisting Conditions: Blood Clot / Clotting Disorder / Hypertension / ADHD
Allergies: Coumadin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt administered Pfizer COVID-19 vaccine 0.3mL, IM, Right Deltoid. Pt had Hx of Anaphylaxis to Coumadin, 30 minute wait period recommended after vaccination. Appx 15 minutes after vaccination, Pt states they were experiencing "hot/flushed feeling", "rapid heartbeat", "general weakness". No prior reactions to vaccines. Vital signs taken at 0949, B/P-178/114 Left Arm, seated position, Pulse-102, SPO2 on Room Air-99%, Temp-98.5 degrees F. Pt moved to supine position, given ice pack and water. Dr. contacted to evaluate Pt. Pt taking 30mg Adderall, last taken 0600. Hx of blood clot in 2013, and 2 cesarean section births. Last oral intake 0800, "normal breakfast". Vital signs repeated at 0954, supine position, B/P-154/105 Left Arm, Pulse-91, SPO2 on Room Air-98%. Pt transferred to observation room vial wheelchair, Pt care transferred to Dr.


VAERS ID: 1623845 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: no adverse reaction, pt came in and presented with false dob. Therefore, administration error in age


VAERS ID: 1623891 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Hyperhidrosis
SMQs:, Neuroleptic malignant 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:
Current Illness:
Preexisting Conditions: Anxiety
Allergies: Lidocain/Sudapen
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT complained of sweaty palms and anxiety. RN asked to remove mask and started breathing exercises. PT stated she has been diagnosed with anxiety disorder and that she could not sleep the night before. Vitals were monitored... 0939 120/78 0949 117/80 PT was held an additional 10 minutes after the 15 minute observation period then discharged to sister and recommended her to contact her primary doctor in case symptoms persist.


VAERS ID: 1623916 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Malaise, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I gave a first dose of the Pfizer vaccine to a patient this morning and about 5 minutes after I gave it to him, he was feeling light headed and having blurry vision. I got him a water and he asked to lay down. He never passed out and his symptoms cleared in 10 minutes. I continued to monitor him for another 15-20 minutes. He was able to get ahold of his wife to let her know he was not feeling well. After 30 minutes, he was felt comfortable leaving and all of his symptoms were cleared. I checked back in with him several hours later and he is feeling better and not having any more symptoms.


VAERS ID: 1623939 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Minocycline, busirone, lorazepam, ativan, coreg, vitamin d3, protonix, hydroxyzine
Current Illness: n/a
Preexisting Conditions: anxiety, PCOS, GERD
Allergies: penicillin, sulfa, metformin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Shortly after vaccination, pt experienced episode of "blacking out". She did not faint, but everything turned dark- she was light-headed, like she was going to pass out. This only lasted a couple of minutes and then she felt back to normal.


VAERS ID: 1623940 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Syncope, Vaccine positive rechallenge
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: PT stated any shot brings on this type of reaction.
Other Medications:
Current Illness:
Preexisting Conditions: hypertensive
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT fainted after observation time on her way out. PT became alert immediately and was in no physical difficulty. No pain reported, PT stated she had not eaten since early morning. Vitals taken BP 122/74 O2 100% on RA HR 71 PT offered snacks and water then observed for another 15 minutes. No difficulty reported. PT stated she usually faints after receiving a shot. PT was released after instructed to call for medical attention in case of any further distress.


VAERS ID: 1623943 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-28
Onset:2021-08-23
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 - / IM

Administered by: Public       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: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: During event, client approached me and asked for another COVID-19 card as she had lost her card. Upon checking her record, I noticed patient was given J&J vaccine on 05/07/2021 and then given 1st shot of Moderna on 06/28/2021. Patient was well and not exhibiting any health problems and had no medical complaints. Sending report for documenting incident.


VAERS ID: 1623957 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: patient received 2nd dose of pfizer vaccine before 21 day interval


VAERS ID: 1623958 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / IM

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

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

Write-up: Needle separated from barrel during administration. All of the dose emptied from barrel down patients arm


VAERS ID: 1623967 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD08448 / 1 LA / IM

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

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

Write-up: Pt. received injection at 11;34 at 11:38 pt had LOC( approx. E seconds . pt fell from chair and hit his R temple when he hit the floor before staff could get there. Pt rolled to back with spinal precautions EMS called., pt was then alert and oriented x3, Perla, BUE strength equal.O2sats 88% pt encouraged to do deep breathing and O2 sats 91% Hr 46 BP 101/51, Pt c/o head pain and did not want to lay down. pt was attended to by FNP and RN on duty. 11:43 pt was placed in Trendelenburg O2 sats 94% Hr 98, 11:45 EMS arrived and took over care.


VAERS ID: 1623978 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD 8448 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Feeling abnormal, Hyperhidrosis, Nausea, Throat tightness, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: approximately five minutes after receiving the COVID 19 vaccine, patient reported have a metallic taste in her mouth. She also complained of nausea and feeling "weird". BP was 117/73 HR 71. A few minutes later patient began shaking and complaining of her throat feeling tight. Patient was able to swallow. BP was rechecked 126/78 HR 76. Patient became diaphoretic and was taken to the hospital''s ED for further treatment.


VAERS ID: 1623980 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: USE COLD PACK AND WAITED ADDITIONAL 15 MINUTES
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT FELT CHEST TIGHTNESS AND PAIN IN CHEST. USE COLD PACK AND WAITED ADDITIONAL 15 MINUTES. HE IMPROVED AND WAS ABLE TO LEAVE ON HIS OWN


VAERS ID: 1623994 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: School       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: Client felt light/headed dizzy immediately after vaccination. Stated he felt like he was going to ?pass out?. Appeared pale and pulse weak. Assisted to ground with elevation of legs. No LOC or injury. Symptoms resolved. Pulse palpated and no longer weak. He states he has had this happen in the past after a blood draw. Initial vitals 129/68, hr 66. Bottled water given to client. Client remained at site and monitored for 45 minutes after incident. Vitals remained stable. Declined further evaluation. Vitals prior to leaving bp 129/75, hr 72.


VAERS ID: 1624000 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: ADMINISTRATION ERROR : Patient was stuck twice during vaccination. Pharmacist told patient the first shot did not have vaccine, but second shot did. Patient believes he was vaccinated twice on 08/23/2021.


VAERS ID: 1624005 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 3 LA / IM

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

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

Write-up: The client informed me he had received the Pfizer COVID-19 series. I mistakenly administered a Moderna vaccine as the booster dose. He did not experience any adverse effects during the 20 minutes he was observed.


VAERS ID: 1624007 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-31
Onset:2021-08-23
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 3 LA / IM

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

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

Write-up: Patient completed Moderna COVID vaccine on 3/11/2021 and 4/8/2021. Patient received Pfizer dose on 7/31/2021 at our location as listed on this report.


VAERS ID: 1624013 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Patient fainted, he was able to get up on his own. He sat in a chair by the pharmacy for 15 minutes and drank water. When he felt better he left with a friend.


VAERS ID: 1624019 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

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

Write-up: Client received Moderna as first dose on 07/29/21. Client was inadvertently given Pfizer as second dose on 09/23/21. Patient was made aware at the time of the incident. 1415 on 08/23/21.


VAERS ID: 1624022 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Blindness, Dysphagia, Dyspnoea, Hyperhidrosis, Nausea, Pallor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Approximately 4 minutes after injection, patient stated he could not see and "everything went black". Patient appeared anxious, pale, and diaphoretic. Patient denied difficulty breathing, trouble swallowing, and nausea. He was assisted to a semi-recumbant/supine position. After approximately 60 seconds, he stated his vision was returning. Patient received sips of water and ice pack and was monitored for 15 minutes. Patient stated he felt better and was able to walk out of clinic without assistance.


VAERS ID: 1624030 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-02-08
Onset:2021-08-23
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, COVID-19, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: COVID-19 infection, hypoxia


VAERS ID: 1624037 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-04
Onset:2021-08-23
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / IM

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

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

Write-up: The patient MAY have received a dose of Janssen vaccine that was administered after the Beyond Use Date. The provider may have given the dose outside of the 6 hour window after the vial was opened. No symptoms or signs. Pt will be contacted and offered to be re-vaccinated to offer full protection, per our Medical Group.


VAERS ID: 1624039 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Lip swelling, hand swelling, arm tingling


VAERS ID: 1624045 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Feeling hot, Pruritus, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: new patient, no prescription record
Current Illness: unknown, new patient
Preexisting Conditions: unknown, new patient
Allergies: nuts, shellfish, and betadine
Diagnostic Lab Data: no tests was done at the pharmacy
CDC Split Type:

Write-up: Shortly after getting the vaccine patient starting itching , feeling hot, and coughing. No visible rash seen but patient skin looks pink. He said his throat started to itch. He was given liquid benadryl. Patient was coughing and he used his albuterol inhaler that he had with him. It helped with the coughing. Patient started to feel better but had to repeat benadryl and albuterol 2 more times. Patient was monitor for about 50 minutes and all reaction went away. Patient was advised if he develops any other reactions to seek medical help.


VAERS ID: 1624058 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Vaccination site haemorrhage, Visual impairment, Vital signs measurement
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE NOTED
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE KNOWN
Diagnostic Lab Data: BLOOD PRESSURE READING, PULSE AND OXYGEN READINGS. PATIENT WAS ADVISED TO FOLLOW UP WITH STUDENT HEALTH, AND HER MOTHER WAS CALLED DURING THIS TIME. MOTHER WAS GOING TO MEET HER AND THE STUDENT AT THE COLLEGE. PATIENT AND MOTHER WERE ADVISED TO LET US KNOW OF ANY FURTHER ISSUES. EAU HANDOUT WAS GIVEN TO THE PATIENT, AND SHE LEFT AMBULATORY.
CDC Split Type:

Write-up: PATIENT ARRIVED AT 1PM, SHE WAS APREHENSIVE BECAUSE HER SCHOOL REQUIRED THE VACCINE. PHYSICAL ASSESSMENT WAS COMPLETED, AND THE VACCINATION WAS GIVEN AT 1:03. THERE WAS SOME BLEEDING AT THE VACCINATION SITE, AND THE PATIENT ALMOST IMMEDIATELY SAID SHE COULD NOT HEAR AND HER SIGHT WAS ALTERED. SHE COULD NOT DESCRIBE IN WHAT WAY IT WAS ALTERED, JUST THAT IT " WASN''T RIGHT". PULSE OX AND BLOOD PRESSURE READINGS WERE TAKEN AND ON 1ST ATTEMPT HER O2 WAS 98 AND BP READING LOW AT 77/45. PATIENT WAS A VERY SMALL PERSON, AND A MANUAL BP CUFF WAS USED AND BP WAS 94/62. PATIENT WAS GIVEN WATER, AND WAS TALKING TO HER FRIEND DURING THIS TIME. HER SIGHT, HEARING AND OVERALL ASSESSMENT CAME BACK WITHIN NORMAL RANGE. PATIENT WAS VISIBLY UPSET THAT SHE HAD THIS REACTION AND WAS TOLD IT WAS OK. 911 WAS NOT CALLED, BUT PATIENT WAS ADVISED TO FOLLOW UP WITH STUDENT HEALTH CENTER THERE AT THE COLLEGE.


VAERS ID: 1624060 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-08-23
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 3 LA / IM

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

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

Write-up: Patient completed Moderna COVID vaccine series 5/26/2021 and 6/23/2021. Patient then received Pfizer dose on 7/30/2021 as indicated on this report.


VAERS ID: 1624104 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

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

Write-up: was mistakenly giving 2 different vaccines


VAERS ID: 1624111 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-26
Onset:2021-08-23
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Erythema, Inflammation, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (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:
Other Medications: Cipro, Simvastatin,Tramadol, Zolpidem,
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Sulfa Antibiotics
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient stated that their left arm became very inflamed and red, that their arm was ''bloated'' and bigger than usual afterwards.


VAERS ID: 1624142 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-08-23
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

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

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

Write-up: Tested PCR positive for COVID 8/23/21 after being fully vaccinated.


VAERS ID: 1624145 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Pallor, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: Water only.
Current Illness: None to my knowledge.
Preexisting Conditions: Unknown.
Allergies: Vaccine form filled out as "no" hx of allergic reactions.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became lightheaded, pale, and was unresponsive for about 10 seconds. Breathing remained normal, injection site appeared normal, pulse was present throughout episode. Patient was approached near pharmacy by family friend who helped him sit. EMS was called. Vitals were normal taken by EMS. Patient did arouse and improve over time. Patient reported bilateral finger numbness.


VAERS ID: 1624147 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Back pain, Chest pain, Dizziness, Feeling abnormal, Headache, Pain
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness:
Preexisting Conditions:
Allergies: bee stings, "fever" vaccines given with military service
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initially felt lightheaded, and "weird" sensations throughout head/neck area, intermittent headache, legs were elevated, fluid intake, all symptoms had improved, and client ambulated on her own to front office, 2 hrs later she complained of chest pain, initally sharp, mid/left anterior chest with radiation to mid back, no shortness of breath, diaphoresis, jaw/neck pain, or difficulty breathing. All vital signs stable, emergency services called for further evaluation, client take to nearest hospital via EMS.


VAERS ID: 1624155 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-22
Onset:2021-08-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Blood sodium, Chills, Injection site bruising, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe fever of 101, with Ibuprofen and Tyenol. Body Aches , bruising at injection sight Nausea and upset stomach Body chills


VAERS ID: 1624173 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye swelling, Lip swelling
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. c/o swelling around eyes and lips


VAERS ID: 1624192 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Private       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: NUVARING VIT D3 FENUGREEK SEED EXTRACT
Current Illness: adjustment disorder adjustment reaction of adolescence attention deficit hyperactivity disorder Fredrickson type IIa hyperlipoproteinemia hypercholesterolemia intermittent explosive disorder mononucleosis syndrome obesity slow transit constipation
Preexisting Conditions: adjustment disorder adjustment reaction of adolescence attention deficit hyperactivity disorder Fredrickson type IIa hyperlipoproteinemia hypercholesterolemia intermittent explosive disorder mononucleosis syndrome obesity slow transit constipation
Allergies: KNDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: NO REACTION WAS NOTED.


VAERS ID: 1624202 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain the chest region


VAERS ID: 1624206 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NONE STATED
Diagnostic Lab Data: fire dept tested bp and numbers were good.
CDC Split Type:

Write-up: Patient fainted after receiving vaccine.


VAERS ID: 1624220 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
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: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT RECEIVED EXPIRED DOSE THAT WAS LAST DRAWN ABOUT 70 HOURS AGO. PATIENT DID NOT EXPERIENCE ANY ADVERSE EVENTS. REPORTED TO PFIZER DATA SAFETY TEAM FOR CLINICAL INFORMATION ON SAFETY AND INFO ON RE-DOING 2ND DOSE. PFIZER REP STATED SAFETY LESS OF CONCERN THAN EFFICACY. REVIEWING PROCEDURES ON READMINISTRATION AND PATIENT WILL BE INFORMED. SCHEDULED A FOLLOW-UP WITH PATIENT NEXT DAY TO DETERMINE IF STILL NOT EXPERIENCING ANY SE/AE


VAERS ID: 1624228 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dry mouth, Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Nausea Headache Dizzy Dry Mouth Fatigue


VAERS ID: 1624238 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Paraesthesia oral, Pharyngeal paraesthesia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Minutes after second injection, pt began to experience tingling in tongue and throat with visible hand tremors. Pharmacist was called to assess, at which time pt was having difficulty breathing. Due to previous anaphylaxis to shingles vaccine and presentation of current reaction, decision was made to administer epinephrine 0.3 mg autoinjector into patient''s left thigh. Within 15 seconds, pt relayed breathing improved, in 4 minutes she was able to take a deep breath, and within 10 minutes, tingling in throat was completely gone. All symptoms subsided after 30 minutes when patient''s daughter arrived to take her home. Pt was beginning to feel shakiness and fatigue from epipen after-effects but was otherwise back to normal with no vaccination-related symptoms remaining.


VAERS ID: 1624244 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling hot, Nausea, Nervousness, Vomiting
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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient felt dizzy, hot, clammy, nauseous, shaky. she did end up vomiting a few minutes after feeling symptoms.


VAERS ID: 1624246 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dyspnoea, Erythema, Injection site erythema, Injection site pruritus, Pruritus, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 5 minutes following vaccination patient reported redness and itchiness around injection site. A few (~5 minutes) minutes later patient reported itching spreading down same arm, cold and clammy hands, and itchiness of chest. A few minutes after that she reported mild tightness in throat (slight inability to breath normally).


VAERS ID: 1624252 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

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

Write-up: Patient was possibly given the entire vial. LPN states she measured out 0.3 ml but there was no vaccine left in vial for the next injections. No adverse events or symptoms noted. Patient remained in office for 15 minutes following injection. Called patient at 3:45 pm and spoke with his wife to explain what had happened and she stated he was doing fine and he stated that his arm was "a little sore" at the injection site.


VAERS ID: 1624255 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dysphagia, Nausea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (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 (narrow), Vestibular disorders (broad), Hypersensitivity (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: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt (DOB 11/13/2008) reported feeling nauseous to EMT Observer at 12:45 after receiving the 2nd dose COVID vaccine (Pfizer, Lot # FC3183) in the left arm on 08/23/2001. EMT observer took client vitals, transferred client to zero gravity chair, provided emesis bag, provided water bottle, and reported findings to Co-lead RN. Vitals were taken by EMT at 1248 with BP 128/88 in L arm sitting upright, HR 100, and O2 saturation level 98%. Co-Lead assessed client who presented A&O to person, place, time and situation. No loss of consciousness occurred. Client denied SOB, trouble swallowing, numbness, and tingling. No redness or swelling observed. At 1250 client reported she last ate at around 8am and felt an onset of mild dizziness. EMT provided client granola bar. Client reported that she did not have any adverse reactions to the first dose Pfizer vaccine. Client reported to Co-Lead that "this feeling is similar to when I have anxiety". Client ate granola bar and finished 1 bottle of water, client was provided another bottle of water. At 1252 patient stated her stomach and dizziness was getting better. Client has no hx of fainting or dizziness with previous vaccines. Client has NKDA and no hx of chronic health conditions. At 1:05 the client reported she felt a tightness in her throat and stated it was "a little hard to swallow water". Co-Lead assessed client''s throat and observed no swelling. Co-Lead offered IM benedryl and provided mother of client education. Client''s mother was spanish speaking and required assistance of translator. Client''s mother provided consent to administer IM benddryl to client and provided client''s weight of 110 lbs. At 1:10 EMT prepared 1mL syringe of benadryl and Lead called EMS. At 1:15 Co-Lead administered 1mL of IM benadryl to client in the right arm. At 1:18 EMT took client vitals with BP 118/84 in L arm sitting upright, HR 84, O2 saturation level 99%, and RR 18. At 1:20 EMS arrived on-site and assumed patient care. Client''s mother denied additional medical services AMA. Co-Lead recommended an additional 30 minutes of observation time from when client received benadryl. Client''s mother consented to staying for additional observation time. At 1230 client reported she was feeling better and denied dizziness, trouble swallowing, and SOB. Co-Lead educated about V-safe information, ER precautions, and when to follow up with PCP. Patient ambulated with even and symmetrical gait when leaving site with her mother at 1:45.


VAERS ID: 1624268 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Deafness
SMQs:, Hearing impairment (narrow)

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

Write-up: Partial Loss of hearing one hour after vaccination


VAERS ID: 1624269 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-22
Onset:2021-08-23
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

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

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

Write-up: Fully vaccinated tested positive for COVID 19


VAERS ID: 1624272 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Patient reported dizziness 10 minutes after COVID 19 Vaccine. Patient?s legs elevated and vitals sign monitored every 5 minutes. Inital blood pressure 87/49 with heart rate of 102. Patient was discharged home once symptoms subsided and blood pressure was 125/74 with heart rate of 90. Instructed patient to drink fluids.


VAERS ID: 1624273 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Chest discomfort, Deafness, Dyspnoea, Flushing, Hypoaesthesia, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Approximately one minute after receiving vaccine, patient began feeling flushed. He had a syncope episode immediately afterwards. Patient received epinephrine 0.6 ml IM to right thigh, cool compress, Trendelenburg position, and oxygen at 3L/nc. Patient complained of chest tightness, shortness of breath, temporary hearing loss, and numbness/tingling of arms and feet. Patient reports feeling 80% back to normal; alert, oriented x 4. Patient began feeling flush again and complained of chest tightness and feeling flush again after placed in sitting position. Ambulance transported to


VAERS ID: 1624274 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-23
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily vitamin, D3, Magnesium, Lutien, A, Omega 3, calcium, Super B complex
Current Illness: None
Preexisting Conditions: Lupus
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site is swollen, hot to the touch and very tender


VAERS ID: 1624276 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Head injury, Presyncope
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient got vaccinated then immediately vasovagal happened she ended up on the floor and hit her left side forehead and got a golf sized knot. Took vitals, WNL, bilateral pupils 2mm, brisk, equal. Offered to called ambulance but she refused.


VAERS ID: 1624284 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO183 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling abnormal, Hyperhidrosis, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Flovent
Current Illness: n/a
Preexisting Conditions: asthma
Allergies: severe allery (anaphylaxis) to seafood and nuts
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Center was performing an outreach vaccine clinic at an outdoor setting. Patient received 1st dose of Pfizer at 10:30am on 8/23/2021 in the Left deltoid. At 10:30am, patient complained of "feeling funny" and appeared pale and sweaty. After talking with patient for about 30 seconds, he appeared to be unresponsive to voice while sitting in the chair. Ambulance was called, epinephrine 0.3mg was prepped for standby, patient legs were elevated. Heartrate was 50 and BP was 104/60. at 10:45am, Paramedics arrived. Paramedics evaluated the patient, and patient declined transport and was able to stand and walk off under his own power.


VAERS ID: 1624289 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-08-23
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Flushing, Hypoaesthesia, Laboratory test, Ultrasound Doppler
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: Gilberts Syndrome
Allergies: none
Diagnostic Lab Data: Needle sensation studies that were normal, ultrasound of carotid arteries in neck
CDC Split Type:

Write-up: numbness of left side of upper body. Pt felt hot and flushed. Symptoms lasted four days.


VAERS ID: 1624293 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received one dose of the Janssen COVID vaccine on8/23/2021 after previously receiving two doses of the Pfizer vaccine on 4/8/2021 and 4/29/2021.


VAERS ID: 1624298 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-22
Onset:2021-08-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2029219 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Bradycardia, Chest pain, Electrocardiogram, Fatigue, Night sweats, Pain
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: N/a
Allergies: No known allergies
Diagnostic Lab Data: EKG done 08/23/21 at the same site of the vaccine. EKG findings, bradycardia with possibility of LVH r/t voltage on specific EKG electrodes.
CDC Split Type:

Write-up: Transient Chest pain the following morning followed by weakness fatigue, body aches and sweating during sleep.


VAERS ID: 1624301 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-22
Onset:2021-08-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS Z9AD5 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol hfa, hydrochlorothiazide, breo ellipta, levothyroxine
Current Illness:
Preexisting Conditions:
Allergies: no allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: left eye swollen severely, right eye swollen as well but less severe than right eye. patient noticed it upon awakening in morning.


VAERS ID: 1624310 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

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

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

Write-up: PT had a seizure after administration 911 called taken to hospital


VAERS ID: 1624313 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-23
Onset:2021-08-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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:
Other Medications: unknown
Current Illness: none stated
Preexisting Conditions: none stated
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out immediately after receiving injection. pt has history of fainting per her mother. Patient was alert within a few seconds and then vomited. Pt sat and was observed for approx 25 minutes and was feeling ok to leave with mother.


VAERS ID: 1624323 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-31
Onset:2021-08-23
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

Administered by: Private       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? 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: 17 y/o received Moderna out of EUA approval.


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