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

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



Case Details (Reverse Sorted by Onset Date)

This is page 44 out of 8,010

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VAERS ID: 1757576 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-15
Onset:2021-10-03
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Angina pectoris, Cardiac discomfort, Exercise tolerance decreased
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: Pain and pressure around heart when running - feels similar to Myocarditis symptoms Have run half marathons early for a few years Ran half a mile - first time - 14 days of first dose Pain and pressure have reduced but continue to exist after 12hrs Haven''t seen doctor yet


VAERS ID: 1762705 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-21
Onset:2021-10-03
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Ear discomfort, Headache, Tinnitus, Vertigo
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Vestibular disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: N/A
Preexisting Conditions: Hashimotos, lichen Sclerosis
Allergies: Not that I?m aware of
Diagnostic Lab Data: Just happened and waiting to see an ENT
CDC Split Type:

Write-up: Almost 2 weeks to the minute I experienced SUDDEN, Onset tinnitus, pressure, intense headache. Followed by dizziness, vertigo, confusion. The tinnitus has remained since the start of it, but the confusion has started to taper. I?ve read HUNDREDS, THOUSANDS with this same experience?! I refuse to get the second. This experience was scary as hell and no one warned any of us! :(((( No one knows how long this will stay?!


VAERS ID: 1784535 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-04
Onset:2021-10-03
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3005235 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic shock, Blood pressure decreased, Depressed level of consciousness, Dyspnoea, Eyelid oedema, Malaise, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Periorbital and eyelid disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Depressed level of consciousness; Anaphylactic shock; Eyelid oedema; Malaise; Urticaria; Dyspnoea; Blood pressure decreased; This case was received via regulatory authority (Reference number: JP-TAKEDA-2021TJP103648) on 06-Oct-2021 and was forwarded to Moderna on 11-Oct-2021. This case, initially reported to the regulatory authority by a physician, was received via the regulatory authority (Ref, v21128732). On 04-Sep-2021, the patient received the 1st dose of this vaccine. On an unknown date, body temperature before vaccination: 36.1 degrees Celsius. On 02-Oct-2021, at 16:00, the patient received the 2nd dose of this vaccine. At 22:00, the patient felt an irritated sensation in the extremities that wheal could occur. The patient went to bed with doing nothing. On 03-Oct-2021, at 07:00, on awakening, the patient experienced eyelid oedema and intense malaise. Around 12:00, rash developed on the extremities, face, and abdomen with itchy. At 13:00, the patient was transferred to a medical institution because dyspnoea also developed. On arrival, decreased level of consciousness was noted, blood pressure could not be measured, and the radial artery was not palpable. The patient was diagnosed with anaphylactic shock, and adrenaline was injected intramuscularly. The skin eruption remained afterwards, but blood pressure and consciousness level recovered. The patient was transported to the reporting hospital. There was no digestive symptom. After admission to the hospital, the patient was treated with antihistamines and steroids, and the symptoms were resolving. On 05-Oct-2021, recovery of symptoms was confirmed. The patient was discharged from the hospital. The outcome of eyelid oedema, malaise, urticaria, dyspnoea, depressed level of consciousness, blood pressure decreased, and anaphylactic shock was reported as resolved. Follow-up investigation will be made. Company Comment: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter''s Comments: The timing of onset was late, but the symptoms were severe, so this case was reported.; Sender''s Comments: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship. This case involves a 14year-old female subject with no known medical history or concurrent medical conditions who one day after her second vaccination developed the serious unlisted adverse events of depressed level of consciousness, eye lid oedema, malaise, urticaria, blood pressure decreased, dyspnoea and anaphylactic shock. 2 days after treatment in the hospital with antihistamines and steroids, all symptoms resolved. The benefit-risk relationship of mRNA-1273 is not affected by this report.


VAERS ID: 1755612 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-10-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Liothironine, esomaprazole magnesium, loratadine, diphenhydramine HCL, Vitamin D 20,000, niacin, PreserVision AREDS 2
Current Illness: None
Preexisting Conditions: Asthma, Depression, Anxiety, obesity, SRC-1 mutation
Allergies: Milk 1%
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I suddenly got a red rash or flush after taking my nightly medications. This has happened a few other times this year, but not so closely after taking the covid-19 vaccine.


VAERS ID: 1756408 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: armour thyroid, xyzal, 3fluticasone prpionate, biotin, red yeast rice, zinc, bioshield md ( immune support) and vitamin d3
Current Illness: none
Preexisting Conditions: hypothyroidism
Allergies: sulphur drugs ( bactrum), entex, and pseuphederine
Diagnostic Lab Data:
CDC Split Type:

Write-up: rapid heart beat and chest tightness


VAERS ID: 1756500 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GABAPENTIN 300MG, AMLODIPINE, OMEPRAZOLE, ATORVASTATIN
Current Illness:
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: 108 degree fever this AM, treated with ibuprofen and tylenol and ice, headache


VAERS ID: 1756519 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Fatigue, Injection site pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: None
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe pain at injection site. Fever. Aches. Cough. Fatigue.


VAERS ID: 1756556 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-28
Onset:2021-10-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown at this time
Current Illness: Diabetes
Preexisting Conditions: diabetes
Allergies: NKDA that I recall
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had a diagnosed CVA


VAERS ID: 1756561 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Vaccine positive rechallenge
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash; swollen face; eyes swollen almost shut; dry, scaly skin on eyelids & undereyes; SOB, extreme trouble breathing; post nasal
Other Medications: Venlafexine; busiprone; alpralozam
Current Illness: Allergic reaction to covid 19 vaccine dose #1
Preexisting Conditions: Chronic migraine disorder Generalized anxiety
Allergies: ALL Triptans; Prochlorperazine; Promethazine; ALL Phenothiazines.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash; swollen face; eyes swollen almost shut; dry, scaly skin on eyelids & undereyes; SOB, extreme trouble breathing; post nasal drip; lung congestion.


VAERS ID: 1756571 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 62OF21A / 2 RA / SYR

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

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

Write-up: Rash over stomach, back and chest


VAERS ID: 1756581 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 AR / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Photophobia, Somnolence, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen 800 milligrams ( 3 times a day) , Tylenol rapid release 500 milligrams times two every 6 hours
Current Illness: No prior illnesses until one day following the vaccine.
Preexisting Conditions: No chronic conditions
Allergies: Ativan Hadol Zoloft Glitter Pork
Diagnostic Lab Data: No medical test
CDC Split Type:

Write-up: I received the vaccine on 10/01/2021, I waited 15 minutes after receiving the first does. After driving home, I became tired ( sleepy). The following day 10/02/2021 I woke up with a massive headache, blurred vision, sensitivity to light, dizzy and some weakness during ambulating. I took two Tylenols and one Ibuprofen. symptoms were alleviated.


VAERS ID: 1756590 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Headache, Nausea, Palpitations, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Tiredness, chills, headache, heart palpitations, feeling weak, shakiness, fever (100.9), and nausea


VAERS ID: 1756602 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aleve taken at least fours before vaccinated
Current Illness: Cold, verified COVID negative. Secondary polycythemia Vera, cysts found on lungs, liver, and ovaries. Testing still in progress on causes.
Preexisting Conditions: Asthma
Allergies: Medrol dose pak causes rash
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Broke out in hives an hour after vaccination, went back to the pharmacist where I was given two Benadryl, and told to stay there on watch. After Benadryl kicked in, pharmacist sent me home with an Epi pen to be on the safe side.


VAERS ID: 1756606 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 RA / IM

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

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

Write-up: Pt c/o dizziness. Pt placed on yoga mat. Pt drank some juice and ate some cheetos. Pt states that he is diabetic and did not eat breakfast. Pt reports that his blood glucose monitoring kit is at home. BP=162/96, HR=92. Ice pack placed on forehead. After laying down for approximately 10 minutes, pt states that he felt better and was ready to go home.


VAERS ID: 1756610 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin, Calcium D3. Liquid IV.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Very swollen lymph node on left armpit about 3 inches.


VAERS ID: 1756673 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dysphagia, Dyspnoea, Nervousness, Pruritus
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: stated vomiting after flu shot several years ago. Patient''s age at event unknown.
Other Medications: Unknown
Current Illness: None noted
Preexisting Conditions: None noted
Allergies: Eggs
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was administered vaccine and stated she was nervous but no other concerns regarding the vaccine. Patient''s timer was set and patient was instructed to sit out in the chairs in front of the pharmacy to be monitored. At approximately 11:10 AM, patient approached the counter. I (pharmacist) asked the patient if she was having any problems. She nodded her head yes. I then took her into the office and asked her what was going on. She stated she felt like her chest was tightening and she couldn''t breathe. She also stated that she felt like she couldn''t swallow. Patient''s mother who was with her administered the patient''s self-prescribed epipen. Patient sat in chair while one of my technicians contacted 911 to have the ambulance sent to the store. Patient remained in chair and was itching her right arm as well as stating she felt like she couldn''t swallow. Ambulance arrived and took the patient to the emergency room for further evaluation.


VAERS ID: 1756679 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, 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: Latanoprost eye drops, B6, Calcium, B12, Biotin, Colace, D
Current Illness: none
Preexisting Conditions: none
Allergies: Sporonox, Diflucan
Diagnostic Lab Data: none
CDC Split Type:

Write-up: sore arm but the next day pain in underarm axilla - the pain continues - this is the 2nd day of it


VAERS ID: 1756685 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-29
Onset:2021-10-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / -

Administered by: Military       Purchased by: ?
Symptoms: Aphthous ulcer
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: dental pain
Preexisting Conditions: hypertension, hyperlipidemia, CKD2
Allergies: penicillin
Diagnostic Lab Data: refused labs while in emergency room
CDC Split Type:

Write-up: aphthous ulcer to distal, right-sided tip of tongue, developed two days after getting vaccine


VAERS ID: 1756696 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lymph node pain, Lymph node palpable, Lymphadenopathy, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: resting Tachycardia 10/1 hr 120 Swollen lymph nodes right side 10/2 armpit and next. Painful and large to palpate


VAERS ID: 1756704 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Flushing, Musculoskeletal discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), 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: Hormone patch
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Dizziness, pressure on back of neck, flushed. EMS attended and cleared patient.


VAERS ID: 1756705 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pharyngeal paraesthesia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Shrimp
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Around 10:28, client expressed tingling in the throat and wheezing. EMS attended. Vitals BP 134/87, O2 99%. EMS released customer at 10:33, which he wanted to remain under observation for 30 minutes more. Client stated he was fasting.


VAERS ID: 1756713 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Fatigue, Headache, Injection site pain
SMQs:, Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

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

Write-up: Headache, achy joints, chills, Fatigue, Weakness Injection site tenderness


VAERS ID: 1756762 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO158 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Asthenia, Extra dose administered, Loss of personal independence in daily activities
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Medication errors (narrow)

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

Write-up: Weak, temp. 98.7 Not able to perform normal tasks This is the Booster in a series of 3. First two doses were given 2/27/21 and on 3/20/21 No visit to the doctor or other medical facility


VAERS ID: 1756765 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 3 LA / SYR

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

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

Write-up: Severe shivering and chills, teeth chattering, cold extremities, fever, and nausea that went on for 2 hours.


VAERS ID: 1756779 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

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


VAERS ID: 1756787 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / SYR
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. UNKNOWN / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: xeralto, metoprolol, gabapentin, multivitamin, prevacid, claritin
Current Illness: none
Preexisting Conditions: cerebral aneurysm, obesity, mild asthma
Allergies: latex sensitive
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: swollen painful glands in neck and under left arm *not sure of flu shot info.


VAERS ID: 1756789 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / N/A LA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1756790 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-273-10 / 2 LA / IM

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

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

Write-up: Headache. Sore all over fever


VAERS ID: 1756806 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

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

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

Write-up: dizzy, nausea, hot/cold


VAERS ID: 1756815 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Muscle spasms, Muscle tightness, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Assessed patient''s pulse, which was normal.
CDC Split Type:

Write-up: Immediately after administering vaccine, patient leaned up against the wall. Patient was pale. Individual that accompanied patient was unable to get a response from him, though his eyes were open. We shouted his name several times. His muscles tensed/clenched/spasmed. This lasted about 30 seconds. After 30 seconds patient responded, and asked for water.


VAERS ID: 1756821 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ74SAB / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carvedilol, methenam hip
Current Illness: none
Preexisting Conditions: osteoporosis, chronic uti, hypertension
Allergies: tetracyclines
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient given pfizer instead of moderna as booster/3rd dose/additional dose...patient did not have covid card at time of shor and patient and patients rep assured us it was pfizer then presented after shot given with card w/ moderna listed


VAERS ID: 1756828 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 7H994 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Facial paralysis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirena IUD Hydro-chlorothiazide ibuprofen Cyclobenzaprine
Current Illness: unknown
Preexisting Conditions: HYPERTHYROIDISM HTN (HYPERTENSION) GRAVES DISEASE
Allergies: NKDA
Diagnostic Lab Data: CT head 10/2/2020
CDC Split Type:

Write-up: left sided facial numbness and droop


VAERS ID: 1756838 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-25
Onset:2021-10-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Loss of consciousness, Oral mucosal blistering, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Severe cutaneous adverse reactions (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: patient reports - developed fever with sweats and chills the night following the injection. - lost consciousness (not fell asleep) for undetermined time - developed painful blisters on roof of mouth which have mostly resolved at time of reporting. - made phone report on 10/2/21 at 2:30 PM and accepted RPh offer to report the event


VAERS ID: 1756842 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / IM

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

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

Write-up: Client light headed/dizzy, sweaty within a couple minutes after vaccination. Had client lay on floor/feet elevated. Initial BP 134/79, p: 70-easy to palpate. Symptoms resolved. Observed additional 30 minutes. Feeling better, declined further evaluation and released. Vitals before leaving: 122/75, pulse 75, rr 16.


VAERS ID: 1756843 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Pallor, 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: None
Current Illness: The patient & female accompanying him said he hadn''t eaten today & he was also dipping tobacco. No other illnesses.
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I administered the imz to pt & then told pt to wait in designated waiting area for 15 minutes. During that time, the woman accompanying the pt started yelling that she needed help. I was on the phone with another pt & in the time it took me to put that pt on hold, my certified immunizing tech responded to pt. The pt had slummed over to the floor & had fainted. I responded immediately after putting telephone customer on hold. I told my staff to call 911, had the tech bring me the emergency kit and paged management. I checked the pt''s pulse and he immediately came to. He was clammy all over and pale in color, but his color came back to him quickly. After making sure he was ok, I sat the pt upright and gave him a few sips of water and a cool compress. He then moved himself to a bench and then a chair. EMS and management responded. The pt insisted that he was fine, but reluctantly let EMS check his blood pressure and management do their report. He was cleared and left on his own.


VAERS ID: 1756861 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3Q184 / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Headache, Malaise, Myalgia, Pyrexia, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar responses to first and specifically 2nd dose of series
Other Medications: Vitamin D, lecithin
Current Illness: Cold 2 weeks prior, covid negative
Preexisting Conditions: None
Allergies: Adhesive tape
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever over 101.6 for over 23 hours, myalgias and malaise, headache


VAERS ID: 1756863 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 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: melatonin, ashlyna
Current Illness: UTI
Preexisting Conditions: n/a
Allergies: pineapple, tomatoes, grapefruit
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient was given Moderna as a 13 year old, was told by manager that 2nd dose was to be given per CDC recommendations since patient was over the age of 12.


VAERS ID: 1756867 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: 57
Other Medications: None
Current Illness: Injection site reaction to initial dose
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Chills severe headache. Body aches pain at injection site Fever 102. Still for over 24 hours. Headache won?t quit. 8/10


VAERS ID: 1756874 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

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

Write-up: PATIENT FALSIFIED HER ADMINISTRATION FORM AND VACCINE INTERVIEW CLAIMING SHE HAD NEVER HAD THE COVID VACCINE BEFORE. UPON BATCH FILLING HOURS LATER, CMS REJECTED STATING SHE ALREADY RECEIVED THE J&J VACCINE. LOOKING AT SYSTEM, PATIENT RECEIVED VACCCINE IN MARCH 2021. WILL CONTACT MD MONDAY


VAERS ID: 1756892 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle spasms
SMQs:, Dystonia (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 mentioned he had a cramp in his left thigh. Declined pain medication. Took blood pressure. Offered patient cold water. Advised to be observed for additional 30 minutes. Patient felt better and was cleared by Nurse.


VAERS ID: 1756900 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, 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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Client misrepresented herself when asked if she had received previous vaccinations. Client stated that she has not received any type of COVID 19 vaccinations. No acute adverse reaction noted.


VAERS ID: 1756923 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Injection site rash, Injection site urticaria, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 10 minutes post 2nd Pfizer (30155BA) pt started complaining of "itching" to injection arm- L arm. RN noted redness with 3-4 areas of hives/rash. Pt denied any itching, swelling, rash anywhere else on her body. She also denied any respiratory symptoms. There were no other physical areas upon assessment with any itching, swelling or rash. Ice applied to injection site, bandaide removed, however after further pt developed more hives/rash to the injection site. ER MD notified and verbal orders for Ceterizine 10mg po was given. Pt tolerated really well and there was a decrease in itching, swelling and rash/hives. After 30 mins of monitoring and no worsening of symptoms, nor was there any new development of symptoms, ER MD advised it was safe to discharge pt home with instructions to mom to go to ED if she develops new symptoms or her current symptoms do not improve, changes or worsens.


VAERS ID: 1756928 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysphagia, Throat tightness, Tremor
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sulfa
Other Medications: 2 Tylenol, 1 Benadryl 45 minutes prior to vaccine
Current Illness:
Preexisting Conditions: High Blood pressure
Allergies: Acute delayed reaction to Sulfa. Anaphylaxis immediately following.
Diagnostic Lab Data: Vitals were taken and all checked out before the paramedics left.
CDC Split Type:

Write-up: At 11:ooam this morning I started to feel light headed a it eventually progressed to trouble swallowing, throat closing and uncontrollably shacks. Administered the Epi pen myself at about 11:20 right before the paramedics showed up 5 minutes later. Paramedics stayed until the Epi wore off and the shacks stopped.


VAERS ID: 1756963 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Blood gases, C-reactive protein, Chest pain, Dyspnoea, Electrocardiogram, Fibrin D dimer, Flushing, Full blood count, Injection site pain, Metabolic function test, Paraesthesia, Troponin
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspar - Taken for first time, after COVID vaccine, and before onset of symptoms.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: EKG, CBC, BMP, Troponin, CRP, D-dimer, VBG.
CDC Split Type:

Write-up: Patient presented with complaints of mild left local injection site pain at the site, but also anxiety, chest pain, shortness of breath, tingling and flushing.


VAERS ID: 1756964 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Feeling hot, Headache, Pain, Pharyngeal swelling, Rash, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nexus and Linsinipril.
Current Illness: Covid 19 on 8/30/2021
Preexisting Conditions: Acid reflex/Barrett disease. High blood pressure.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Aches in whole body, headache, considerable swelling of throat and neck, coughing, rash on sides of face from ears to chest. Face feeling warm without fever.


VAERS ID: 1756970 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N9ne
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Throughout thy day on October 2, my pulse rate was getting in the 120''s for long periods of time. It would sometimes go down to around 1 10 but it never got down to normal. I had some lorazepam for anxiety that I had not taken in monrhs so I took one pill and it brought my pulse rate dowm to the upper 70''s to low 80''s. I feel like since I received the Pfizer Booster shot yesterday, it is probably related to that.


VAERS ID: 1756973 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Immunisation, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Pt given a vaccine from a vial that had been opened more than 24 hours before. No ADRs reported. Vaccination repeated with a "fresh" vial same day.


VAERS ID: 1756974 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

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

Write-up: fever over 102 chills headache passed out for approximately 30 seconds. symptoms started 14 hours after administration


VAERS ID: 1756976 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metropolol, simvistatin Multi vitamin, co-Q10, vitamin d, fish oil
Current Illness: None
Preexisting Conditions: Hypertrophic cardiomyopathy
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Increasing Fever. Began at 99.7 at 9:00 on 10/1/21 Now 10/2/21 at 8:00 temp is 101.7


VAERS ID: 1756978 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-08
Onset:2021-10-02
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Cerebral palsy, Dyspnoea, Electrocardiogram, Fibrin D dimer increased, High-resolution computerised tomogram of lung, Hypoxia, Muscle strain, Oxygen saturation decreased, Pulmonary embolism, Tachycardia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: METFORMIN, GLIPIZIDE, UNKNOWN DIURETIC
Current Illness: NONE
Preexisting Conditions: DM, HTN
Allergies: NKDA
Diagnostic Lab Data: CTPE: multiple L-sided pulmonary emboli with cardiac strain, elevated d-dimer to $g500
CDC Split Type:

Write-up: Pt received 2nd dose of Pfizer on 09/08/21, with development of severe L-sided CP and SOB x3 days ago. Pt tachycardic and hypoxic on arrival to ED. Pt desatted to 89% on RA, placed on 2L NC to improve sats to 94%. Pt tx with IV narcotics/antiemtics, EKG and CTPE done. As pt has new oxygen dependence, pt requiring transport to higher level of care. Pt still in ED, pending transfer to outside facility.


VAERS ID: 1756982 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin Senokot Prednisone Doxycycline Ferrous Sulfate
Current Illness: unknown
Preexisting Conditions: Sarcoidosis Anemia HTN diabetes
Allergies: NKA
Diagnostic Lab Data: ED visit
CDC Split Type:

Write-up: lightheaded hypotension diaphoretic


VAERS ID: 1756984 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Aspiration, Cough, Dizziness, Dyspnoea, Heart rate irregular, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient received 2nd dose of COVID-19 Moderna vaccine. Monitored patient for 10 minutes and she reported feeling faint and dizzy. She had not eaten since breakfast. Patient slid out of chair. RN helped ease to floor; observed gasping. The patient became unconscious. RN called 911, initiated CPR and administered EpiPen. Patient responded to CPR and EpiPen. She began aspirating. She was turned to her side and began coughing. Her pulse was irregular. The patient continued to be monitored and vitals obtained: RR 22, pulse 102, SPO2 97, BP 190/56. An ambulance arrived; patient was alert and oriented.


VAERS ID: 1756985 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-27
Onset:2021-10-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013OBA / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Blood test, Ultrasound scan, Vaginal haemorrhage
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Propranolol 20 mg x 2 Metformin 1000 mg x2 Vyvance 20 mg Omaperzole 40mg Zrytec Probiotic Thyroid energy (b 6, iodine, zinc, selenium, copper, folate ) Latuda 80 mg Vitamin d 5000i Sodium bi carbonate
Current Illness:
Preexisting Conditions: Polycystic ovarian syndrome Obesity Pandas Gerd Depression Generalized anxiety disorder
Allergies:
Diagnostic Lab Data: Sonograms , blood work
CDC Split Type:

Write-up: Spontaneous vaginal bleeding


VAERS ID: 1756988 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK 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: patients received 1st dose Pfizer on the 09/25/2021 at a difference pharmacy. Patient requested a J&J vaccine at 10/02/2021 and administered at 4:30pm. Patient did not show us the previous vaccine card or let us know they received a Pfizer vaccine prior to visit. Patient was called right after discovery on 10/02 at 4:45pm and will inform them of any further information of the event.


VAERS ID: 1756993 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

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

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

Write-up: Upon sitting down in observation area, client became pale, diaphoretic, and reported feeling dizzy. Client assisted into cot to lie down. Provided water and granola bars. Advised to report adverse effects to primary care provider and VSAFE. Advised client to call 911 or seek emergency medical services if side-effects worsen or severe side-effects develop. Client observed for 30 minutes and vital signs taken every 5 minutes. Adverse effects completely resolved after 30 minutes and client left site unassisted with steady gait.


VAERS ID: 1757008 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-08
Onset:2021-10-02
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

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

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

Write-up: NO REPORTED ADVERSE EFFECTS. IMMUNIZATION CONSENT FORM, WHICH WAS FILLED OUT BY PATIENT OR SOMEONE IN FAMILY ON-LINE, ERRONEOUSLY HAD THE INCORRECT BIRTHDATE. PRODUCT TO BE GIVEN SELECTED ON-LINE WAS MODERNA. I SPOKE TO Patient''s MOTHER THIS EVENING. SHE SAID SHE WAS CONTACTED BY SOMEONE ELSE THIS WEEK, AND WAS TOLD PER CDC RECOMMENDATION, IF THE INCORRECT PRODUCT WAS ADMINISTERED, THE SECOND SHOT SHOULD BE THE SAME PRODUCT. WE PLAN TO GIVE A SECOND DOSE OF MODERNA THIS WEEK.


VAERS ID: 1757011 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry eye, Dyspnoea, Eye swelling, Eyelid exfoliation, Gait disturbance, Rash
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Corneal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Around 10 hours after Vaccine pt said had swollen eyes. Dry and scaley around her eyes and eyelids. Skin rash. Pt said had hard time walking upstairs. Trouble breathing. Breathing was labored. I told pt she needed to seek medical attention.


VAERS ID: 1757013 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-05
Onset:2021-10-02
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Ultrasound foetal abnormal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins
Current Illness: N/a
Preexisting Conditions: None
Allergies: Ceclor, pediazol, rhondec DM
Diagnostic Lab Data: Ultrasound
CDC Split Type:

Write-up: Miscarriage occurred that same week


VAERS ID: 1757015 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-27
Onset:2021-10-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Ear pain, Headache, Influenza like illness, Joint range of motion decreased, Oropharyngeal pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levythyroxine, peptide, naltrexone, wellburtron
Current Illness: Hashimotos, Rynauds disease, Graves? disease, food allergies, irritable bowel syndrome
Preexisting Conditions: Chronic and all were disclosed. Doctor said don?t get vaccine. Work required it or get fired.
Allergies: Allergies to most foods and gluten, allergic to most pain killers
Diagnostic Lab Data: No medical tests. I did report it to doctor. They said to take Tylenol and Advil.
CDC Split Type:

Write-up: Soreness in arm, could not lift arm for 48 hours, flu like symptoms started that night, on day 6 after vaccine still have sore throat, headache, severe stomach pains, ears ache, sore throat.


VAERS ID: 1757022 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Insomnia, Intermenstrual bleeding, Pain, Pain in extremity, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Breakthrough bleeding, when I have an IUD and haven?t had a period in over 3 years, sore arm, body aches, severe body aches, headache, sleeplessness, fever, aches


VAERS ID: 1757029 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole 20mg Norco 7.5/325mg HCTZ 25mg Vyvanse 7mg
Current Illness: RSV
Preexisting Conditions: GERD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 101.5 Chills Body aches Headache


VAERS ID: 1757046 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen; finesterade; Atorvastatin; diclofenac; turmeric; resveretrol; docusate sodium
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Swollen lymph node in groin; tender and painful to the touch ; seemingly just one, no other lymph nodes apparently affected.


VAERS ID: 1757070 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Erythema, Lymphadenopathy, Oedema, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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: Flonase Claritin
Current Illness: None
Preexisting Conditions: Seasonal allergies
Allergies: Cinnamon
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left axillary lymphadenopathy ( marked edema, pain ,warmth and slight erythema).


VAERS ID: 1757076 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

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

Write-up: Rash, itching began 2 days post vaccine, incorporation whole body.


VAERS ID: 1757091 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-23
Onset:2021-10-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR - / 1 RA / IM

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

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

Write-up: Severe allergic reaction and swelling of the hands feet groin scalp/neck & buttocks


VAERS ID: 1757099 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Paraesthesia, Periorbital swelling, Visual impairment
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Visual Changes/Disturbances-Medium, Additional Details: Patient said her hands tingled and that she didn''t have bags under eyes until after vaccine. She said she felt "whoozy" like she couldn''t see clearly. She listed no allergies on intake form but after said she was gluten allergic and "lots of others" but she could not elaborate on any other medications she might be allergic to. She mentioned she had a stroke in past (dont know date) she said her neurologist told her to get the vaccine. Didn''t know his name just that he had an office locally.


VAERS ID: 1757100 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysphagia, Dyspnoea, Flushing, Hyperhidrosis, Hypoaesthesia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild


VAERS ID: 1757103 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Pruritus, Throat clearing
SMQs:, Anaphylactic reaction (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Allergic: Itch (specify: facial area, extremeties)-Medium, Additional Details: pt experienced itching of through, coughing, increased need to clear throat. no swelling


VAERS ID: 1757107 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Allergic: Difficulty Breathing-Mild, Systemic: Dizziness / Lightheadness-Mild


VAERS ID: 1757109 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 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: Error: Booster Given Too Early-


VAERS ID: 1757110 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

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

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

Write-up: Systemic: Fainting/Unresponsive-Medium, Systemic: Hypotension-Medium, Additional Details: Patient had vasovagal reaction.


VAERS ID: 1757111 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Dyspnoea, Eye swelling, Mouth swelling, Swelling face, Swollen tongue, Tremor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Abdominal Pain-Medium, Systemic: Shakiness-Mild


VAERS ID: 1757115 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: contrast dye for X-rays
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme itchiness, especially around face and arms. Slight redness. Very itchy.


VAERS ID: 1757117 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Extra dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Error: Wrong Patient (documentation in EMR)-


VAERS ID: 1757121 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Burning sensation, Eye irritation, Eye swelling, Paraesthesia, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Corneal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medications
Current Illness: Loss of voice, sinus infection, cough, fatigue, sore throat - 9/2-9/11
Preexisting Conditions: Loss of smell from Covid- 12/2020 No other health conditions
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Start: 10/2 @ 1800- burning/tingling of left eyelid Woke up 10/3 @ 0250- Left eye swollen completely shut, severe burning and irritation, mild swelling of right eye Current: 10/3 @0784- left eye swollen 3/4 shut, burning still present, right eye slightly swollen.


VAERS ID: 1757123 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1757127 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Chest X-ray, Computerised tomogram abdomen, Electrocardiogram, Full blood count, Malaise, Metabolic function test, Nausea, Troponin
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: dilt xr, lisinporil, eliquis, terbinafine, oxybutynin, lasix
Current Illness:
Preexisting Conditions: chf, ckd, afib, aortic valve regurg
Allergies: amlodipine, atenolol, lovastatiin
Diagnostic Lab Data: labs including trop, cbc, cmp, ct abdomen, cxr, ekg all done on 10/2/21 mild bump in cr from baseline
CDC Split Type:

Write-up: nausea, abdominal pain, malaise


VAERS ID: 1757136 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza vaccine; Shingrix (shingles vaccine) 06/14/2021 and 8/30/2021.
Other Medications: Amlodipine Besylate 5mg; Calcium, Magnesium
Current Illness: None
Preexisting Conditions: Osteoporosis, high blood pressure, ASD
Allergies: Eggs, Benicar, Ciprofloxacin, Hydrochlorothiazide, Hydroxyzine HCL, Influenza vaccine, Iodinated contrast media, Lisinopril, Olmesartan, Penicillin, Sulfa, Triamterene
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I woke up at 12:45 am from sleep to find my throat uncomfortably tight. I could not breathe or swallow. I took 2 OTC Benadryl and within 45 minutes I felt my throat less tight. I was more comfortable. I went back to sleep and awoke at 3:00 am. My throat felt much better. I took 2 more Benadryl at 7:45 am because my throat felt a little tight.


VAERS ID: 1757138 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Fatigue, Loss of personal independence in daily activities, Myalgia, Oedema peripheral, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shin grid caused high fever and flu like symptoms
Other Medications: Amlodopine 10 mg , levothyroxine 75 micrograms, vitamin D 2000 units daily
Current Illness: None
Preexisting Conditions: Hypertension and Hashimoto?s thyroiditis
Allergies: Penicillin and cephalosporins
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Axillary swelling and pain (severe) on the same side as injection, fever, severe myalgia, vomiting, debilitating fatigue and inability to perform ADLs. Symptoms are ongoing at 48 hours after dose.


VAERS ID: 1757140 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Headache, Hypersomnia, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12, D3, Vitamin C, Zinc , multi vitamin, calcium, hair skin and nails, collegen, birth control
Current Illness: No
Preexisting Conditions: I don?t have a speen
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm, headache, no energy, could not do anything but sleep all day yesterday and head still is pounding today.


VAERS ID: 1757145 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

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

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

Write-up: Patient reported blacking out while waiting her allotted 15 minutes post vaccination and urinated on herself. The pharmacist on-duty was alerted to the incident per the patient. Once the patient came out of her black out stage the pharmacist sat with the patient for 15 additional minutes and the patient reported feeling fine and her uncle picked her up the the pharmacy.


VAERS ID: 1757162 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-30
Onset:2021-10-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Patient stated noticed itching at injection site on morning of 10/02/2021. Patient noticed rash at injection site on 10/03/21 (noticed at 6am)


VAERS ID: 1757171 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-10-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Rash erythematous
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: high blood pressure meds, sleeping aid, immitrex
Current Illness:
Preexisting Conditions: migraine, high blood pressure
Allergies: cleosin, shellfish, AMLODIPINE, TOPIRAMATE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red rash, swollen arm, painful swelling


VAERS ID: 1757182 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea, Lipase increased, Nausea
SMQs:, Acute pancreatitis (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data: Lipase obtained on 10/03/2021 elevated; (102).
CDC Split Type:

Write-up: This patient without history of pancreatitis developed abdominal pain, nausea, and diarrhea post third Pfizer Covid 19 vaccine; emergency department workup revealed elevated lipase.


VAERS ID: 1757184 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Oedema, Pain, Sleep disorder
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Succinate 12.5 mg, Dexilant 60 mg
Current Illness: None
Preexisting Conditions: Postural Orthostatic Tachycardia Syndrome, Gastroesophageal Reflux Disease
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches, sleep disturbance, edema and erythema 3cm distal from injection site. Symptoms started night after injection and lasted at least two days following. Body aches treated with ibuprofen with temporary relief. No specific modalities attempted for arm symptoms.


VAERS ID: 1757188 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, pravastatin, valacyclovir, tadalafil, ezitimibe, ubiquinol, vitamin b12, vitamin d3, aspirin
Current Illness:
Preexisting Conditions: high cholesterol, high blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: severe sciatica-like pain in buttocks, hamstrings and lower back (initially right buttock) when lying down, walking relieved pain to some extent, improved substantially after 36 hours


VAERS ID: 1757197 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

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

Write-up: Body aches, tired, stomach ache


VAERS ID: 1757213 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 LA / IM

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

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

Write-up: Administration error mixed series mRNA vaccination Pfizer and Moderna


VAERS ID: 1757214 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness unilateral, Ear pain
SMQs:, Hearing impairment (narrow)

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

Write-up: Moderate pain and hearing loss in right ear.


VAERS ID: 1757217 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccination Pfizer and Moderna


VAERS ID: 1757218 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccination Pfizer and Moderna


VAERS ID: 1757219 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 LA / IM

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

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

Write-up: Administration error mixed series mRNA vaccination Pfizer and Moderna


VAERS ID: 1757220 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Dry mouth, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Immediate localized muscle pain. After about 12 hours, a strong fever, joint pain in knees and ankles, dry mouth, headache, chills, nausea, still in effect approximately 24 hours after vaccination.


VAERS ID: 1757221 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccination Pfizer and Moderna


VAERS ID: 1757222 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccination Pfizer and Moderna


VAERS ID: 1757224 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccination Pfizer and Moderna


VAERS ID: 1757225 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccination Pfizer and Moderna


VAERS ID: 1757226 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccination Pfizer and Moderna


VAERS ID: 1757228 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccination Pfizer and Moderna


VAERS ID: 1757234 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-02
Onset:2021-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Pain, Pyrexia, Seizure
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (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), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid Moderna vaccine dose 1 one month prior; same adverse reaction
Other Medications: Midodrine 5 mg TID Corlanor 2.5 mg BID
Current Illness: Common cold the week before vaccine
Preexisting Conditions: POTS syndrome Inappropriate Sinus Tachycardia Orthostatic Intolerance Supraventricular tachycardia
Allergies: Cefzil Penicillin Erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe full body convulsions lasting 15 minutes, fever 101, moderate full body aches, headache, nausea, headache, fatigue


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