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From the 7/23/2021 release of VAERS data:

Found 506,830 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 43 out of 5,069

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VAERS ID: 1486373 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-07-08
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / -

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
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: LIPITOR [ATORVASTATIN]; NORVASC; CELEBREX
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; High cholesterol; Osteoarthritis
Allergies:
Diagnostic Lab Data: Test Date: 20210711; Test Name: Rapid; Result Unstructured Data: Test Result:Positive; Comments: Nasal Swab
CDC Split Type: USPFIZER INC2021886231

Write-up: COVID-19 Infection; COVID-19 Infection; This is a spontaneous report received from a contactable other hcp. A 46-years-old non-pregnant female patient received bnt162b2 (COMIRNATY, formulation: solution for injection, Batch/Lot Number: EL3248), via an unspecified route of administration, administered in arm left on an unspecified date (age at vaccination 45 years) as DOSE 2, SINGLE for covid-19 immunization. Medical history included high blood pressure, high cholesterol, and osteoarthritis from an unknown date and unknown if ongoing. The patient''s known allergies were none. The patient was not tested for covid prior to vaccination but was tested positive after vaccination. The patient did not take any other vaccine in four weeks. The patient''s historical vaccine included BNT162B2 (1st dose was taken by patient via intramuscular in left arm on 03Mar2021,11:15 am, lot number: EN6203, age 45 years). Concomitant medications included atorvastatin (LIPITOR), amlodipine besilate (NORVASC) and celecoxib (CELEBREX) taken for an unspecified indication, start and stop date were not reported. The patient experienced covid-19 infection (drug ineffective) and covid-19 positive on 08Jul2021. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 11Jul2021 Nasal Swab (rapid). The patient did not take the treatment for events. The patient was not admitted to hospital, awareness date was reported to be 11Jul2021 and device stamp date was 13Jul2021. The outcome of the events was not resolved.; Sender''s Comments: Based on the known safety profile of the drug, a causal association between the reported events of drug ineffective, covid-19 and suspect drug bnt162b2 cannot be excluded.


VAERS ID: 1486375 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-28
Onset:2021-07-08
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Headache, Hypoaesthesia, Hypoaesthesia oral, Limb discomfort
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021887714

Write-up: had very heavy legs; a sharp and constant pain in my chest; my arms, legs and mouth have gone numb; my arms, legs and mouth have gone numb; had a very bad headache; This is a spontaneous report from a contactable consumer (patient). A 27-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection; lot number: EW0196 and expiration date: not reported), via an unspecified route of administration, in Left arm, on 28Jun2021 at 11:30 (at the age of 26-year-old), as DOSE 1, SINGLE for covid-19 immunization at Pharmacy or Drug Store. Medical history included penicillin allergy. The patient''s concomitant medications were not reported however it reported that the patient received an unspecified antibiotic within 2 weeks of vaccination. The patient was not pregnant at time of vaccination. The patient didn''t receive any other vaccines within 4 weeks prior to the COVID -19 vaccine. Prior to vaccination, patient was not diagnosed with COVID-19. After the vaccination patient has not been tested for COVID-19. On 08Jul2021, the patient had very heavy legs, a sharp and constant pain in chest, her arms, legs and mouth have gone numb and have had a very bad headache. No treatment was taken as a result of events. It was reported that events result in doctor or other healthcare professional office/clinic visit. The outcome of the events was not recovered at time of report.


VAERS ID: 1486592 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 AR / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1486843 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Allergy to Amoxicillin.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient experienced a fever, chills, aches, fatigue. The fever lasted 34 hours, and at the high point was at 103.6 degrees.


VAERS ID: 1486964 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Erythema, Headache, Influenza like illness, Injection site pain, Paranasal sinus discomfort, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, Singalar, Pramastaton, Lathortin, Flonase, Pepcid, Alprasalone, Mucinex, Hormone Patch-Estrodol
Current Illness: N/A
Preexisting Conditions: Seasonal Allergies
Allergies: Fish, Carrots, Oysters, grass/trees Outdoor/Indoor Allergies, Penicillin, Sulfa, Codeine, Narcotics
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states after receiving the 1st dose of the Phizer shot 07/08/2021, started experiencing severe headache (36hrs), added sinus pressure, chills *with Fever 101.2/99.8 (lasting 48hrs), flu-like symptoms, arm redness (Circle from the top of the shoulder to elbow), arm pain (injection site) continuing on/off. Physician communications 07/10/2021 recommended Urgent Care if worsening. Urging reporting. (March received infusion after contracting Covid-19)


VAERS ID: 1487075 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-07-08
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Cephalexin
Diagnostic Lab Data: POCT SARS-COV-2 Rapid: SARS-COV-2 detected (7/8/2021)
CDC Split Type:

Write-up: Pt is 36 yo male, employee at this institution. He is s/p Moderna COVID-19 full vaccination: first dose on 1/2/2021, second dose on 2/9/2021. Underwent voluntary COVID-19 rapid testing on 7/8 after experiencing symptoms including headache, sore throat, and congestion/runny nose. Pt reported possible exposure to COVID-19. Rapid test resulted positive. Patient advised to self-isolate for 10 days after symptom onset and contacted by local health department.


VAERS ID: 1487126 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-07-08
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Electrocardiogram, Pneumonia, SARS-CoV-2 test positive, X-ray
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Pneumonia due to COVID
Preexisting Conditions: COPD, Chronic DVT- on xerelto, CHF, A fib
Allergies:
Diagnostic Lab Data: x-ray and EKG
CDC Split Type:

Write-up: Patient was hospitalized with pneumonia from 7/11/2021- 7/14/2021 related to COVID infection. COVID test positive 7/12/2021. Patient became symptomatic 7/8/2021. Patient was fully vaccinated at this time.


VAERS ID: 1487214 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sudafed, Zyrtec, daily vitamin
Current Illness: None
Preexisting Conditions: Migraine headaches
Allergies: Peanuts, peanut prodcuts, Leviquin
Diagnostic Lab Data: Chest x ray on July 15, 2021.
CDC Split Type:

Write-up: On the second day after the shot, I experienced shortness of breath. This symptom occurred off and on throughout the days and nights in the following 2 weeks. I saw my personal physician a few days after these syptoms began. He ordered a chest x ray which showed no adverse events. The shortness of breath sypmtoms gradually went away each day. As of today (July 20, 2021), the sympotms are almost non existent.


VAERS ID: 1487299 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No adverse medical reaction. The patient is 16 years old, too young for the Moderna vaccine We have contacted the health department and moderna


VAERS ID: 1487304 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No adverse medical reaction. The patient is 17 years old, too young for the Moderna vaccine We have contacted the health department and moderna


VAERS ID: 1487308 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No adverse medical reaction. The patient is 14 years old, too young for the Moderna vaccine We have contacted the health department and moderna


VAERS ID: 1487446 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-01
Onset:2021-07-08
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/8/2021 POSITIVE COVID TEST
CDC Split Type:

Write-up: PATIENT ADMITTED TO REHAB FROM DR''S OFFICE COMPLETED MODERNA VACCINATIONS THE 1ST OF FEBRUARY PER PATIENT STATEMENT ADMITTED TO ACUTE CARE 7/19/21 WITH INTERMITTENT FEVER, SOB STILL INPATIENT


VAERS ID: 1489568 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-07-08
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Injection site pain, Insomnia, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (1-2 beers per week); Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies, no drug abuse or illicit drug usage and no pertinent medical history.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210740076

Write-up: INSOMNIA (COULD NOT SLEEP FOR THREE TO FOUR NIGHTS); COUGH; BODY ACHE; SORE THROAT; FEVER; INJECTION SITE PAIN; This spontaneous report received from a patient concerned a 40 year old male. The patient''s weight was 169 pounds, and height was 66 inches. The patient''s concurrent conditions included alcohol user, and non-smoker, and other pre-existing medical conditions included the patient had no known allergies, no drug abuse or illicit drug usage and no pertinent medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 202A21A, expiry: 07-AUG-2021) dose was not reported, administered on 08-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 08-JUL-2021, the subject experienced injection site pain. On 11-JUL-2021, the subject experienced sore throat. On 11-JUL-2021, the subject experienced cough. On 11-JUL-2021, the subject experienced body ache. On 11-JUL-2021, the subject experienced fever. On 15-JUL-2021, the subject experienced insomnia (could not sleep for three to four nights). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from injection site pain on 09-JUL-2021, and fever on 14-JUL-2021, was recovering from body ache, and insomnia (could not sleep for three to four nights), and had not recovered from cough, and sore throat. This report was non-serious.


VAERS ID: 1489824 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3099 / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021861829

Write-up: I can''t even see it, my eyes are so bad; I am feeling really achy; This is a spontaneous report from Consumer or other non health professional (patient). A 61-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Solution for injection; Lot number: 3099, Expiry Date: Unknown), via an unspecified route of administration on arm right on 07Jul2021 (Age at Vaccination: 61 years) as DOSE 1, SINGLE for COVID-19 immunization. The patient medical history was not reported. Other products was reported as no. The patient Concomitant medications were not reported (No, I don''t take other medication at all). On 08Jul2021, the patient experienced I am feeling really achy. It was reported that patient stated "Yes, I got shot yesterday and I woke this morning and I am feeling really achy. I know they said that might be some of the side effect, I am just wondering how long it does last?" On an unspecified date, the patient reported that "I can''t even see it, my eyes are so bad. I have my glasses on and I can''t see it." The outcome of the events was not recovered.


VAERS ID: 1489835 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021869050

Write-up: Starting last night and continuing into today he reports he has red blotches all over his body; This is a spontaneous report from a contactable consumer or other non hcp. A 85-years-old elderly male patient received second dose of bnt162b2 (Pfizer BioNTech Covid 19 vaccine, Solution for injection; Batch/Lot number: Not reported) via an unspecified route of administration on 07Jul2021 as a Dose 2,Single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Two days ago on 07Jul2021,the patient got the second shot and he got all red blotches starting last night and today on his body. The outcome of the event was unknown. No follow-up attempts possible. No further information expected.


VAERS ID: 1489841 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-12
Onset:2021-07-08
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 antibody test, SARS-CoV-2 test, 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: METFORMIN; JANUVIA [SITAGLIPTIN]; PIOGLITAZONE; PRAVASTATIN; SYNTHROID; HYDROXYZINE; TRULICITY
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cholesterol (Verbatim: Cholesterol); Diabetes (Diabetes was family related and had nothing to do with the vaccine.); Hashimoto''s disease (Verbatim: Hashimoto''s Disease Hypothyroidism)
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Covid antibody test; Result Unstructured Data: Test Result:Unknown; Comments: Full protection; Test Date: 20210708; Test Name: Covid-19 2 hour nasal test; Test Result: Positive
CDC Split Type: USPFIZER INC2021873054

Write-up: Tested positive for the covid virus after having both doses of the vaccine; Tested positive for the covid virus after having both doses of the vaccine; This is a spontaneous report from a contactable consumer (patient herself). A 65-year-old female patient received BNT162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number- EL0142) via an unspecified route of administration in left arm on 22Dec2020 12:00 as dose 1, single and received BNT162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number- EL0142) via an unspecified route of administration in right arm on 12Jan2021 as dose 2, single (at the age of 65-years-old) for COVID-19 immunization. Vaccination Facility Type was reported as Hospital. Vaccine was not administered at a facility. Patient medical history included Diabetes which was family related and was nothing to the vaccine, cholesterol, Hashimoto disease (hypothyroidism). The concomitant medications included ongoing metformin from 2001 at a dose and frequency of 500 mg, 3x/day with a daily dosing of 1500 mg taken for diabetes mellitus, Sitagliptin (JANUVIA [SITAGLIPTIN]) from 2013 at a dose and frequency of 100 mg, daily taken for diabetes mellitus, pioglitazone from 2015 at a dose and frequency of 45 mg, daily taken for diabetes mellitus, pravastatin from 2011 at a dose and frequency of 20 mg, daily taken for cholesterol, levothyroxine sodium (SYNTHROID) from 2001 at a dose and frequency of 125 ug, daily taken for Hashimoto Disease, hydroxyzine from 2016 at a dose and frequency of 50 mg, 4x/day with a daily dosing of 200 mg taken for itchy skin from diabetes, dulaglutide (TRULICITY) at a dose and frequency of 0.75 mg, single weekly with a daily dosing of 0.107 mg taken for diabetes. Patient stated it had truly been very helpful in keeping her A1C low, it has been great. Patient had the covid vaccine, both doses in December, and she just tested positive for the covid virus yesterday (08Jul2021 at 12:30). She had the first one on 22Dec2020, and the second one the first week or so of January, as best as she can remember without getting out her card. She stated she was a rehab nurse, and clarified she was a registered nurse. She was just diagnosed yesterday, and her daughter was an ER nurse, and she said they see their worse side effects days seven through eleven, and she was not there yet. She added, to her it was all of the above because she did not know yet what it was going to be, but it was very significant, but could be life threatening. She states, she got the vaccine hoping to protect her and she did not feel like the vaccine caused her to get it, but it did not prevent her from getting it. She stated, she was tested monthly for covid and for antibodies and she was told less than a month ago, she had full antibody protection from her Pfizer vaccine. She confirmed her most recent test for antibodies was done late May2021 or Jun2021. Patient thought there was a need for the booster dose as was suggested by Pfizer as she had tested positive for COVID-19 after getting the vaccine. Patient did not receive any treatment for the adverse events. The reported seriousness criteria for the event was other medically important condition, medically significant. Relatedness of drug to reactions/events: Tested positive for the covid virus after having both doses of the vaccine using global introspection as the method of assessment was reported as unrelated. The adverse events did not result in emergency room or physician office visit. The lab test and procedures included COVID-19 nasal swab test with result as positive on 08Jul2021, COVID-19 antibody test with result as full protection on an unspecified date in late May2021 or Jun2021. Description of complaint included patient tested positive for the covid virus after having both doses of the Pfizer vaccine. The outcome of the events was not recovered.; Sender''s Comments: As per the available information, the causal association between the event and the suspect drug cannot be excluded. The case will be reassessed once new information is available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1490039 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-24
Onset:2021-07-08
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Chest X-ray, Condition aggravated, Dyspnoea, Productive cough
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL EXTRA STRENGTH) 500 mg tablet albuterol 2.5 mg /3 mL (0.083 %) nebulizer solution albuterol HFA (PROAIR HFA) 90 mcg/actuation inhaler allopurinoL (ZYLOPRIM) 100 mg tablet amLODIPine (NORVASC) 10 mg tablet aspirin 81 m
Current Illness: suspected liver cirrhosis.
Preexisting Conditions: Nervous Coronary artery disease involving native coronary artery of native heart with angina pectoris (CMS/HCC) Osteoarthritis of thoracic spine with myelopathy Benzodiazepine dependence, episodic (CMS/HCC) Precordial chest pain Respiratory Chronic obstructive pulmonary disease (CMS/HCC) Cough Multifocal pneumonia Acute respiratory failure with hypoxia (CMS/HCC) Circulatory Aortic stenosis Essential hypertension External hemorrhoids ACS (acute coronary syndrome) (CMS/HCC) Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (CMS/HCC) Digestive Gastroesophageal reflux disease Vitamin D deficiency BMI 40.0-44.9, adult (CMS/HCC) Genitourinary Type 2 diabetes mellitus with stage 4 chronic kidney disease, with long-term current use of insulin (CMS/HCC) Chronic kidney disease (CKD), stage III (moderate) (CMS/HCC) Infective urethritis Renal dysfunction Urinary tract infection without hematuria, site unspecified Musculoskeletal Arthritis Cellulitis of finger of right hand Abscess of right ring finger Endocrine/Metabolic Mixed hyperlipidemia Hypothyroidism Infectious/Inflammatory COVID-19 Immune Sjogren''s syndrome (CMS/HCC)
Allergies: Hydrocodone-acetaminophenIndigestion / GI upset Iodinated Contrast MediaOther (document details in comments), Anaphylaxis IodineOther (document details in comments) Iodine Containing MultivitaminAnaphylaxis LisinoprilCoughing MeperidineNausea and Vomiting, Other (document details in comments) MorphineIndigestion / GI upset PenicillinsItching Propoxyphene N-acetaminophenNausea and Vomiting Sulfa (Sulfonamide Antibiotics)Itching PropoxypheneNausea And Vomiting Tramadol HydromorphoneOther (document details in comments)
Diagnostic Lab Data: Chest X-ray
CDC Split Type:

Write-up: Acute respiratory failure with hypoxia wet cough Shortness of breath


VAERS ID: 1490327 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-06
Onset:2021-07-08
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: admitted to the hospital for symptoms of COVID 19 post vaccination.


VAERS ID: 1490587 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, COVID-19, Chest X-ray, Electrocardiogram, Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetic; Congestive Heart Failure; Defibrillator
Allergies:
Diagnostic Lab Data: Bloodwork, Chest X-ray, EKG
CDC Split Type: vsafe

Write-up: After taking the vaccine, I didn''t have any symptoms. The next day, my arm got a little sore later on in the day. That day at night, I started to feel a little headache. The next day after that, I started to get a little fever and a little headache. After that, everyday I was getting a headache and a fever for over a week. I went to the hospital and they said I had covid.


VAERS ID: 1490670 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490680 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490691 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490709 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

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: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490725 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490728 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1490736 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490768 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490852 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 06/17/2021. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1491025 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / -

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: Received vaccine not stored according to manufacturer recommendations


VAERS ID: 1493242 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Unknown  
Location: Texas  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Malaise, Pyrexia, Vaccination site pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: body temperature; Result Unstructured Data: Test Result:37.7 ?C
CDC Split Type: USPFIZER INC2021875528

Write-up: Pain in the injection site; Fever of 37.7 ?C; Malaise; This is a spontaneous report from a contactable consumer. This is one of the two reports. A 14-years-old patient of an unspecified gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on 08Jul2021 (reported as yesterday noon) (age at vaccination: 14 years) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunization. Medical history and concomitant medications were not reported. On 08Jul2021 at night, the patient had malaise. On 09Jul2021, the patient experienced pain in the injection site, and fever of 37.7 degree c. The patient underwent body temperature test which was 37.7 degree C. The patient was given paracetamol as treatment for the events. The outcome of the events was unknown. Information on lot /batch number has been requested.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-2021868661 same reporter/ drug, different AE/patient


VAERS ID: 1493623 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-12
Onset:2021-07-08
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Zyrtec
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Experiencing unusually high/extremely high blood pressure.


VAERS ID: 1493650 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-02
Onset:2021-07-08
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Anosmia, Back pain, COVID-19, Cough, Fatigue, Headache, Malaise, Oxygen saturation decreased, Pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-Vitamin Concerta
Current Illness: Tick Bite; Concern about Lyme disease carrier (deer tick). Had to visit the clinic and revived single does of antibiotic. 1 week prior to vaccine
Preexisting Conditions: non
Allergies: non
Diagnostic Lab Data: Tested Positive for Covid19 on 07/08/2021. Suspected Delta Variant PCR test
CDC Split Type:

Write-up: Tested Positive for Covid19 on 07/08/2021. Suspected Delta Variant Had Covid19 Symptoms, including headache, body pains, Severe lower back pain, Loss of smell, Low oxygen levels (83%), persistent cough, fatigue- Lasted 10days Recovered, but persistent cough, mild headaches and mild fatigue


VAERS ID: 1493982 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Limb injury, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1494025 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Hyperhidrosis, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (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: Lisinopril, metropolico, norvac, vit d, cholesterol pills
Current Illness: no
Preexisting Conditions: high blood pressure
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sweating, dizziness, vomiting and diarrhea a week later after getting the vaccine


VAERS ID: 1494209 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-20
Onset:2021-07-08
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Full blood count, Immunosuppressant drug therapy, Platelet count decreased, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine cellcept plaquenil lisinopril prednisone furosemide aspart glargine
Current Illness:
Preexisting Conditions: systemic lupus devic''s syndrome diabetes hypertension kidney stones obstructive sleep apnea
Allergies: metformin
Diagnostic Lab Data: cbc 7/8/2021
CDC Split Type:

Write-up: Pt developed thrombocytopenia to 8000. she was on cellcept and plaquenil at the time.


VAERS ID: 1494319 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levemir, Novolog, Clopidogrel, Lisinopril, Alogliptin, Aspirin, Metformin, Simvastatin, Metoprolol, Carboxymethylcellulose
Current Illness: None
Preexisting Conditions: Diabetes, Hypertension, Hyperlipidemia, Coronary artery disease, Plantar fascitis
Allergies: Amoxicillin, Ibuprofen, Levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt states right upper arm hurt immediately upon 2nd COVID-19 vaccination on 7/9/21 and the pain has continued but has lessened in severity. Pt saw provider on 7/22/21 who recommended pt use acetaminophen to help with pain. Provider reviewed arm and noted there was still bruising to the area and noted that injection was done higher than normal. Discussed injection placement with vaccinator.


VAERS ID: 1495708 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-19
Onset:2021-07-08
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Gestational diabetes, Maternal exposure during pregnancy, Ultrasound scan normal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine, Prozac, VitaFusion Prenatial Gummie
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: 07/13/2021 Ultrasound Normal (Results from home test given for diagnosis)
CDC Split Type: vsafe

Write-up: 2nd pregnancy 09/11/2021EDD, Gestational Diabetes Onset, Ongoing as of 07/22/2021


VAERS ID: 1497452 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CELEXA [CELECOXIB]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021862623

Write-up: Sharp pains shooting down arm of injection into hand; This is a This is a spontaneous report from a contactable nurse. This 21-year-old adult non-pregnant female nurse (patient) reported for herself that she received second dose of bnt162b2 ((PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number, Expiry Date: Unknown), via an unspecified route of administration, administered in left arm on 08Jul2021 at 09:45AM (at the age of 21 years) as a single dose for COVID-19 immunization. The patient previously received first dose of BNT162b2 (Solution for injection, Batch/Lot Number, Expiry Date: Unknown) via an unspecified route of administration on an unknown date (at the age of 21-years-old) as a single dose for COVID-19 immunization. The patient medical history was not reported. Concomitant medication(s) received within 2 weeks of vaccination included celecoxib (CELEXA [CELECOXIB]) 10mg taken for an unspecified indication, start and stop date were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Since the vaccination, the patient had not tested for COVID-19. The patient diagnosed not with COVID-19, prior to vaccination. The patient experienced sharp pains shooting down arm of injection into hand on 08Jul2021 at 15:00. No treatment was given. The clinical outcome of events were not recovered. Information on the lot/batch number has been requested.


VAERS ID: 1497494 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache
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: USPFIZER INC2021873443

Write-up: Headache/All she got was a headache; This is a spontaneous report received from contactable consumer (Patient''s husband reported for female consumer reporter''s wife). A female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA-1273 VACCINE, Solution for Injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date in Jul2021 as dose number unknown, single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. The patient experienced headache/all she got was a headache on 08Jul2021. Reporter stated his wife got another vaccine. She got the Pfizer shot. All she got was a headache. Reporter wife received Pfizer Covid-19 vaccine. He reports she experienced a headache. Outcome of the event was unknown. Follow-up attempts have been completed; information about lot/batch number cannot be obtained.


VAERS ID: 1497561 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intermenstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021886773

Write-up: Experienced spotting and bleeding and it was not supposed to be my normal cycle; Experienced spotting and bleeding and it was not supposed to be my normal cycle; This is a spontaneous report from a contactable consumer (patient). A 45-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/lot number: EW0198) via Intramuscular in right arm on 01Jul2021 (in the afternoon probably a little closer to 2 O''clock) as single dose (at the age of 45-year-old) for COVID-19 immunisation at pharmacy. Medical history and concomitant medications were none. Patient was healthy, and don''t take any other prescriptions. No other vaccination received 4 weeks prior to COVID 19 Vaccine. Patient received vaccine on 01Jul2021 on Thursday and a week after that she experienced spotting and bleeding and it was not supposed to be her normal cycle, so she found that a little odd on 08Jul2021. She was still experiencing, it''s been, let''s see Thursday Friday Saturday Sunday and yeah, it''s almost been five days now. She stated it looks like it was starting to Improve. The second one is coming up on Thursday it''s going to be 22Jul2021. Patient not had physical yet so it''s been a year. No treatment was received. The outcome of events was recovering.


VAERS ID: 1497578 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-25
Onset:2021-07-08
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Body temperature decreased, Chills, Cough, Drug ineffective, Dyspnoea, Fatigue, Headache, Nasal congestion, Pain, SARS-CoV-2 test, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: Test Date: 20210708; Test Name: Low grade temperature; Result Unstructured Data: Test Result:Not reported; Test Date: 20210710; Test Name: COVID-19; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC2021894554

Write-up: Tested positive after receiving the vaccine; Tested positive after receiving the vaccine; Shortness of breath on exertion; Congestion; Cough; body aches; Chills; Headache; low grade temperature; Loss of taste; Loss of smell; Tired; This is a spontaneous report from a contactable consumer (patient, self-reported). A 45-year-old female patient received second dose of BNT162B2 (PFIZER-BIONTEC COVID-19 mRNA VACCINE, Solution for injection, lot number: EL3248 and expiry date was not reported), via Intramuscular, on 25Mar2021 (age at vaccination: 45 years), as a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. Historical vaccine included second dose of BNT162B2 (PFIZER-BIONTEC COVID-19 mRNA VACCINE, Solution for injection, lot number: EN6203 and expiry date: 30Jun2021), via Intramuscular, on 03Mar2021, as a single dose for COVID-19 immunization. The patient stated that she has to call colleagues when they get Covid and in the past several days several colleagues got Covid vaccine and tested positive. She stated that she reported two yesterday without a problem and did not have reference numbers from the website from reports yesterday. She had reported two colleagues had Covid vaccine that tested positive afterwards. The colleagues called in to report this and she follows up. She has a colleague to report today that had the Covid vaccine and tested positive.The patient tested positive on 10Jul2021. Caller assumed that patient was still testing positive because she still had symptoms and rates seriousness as medically significant. Her symptoms were congestion, lost of taste and smell, shortness of breath on exertion, cough, body aches, chills, headache, low grade temperature, and tired. Her onset was 08Jul2021, but caller didn''t know when each symptom came. Caller didn''t know if the chills and headache were ongoing and did not have a seriousness to provide for all other symptoms. Caller stated she has not seen the patient nor examined her and didn''t feel comfortable answering seriousness. She felt shortness of breath would be medically significant. The patient underwent lab tests and procedures which included body temperature decreased: not reported on 08Jul2021 and sars-cov-2 test: positive on 10Jul2021. There was a product complaint to report. The outcome of the events chills, headache, drug ineffective was reported as unknown and for all other events, it was not recovered. QA Review & Rationale: The complaint and its classification have been reviewed. No immediate containment action was required. The complaint, its priority,and its classification have been reviewed and determined to be appropriate. A full investigation will be performed. This was a complaint for lack of effect of lot EN6203 of the PFIZER-BIONTECH COVID-19 VACCINE. The initial scope of this investigation was limited to the reported finished goods lot EN6203 and EL3248 pending review of lot genealogy. The investigation will include a review of the returned complaint sample (if received) and reserve samples, if necessary. Investigation Decision: Pfizer (site name withheld) reviewed this complaint and agrees with the site assignment, investigation decision, classification, sub-classification, and priority. The reported lot number was valid and an investigation will be performed. Description of complaint: Covid vaccine: Tested positive for Covid 19 virus after receiving the Covid vaccine. Contain details as- IDC - Level 1: Quality, IDC - Level 2: Product Complaint, IDC - Level 3: Complaint - Function / Therapeutic Properties, (Parent) Complaint Class: Product Use Attributes, (Parent) Complaint Sub-Class: Lack Of Effect, Package Date (GMT): This was the start date when the finished product was packaged into the commercial presentation 26-Jan-2021. Conclusion: The complaint for lack of effect of the PFIZER-BIONTECH COVID-19 VACCINE lot EL3248 was investigated. The investigation included a review of manufacturing and packaging batch records, deviation investigations, and an analysis of complaint history for the reported lot. The final scope included the reported finished goods lot EL3248 and EN6203 fill lot EL3231 and EN5336, and the formulated drug product lot EL3224. A complaint sample was not returned, and photographs were not received. No related quality issues were identified during the investigation. There was no impact to product quality. No root cause or corrective/preventative actions were identified as the complaint was not confirmed. All release testing performed prior to the release of the reported batch was within specifications. Description of complaint: Consumer calling about the Pfizer COVID-19 vaccine, and says that she got the injection twice, and each time she has gotten it and gotten tested after, each test was showing positive. She says the thing was, does Pfizer have information about this, because seems to be herd immunity. Caller does not clarify this last statement. She asks if anyone else has been reporting this. She clarifies that she goes to a nursing home and was tested every 14 days when she goes to see her mom and all times prior to getting the vaccine doses she was negative. She says her first dose of the vaccine was on 26Dec, then four days after that it was time to go get tested to go see her mom and the test was positive within no time it lights up.She says as a medical worker she can wait 5 days after that for it to come up after being positive and after that if it was showing up negative she had to wait 24 hours to confirm negative test and pay again for the test within 24 hours, which was negative too. She says then the time next she got the shot on January 16th she went to go do the shot on this past Saturday, and then she went to go get tested to go back to the nursing home and again it came back positive. Pfizer COVID-19 vaccine NDC/EXP: Caller says that the information on the card was handwritten, NDC/EXP were not written on the card. She says the card says Pfizer COVID-19, and the first dose was on December 26th of LOT: EL5738 given in her right arm. She says that the second dose was January 16th of LOT EL3248 and it was given in her left arm. Caller says that other than having positive tests for COVID she has had no symptoms. Product strength and count size dispensed: two doses. Additional lot numbers: EL3248. was a sample of the product available to be returned, if requested (Y/N): not provided. Packaging sealed and intact? not provided. Summary of investigation: The initial scope of the investigation was limited to the reported finished goods lot. The final scope was expanded to include the reported finished goods lot EL3248, fill lot EL3231, and the formulated drug product lot EL3224. Manufacturing and packaging batch records were reviewed for the reported complaint lot. Pfizer (site name withheld) QO did not receive photographs or a complaint sample for examination. The complaint was not confirmed. There were no planned or unplanned deviations recorded during the manufacture of the complaint lot and associated manufacturing lots that may have caused a complaint of this nature. A review of the manufacturing records confirmed processing steps were performed within pre-established parameters. All raw materials and amounts used in the manufacture of the batch were of the correct weight and identity. The drug product was stored at controlled refrigeration throughout the manufacturing process and a log was maintained documenting the elapsed time out of refrigeration. A review of the logs confirmed that all times were within allowable limits. The product also requires storage in ultra-low temperature freezers following the packaging of the product. A review of the freezer temperature log for the reported batch confirmed that all freezer temperatures were within allowable limits. The results of all analytical tests performed at the time of lot release confirmed that the batch continues to meet potency specifications.


VAERS ID: 1459401 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-08
Onset:2021-07-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Amnesia, Aphasia, Feeling abnormal, Injection site pain, 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), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Sore arm at site of injection Brain fog? hard to focus and concentrate. Loss of words and short term memory loss.


VAERS ID: 1459662 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: Crustaceans; Scopolamine; Metamizole
Diagnostic Lab Data: None. I was only treated with an antihistamine and topical cream to calm the pruritis. I am passing this information along to see if it is of interest to you and your investigation. I am fine and the pruritis was mild and controlled.
CDC Split Type:

Write-up: Pruritis. On the evening of July 8th presented with itching on my left hand on the side where I received the vaccine. Today, on this July morning, I started having pruritis on my neck. The day the vaccine was applied, I broke out with small pruritis in the stomach area, but it was just a short time and did not itch- but the pruritis from last night and this morning did. I am only sharing this information to help analyze and see if there is an existing correlation. I have been fine up until now and have not had any severe reaction.


VAERS ID: 1461994 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-05
Onset:2021-07-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Blood electrolytes, Chest X-ray, Electrocardiogram, Full blood count
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient using Ventolin prn as needed
Current Illness: None
Preexisting Conditions: Similar episode in Jan 2021 after first vaccination
Allergies: Patient denies
Diagnostic Lab Data: CBC, Lytes , CXR and ECG
CDC Split Type:

Write-up: Patient developed an acute Asthma Excacerbation


VAERS ID: 1468397 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-06
Onset:2021-07-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Dizziness, Dyspnoea, Echocardiogram, Erythema, Fatigue, Heart rate increased, Hyperhidrosis, Migraine, Pain, Paraesthesia, Peripheral swelling, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Congenital heart defect asthma
Preexisting Conditions: Congenital heart defect asthma
Allergies: Sulpha
Diagnostic Lab Data: Antihistamine or elevationMedical facilities sent me a way to get blood work done echo cardio gram awaiting results
CDC Split Type:

Write-up: Pain swelling sweats racing heart beat redness tingling in both legs swelling from thigh to toe purple red skim on legs feeling light headed faint fatigue grasping for are if I did any sort of movement like walking out of breath severe migraines was given prescription for mint furosemide 40 mg because swelling didn?t subside with Antihistamine or elevation


VAERS ID: 1453519 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Slight fever, body aching especially in injection site and back, general fatigue


VAERS ID: 1454064 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-05
Onset:2021-07-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

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

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

Write-up: Patient woke up with a mild rash around her face 2 days following vaccine administration.


VAERS ID: 1454068 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Pt is 36 year old female. Shortly after receiving pfizer vaccine pt reported dizziness and slight tightness of the throat. Lungs clear to auscultation. BP and HR within normal limits 118/72, HR 64. No known allergies. Pt is stable after relaxation techniques were implemented.


VAERS ID: 1454073 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris
SMQs:, Other ischaemic heart disease (narrow)

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

Write-up: Heart pain which intensifies during breathing


VAERS ID: 1454076 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Back pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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: Mild rash on lower back at age 15 after taking first dose of oral vaccine for typhoid fever
Other Medications:
Current Illness:
Preexisting Conditions: Major clincial depression coupled with chronic insomnia, mild anxiety disorder Both manifest themselves in physical ways such as pain
Allergies: Mild cashew allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm on side of injection Tender armpit on side of injection Woke up with fever day after injection Pain in middle of back similar day after injection


VAERS ID: 1454114 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / IM

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

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

Write-up: patient given dose that was unknowingly expired


VAERS ID: 1454118 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / IM

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

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

Write-up: Patient started experiencing periods of sweating and cold/hot sweats with visible beads of sweat on his face.


VAERS ID: 1454166 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot, 2006 developed the flu vaccine.
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Latex, Crab Meat
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states received Phizer 07/07/2021, at 7:00pm experienced extreme dizziness lasting until 11:00pm while entering bed. No other symptoms reported.


VAERS ID: 1454189 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-01-07
Onset:2021-07-07
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Dyspnoea, Fatigue, Impaired work ability, Pulmonary embolism, SARS-CoV-2 test negative, Vaccination complication, X-ray
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (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: B Complex, Alegra, Sudafedrin, Vicanicen (All for allergies)
Current Illness: N/A
Preexisting Conditions: Environmental Allergies, mild arthritis, chronic sinusitis
Allergies: N/A
Diagnostic Lab Data: Rapid Test Covid and PCR (both negative). X-ray, CAT scan
CDC Split Type: vsafe

Write-up: Day after vaccine had extreme version of usual vaccine reactions, took Tylenol, still lingering effects the next day, extremely winded while trying to walk, several weeks later symptoms worsened. Extreme fatigue. 2 weeks after shot, was at elevation and extremely winded (usually not someone with respiratory issues). Missed work, drove to ER, lungs clotted. Doctor did not find any clot in legs, assumed it was Covid but did not have any other symptoms of Covid and negative covid test. 6 month recovery expected. Taking Xarelto coagulant, initially was on Eliquis, but responded poorly now on Xarelto.


VAERS ID: 1454218 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: 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), 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: NKDA
Diagnostic Lab Data: 7/7/21 @ 9:29am BP: 100/60 HR: 74 O2: 99%
CDC Split Type:

Write-up: The patient passed out about 12 minutes after receiving second dose of Pfizer covid vaccination. The patient''s mother got the attention of the monitoring nursing staff at which time the patient was alert and staff elevated patients lower limbs, checked BP, HR, pulse ox, and provided cold compresses and water for patient. After about 5 minutes patient also vomited. The patient was monitored for an additional 20 minutes at which time patient felt better and was able to walk out without assistance.


VAERS ID: 1454232 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-07-07
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Military       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: none
Current Illness: None noted
Preexisting Conditions: None noted
Allergies: NKDA
Diagnostic Lab Data: SARS-CoV-2 N Gene Swab on 7July2021 Virus Detected
CDC Split Type:

Write-up: Pt Tested positive for COVID-19 after vaccination with Janssen Vaccine and is symptomatic for COVID-19.


VAERS ID: 1454248 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / ID

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

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

Write-up: 1110am pt c/o numbness, tingling to back of throat denies tightness, water given, BP116/81 P90 SpO2 97%, 1122am pt states"better" B/P 109/73 P 80 R16 SpO2 97%,


VAERS ID: 1454253 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-07-07
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Military       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: none noted
Current Illness: none noted
Preexisting Conditions: none noted
Allergies: none
Diagnostic Lab Data: SARS-CoV-2 N Gene Swab 07July2021 Virus Detected
CDC Split Type:

Write-up: Pt Contracted COVID-19 on 07Jul2021


VAERS ID: 1454280 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad)

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

Write-up: she started to feel dizziness, sweating, and eyes were rolling upward.


VAERS ID: 1454333 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Dizziness, Hyperhidrosis, Hypotension, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient said he couldn''t hear. He felt dizzy, nauseas, and was sweating. Blood pressure was taken it was low. Gave patient water to drink. Took blood pressure repeatedly. Gave patient something to eat (said he hadn''t eaten & that could be cause of nausea). Patient''s blood pressure went back up to normal. Patient felt fine before he left. I had patient sit longer than the 15 minutes, it was at least 30 minutes.


VAERS ID: 1454356 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre 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: 1205p back to clinic c/o "whoozie" and hands tingling, water given, cool cloth to forehead, BP 147/84 P 73 R 18 SpO2 95% RA, 12:16p pt reports "better" denies any s/s, BP 135/78 P69 R 18 SpO2 96% RA, ambulated with RN to valet parking


VAERS ID: 1454380 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Hypoaesthesia, Pallor, Visual impairment
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received dose of vaccine. About 2 minutes later he started coughing. A minute later he started to hunch over in his chair. I went over to make sure if he fainted that he would not fall. He described numbing and tingling in both arms and face. He was having difficulty seeing complaining of seeing white. We took his Bp it was 116/70 and pulse of 63. Ge appeared pale and white. We called for ems, and by the time EMS arrived he was feeling better his color had returned in his face. Patient was able to walk and leave store under his own power and didn''t need to be transported.


VAERS ID: 1454382 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 7+ LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
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: levothyroxone, flonase prn
Current Illness: none
Preexisting Conditions: hypothyrodism
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was administered second dose of Moderna on day 23 post the first dose, instead of on day 28. Patient tolerated the vaccine well and stayed the full 15 minutes after administration. No visible adverse event occurred.


VAERS ID: 1454403 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 his second dose of the Pfizer vaccine today. He is accompanied with his mother. He had no issues with his first dose. Approximately 15 minutes after administration, patient developed mild itching to his bilateral forearms and on examination, he had a few scattered erythematous papules to his bilateral forearms. He had no other rash. No swelling. He had no other symptoms. No shortness of breath, wheezing, cough or chest pain. No angioedema or throat/tongue swelling. He was talking in complete sentences and eating/drinking without any issues. Lungs were clear. See vitals below. Patient took Claritin last night and Allegra this morning for a history of seasonal allergies. He was monitored for greater then 30 minutes. The pruritus had improved, the rash did not get any worse. Patient and mother felt comfortable going home and had no further questions or concerns. Patient will go to the ED with any severe/acute symptoms. Vitals 07/07/21 1147 07/07/21 1148 BP: 110/80 108/80 Pulse: 80 79 Resp: 16 SpO2: 98% 98%


VAERS ID: 1454427 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

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

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

Write-up: Patient is < 12 years old and recieved the Pfizer COVID vaccine. No adverse events occured while he was waiting his 15 minutes. Discrepancy was noticed after patient left when the orders were being entered into the system


VAERS ID: 1454430 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 RA / IM

Administered by: Senior Living       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: Nursing facility, patient, and patient''s family stated this was patient''s first dose of the Covid vaccine. Vaccine was administered without any issues, however upon entering vaccine into patient''s IMPACTSIIS profile, it was discovered that patient had already received 2 doses of the Pfizer Covid vaccine in March of 2021. Due to the fact that this was not known prior to the patient being administered a Moderna vaccine , patient has now been given 3 total Covid vaccines. Nursing facility was contacted made aware of the situation. Patient will now be monitored by a physician for any adverse effects of the Moderna vaccine and a 2nd Moderna vaccine will not be administered.


VAERS ID: 1454444 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

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

Write-up: Patient requested Janssen J&J vaccine. On form, patient denied receiving any previous COVID-19 vaccine of any kind. Shot was administered. When insurance was billed for payment, claim was rejected, stating that one dose of Moderna was given. When given this information, patient denied receiving any Moderna vaccine. Insurance was contacted, and they gave us the date of first shot of Moderna (3/20/21) and the location of the shot. Information was given to patient, patient still denied receiving any Moderna vaccine and said that "he would contact pharmacy to clarify the misbilling and rectify the situation". After trying to contact patient multiple times on both 7/6 and 7/7, we called pharmacy to clarify if vaccine was really given. Pharmacy responded that patient received both doses of Moderna vaccine (first on 3/20/21 and second dose on 4/17/21). Incident report was started after receiving this information. Patient has not return any of our phone calls in reguard to receiving both the full series of Moderna and the Janssen J&J vaccine.


VAERS ID: 1454452 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA (801)853-3700 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Breast feeding, Throat irritation, Throat tightness, Tongue pruritus
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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Levothyroxine, Prenatal Vitamin, Vitamin B complex, Protonix, Flovent, Qvar, Singular
Current Illness:
Preexisting Conditions: Asthma
Allergies: Ciprofoxacin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got COVID Moderna vaccine at 8:35 AM. 10 minutes post vaccine felt like tongue was itching, 4/10. 12 minutes felt like throat was tight. Given 25mg of benadryl oral, 18 minutes (8:53 AM) felt like throat was itching. Given IM epi 1mg L hip. HR at 68. Felt like symptoms stopped worsening. Given 25mg of benadryl IM. She is breast feeding, discussed risks of antihistamines drying breast milk, but needed to stop reaction, encouraged good hydration and pumping for the next several days). Tightness resolved, itching improving. Vitals stable. 9:20, itching resolved. Dad here to drive her home and stay with her. He is a retired nurse so she feels good in his care. Discussed emergent care if needed. Discussed that since she had COVID and 1 vaccine, will need to pre-treat with antihistamines before 2nd vaccine, and may want to hold on receiving 2nd vaccine for now. The patient had the following order(s) completed today: Adrenalin epinephrine inject Per .1 MG. Obtained on 07/07/2021, Dose 1 mg via Intramuscular on Left buttock and Diphenhydramine hcl Benadryl (50 Per Unit). Obtained on 07/07/2021, Dose 25 mg via Intramuscular on Right buttock.


VAERS ID: 1454497 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Unknown
Current Illness:
Preexisting Conditions:
Allergies: No Known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client was dizzy after couple of seconds of receiving janssen vaccine AT 11: 42 AM. Client had 1st seizure at 11:43 am . client layed on the ground, Vitals recorded at 11:46 am HR 56 R 16, BP 100/60 O2 sat 99. client vomited 6-7 times. Client had 2nd episode of seizure @11:49 am for 6-7 seconds. client''s vitals were normal when checked again. Client continued to vomit and called 911. 911 arrived at 12:50 pm and client was taken to medical facility.


VAERS ID: 1454507 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
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: 1454508 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle tightness, Refusal of treatment by patient, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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:
CDC Split Type:

Write-up: PATIENT MENTIONED FEELING TIGHTNESS IN THE BODY. PATIENT FELT THAT THE MEDICATION WAS "STUCK IN THE STOMACH". PATIENT WAS MONITORED DIRECTLY BY THE PHARMACIST FOR SIGNS AND SYMPTOMS. PT WAS OFFERED TO HAVE THE 911 CALLED BUT PATIENT REFUSED. PT WAS MONITORED UNTIL SHE FELT STABLE ENOUGH TO LEAVE.


VAERS ID: 1454513 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Pt fainted...I went across the register where she was... she was fully responsive the entire time. She mentioned that she did have very low blood pressure and anticipated that she might faint. She was responsive to all my questions and was fully cognitive. She laid down little bit with legs raised.. drank some water... Sat in the chair and was Ok the entire time. Spoke with her and she said she was ok.


VAERS ID: 1454518 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: vomitting-Mild, Systemic: Vomiting-Mild


VAERS ID: 1454525 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Palpitations
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Patient developed dizziness, trouble breathing and heart palpitation 5 min after injection. Patient reported not having breakfast before coming, may relate to low blood sugar.


VAERS ID: 1454526 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-14
Onset:2021-07-07
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 RA / SC

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Human chorionic gonadotropin, Ultrasound pelvis
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin Probiotic Vitamin B
Current Illness: None
Preexisting Conditions: Eczema
Allergies: Hydrocodone-Tylenol
Diagnostic Lab Data: pelvic ultrasound and bHCG to confirm diagnosis
CDC Split Type:

Write-up: Patient was newly pregnant when she received her first Covid vaccine. Was later diagnosed with a missed miscarriage


VAERS ID: 1454542 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, 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), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: the patient was a 15 year old male , came in for the first dose of pfizer vaccine, after getting the vaccine , the patient suddenly fainted for a moment, but came back in less than a minute, he was still little dizzy for couple minutes after that, but was perfectly ok after 5 minutes, he also threw up, no other allergic reactions noticed, . mom had mentioned that he hadn''t had anything to eat in the morning and he was really nervous too, that might be the reason she said. but we did monitor the patient for over 30 minutes and he was perfectly fine before he left


VAERS ID: 1454556 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Patient''s mother misinformed us about patient''s age. Listed on form as incorrect DOB when actual birthday is exact date. Mother verbally confirmed the incorrect birthday several times during the visit. Issue was discovered at the time of billing when the insurance informed us of the exact date birthday. When we called the mother back to confirm which is correct, she admitted to putting the wrong birthdate on the form. We informed her that the patient cannot get a follow up immunization until after the actual date of birth.


VAERS ID: 1454611 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Confusional state, Eye movement disorder, Head titubation, Heart rate increased, Panic attack, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), 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: asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 19 year old girl received the shot and was sitting out in front of the pharmacy. She had told me she was very anxious about getting it. Her mother screamed for us, so we rushed out and had a tech call ED. When we went out there, she was hunched over forward as her mother was holding her. She appeared to be having a seizure lasting around 10 seconds and was confused when she stopped. Her mother told us before that happened, her head fell back and her eyes were rolled back. Later, the patient told us she was just having a panic attack. The paramedics arrived and checked her out. All seemed to be fine, with the exception of a fast heartbeat as expected. They convinced her to go to the hospital to be checked out. I will follow-up with her mother this evening.


VAERS ID: 1454632 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Tachyarrhythmia terms, nonspecific (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: Two Tylenol for vaccination appointment to Tylenol or ibuprofen to a surgery later in the day or headache.
Current Illness: Nki
Preexisting Conditions:
Allergies: Nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Elevated fluttering heart rate 90 BPM while resting blood pressure 135/80. Fever 101?


VAERS ID: 1454649 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
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: zoloft 50mg daily
Current Illness: none known
Preexisting Conditions: anxiety/depression
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient came in for 2nd covid vaccine administration; mom did not have card with her and administered vaccine and realized patient was 1 week early for 2nd vaccine; pt waited for 15 minutes in office and did not complain of any adverse effects. Mom notified and informed that patient does not need 3rd vaccine;


VAERS ID: 1454652 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (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: Symbicort, cefepime, Synthroid, Tamsulosin, vancomycin, Tylenol, nicoderm
Current Illness: Hyponatremia, COPD, hypothyroidism, depression, pneumonia, hematuria, malnutrition, sinus tachycardia, leukocytosis, constipation, fracture, iron deficiency anemia, tobacco use disorder, osteoporosis
Preexisting Conditions: COPD, depression, hypothyroidism
Allergies: Fish containing products
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pulmonary embolism treated with heparin


VAERS ID: 1454657 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hyperhidrosis, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Janssen COVID-19 vaccine EUA. Technician administered Janssen Covid-19 vaccine and upon removal of needle patient began to tense up and slide down chair. He began to shake and sweat. Technician asked patient if he was okay and his wife responded "no, he is passing out." The technician then went to get the pharmacist. The patient passed out for 5-10 seconds and then began coming back to. Patient was provided with ice packs and cold water. Pharmacist had the patient lie down with feet elevated until patient felt well enough to stand back up. He was comfortable to leave and divulged that he takes midodrine daily for his vagovasal syncope and has a history of passing out every time he is injected with a vaccine or has a blood draw.


VAERS ID: 1454664 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Heart rate decreased, Pruritus
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ripiprazole Ibuprofen Armadafinil Daily Vite Vitamin C Clopidogrel Metoprolol Benzonatate Vitamin D3 Doxazosin Mesylate Dicyclomine Azelastine Ventolin Symbicort Trintellix Hydrocodone Acetaminofen Montelukast Sodium Simvastatin
Current Illness: N/A
Preexisting Conditions: Arthritis Fibromyalgia Mitral Valve Prolapse HTN Stroke IBS Narcolepsy Carpal Tunnel
Allergies: PCN Keflex Celebrex Viox Iodine Levafloxacin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Dose administered at 1346 on July 7, 2021 into left arm. At 1401 patient complained of chest heaviness and some scratchiness. Gave patient water. At 1405 patient was encouraged to take 2 puffs of her Albuterol Inhaler. Complaints of chest tightness did not subside and patient continued to be undecided if it was related to her asthma or not. Blood pressures taken over the course of the next hour were 176/96, 188/98, and 184/98. Pulse oximetries were 97%-98%. Heart rate dropped from 80s to 70s to 60s. At 1515 a medical first response was called for the patient who was transferred to the Emergency Department for ongoing observation.


VAERS ID: 1454665 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache
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: Headache 15 mins after vaccine


VAERS ID: 1454671 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site reaction, 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? 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: pt was given 50mg Benadryl po at 0915 and watched for an additional 20 minutes.
CDC Split Type:

Write-up: pt started to complain of itching to his left arm. pt was noticed to have a couple welps around the injection site and red raised hive on his upper lip


VAERS ID: 1454707 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / SC

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

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

Write-up: Patient complained of bilateral arm itching about 14 minutes after vaccine. No respiratory distress noted. No rash noted. O2 sats were 98% on RA throughout event. She was given Benadryl 25 mg PO liquid. Instructed to call 911 if she has further distress at home.


VAERS ID: 1454709 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-01
Onset:2021-07-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: bright blood clot from nose


VAERS ID: 1454748 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW018 / 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? 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: VACCINE WAS GIVEN MORE THAN 6 WEEKS AFTER THE FIRST DOSE


VAERS ID: 1454756 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

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

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

Write-up: Patient was given Pfizer vaccine on first dose and inadvertently give Moderna on 2nd dose. No adverse event occurred.


VAERS ID: 1454758 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 RA / IM

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

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

Write-up: The patient called an hour after receiving the shot stating she could feel her throat swelling slightly and having a feeling of numbness throughout her throat and tongue. She said she had no trouble breathing, swallowing fluids or any chest pain. It was recommended to take 2 benadryl tablets now (4:45pm) and 2 tablets before she goes to bed. I had the father get on the phone as well, tell educate him on monitoring her breathing. She was urged to see a doctor or call 911 if breathing issues start or swelling gets worse. I asked her to call the store first thing tomorrow morning when we open to see if there was any relief from the benadryl or if symptoms got worse.


VAERS ID: 1454759 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 RA / SYR

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

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

Write-up: Patient was given initial dose on 6/1/2021, dose given at the time was Pfizer. Today, July 7, 2021 patient arrives for 2nd dose, nurse reviewed papers completed by father which states Moderna and the child is given Moderna instead of the Pfizer vaccine. Patient was monitored for the 15 minutes and parent was notified of the error.


VAERS ID: 1454761 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

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

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

Write-up: Pt received 1st dose of covid-19 vaccine 89 days after receiving monoclonal antibody treatment. One day early from CDC recommendations. No adverse reactions.


VAERS ID: 1454767 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW018 / 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? 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 GOT VACCINE MORE THAN SIX WEEKS AFTER THE FIRST DOSE


VAERS ID: 1454777 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received a 3rd dose of vaccine in error.


VAERS ID: 1454781 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, flexeril, Voltaren doxycycline, Lasix, neurotin, atarax, plaquenil, Flonase, allergra, epi pen, Lidocain, Mag oxide, ativerrt, singulair, Minipress, pyridium Phenergan, Zoloft, Verapamil
Current Illness: Obesity, pelvic pain, Gerd, Biliary colic, chronic pain, Rash, anxiety, Chronic diarrhea, vertigo, asthma, Migraines, PTSd,, Depression, IBS, Endometrosis
Preexisting Conditions: same
Allergies: Aspirin, Beef, Motrin, Nsaids, PCN, soy, sulfa, Trazadone, Wheat, Egg Ahesive, Gluten, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: throat swelling, stridor, redness, itching,


VAERS ID: 1454791 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation 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: unk
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The patient was administered an undiluted dose of the pfizer vaccine


VAERS ID: 1454792 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait disturbance, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pain in left leg. Unable to fully walk due to pain in left leg from the foot to the butt cheek when trying to step down fully.


VAERS ID: 1454796 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A RA / SYR

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

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

Write-up: Immunization was given to a 16 year old


VAERS ID: 1454807 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna Covid-19 vaccine administered to a 17 year old. no resulting reactions or problems noted. reported to parent and consulted CDC protocol


VAERS ID: 1454809 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Other       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 Noted
Current Illness: None Noted
Preexisting Conditions: None Noted
Allergies: None Noted
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. c/o of feeling Light Headed. Stated "I think its more of a mental thing" Pt . vitals as follows: @12:24 pm B/P 150/85 Hr 65 R 16 02 97% on RA. @ 12:38 pm, vitals as follows: B/P 138/80 HR 64 R 14 02 98% Pt. stated she felt better , left at 12:56 pm in stable condition. Advised to follow up with PCP if new or worsening symptoms occur.


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