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

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



Case Details (Reverse Sorted by Onset Date)

This is page 44 out of 5,069

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VAERS ID: 1454817 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Nervousness, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: approximately 10 minutes after giving first covid vaccine patient complained of racing heart, feeling shakey, cloudy, light-headed and burning in chest. asked patient if it may be anxiety and she didn''t know. asked patient if she wanted us to call 911 which she did. 911 arrived, performed multiple tests-- all results were okay. patient refused ride to hospital in ambulance. patient was visibly upset and shaken, was still deciding if she and husband would go to hospital or home when leaving store after ems had conducted tests.


VAERS ID: 1454819 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced light headedness and fainting after receiving vaccine. Patient was give soda to drink and issue resolved. He had not eaten all day before vaccine and had swim practice for several hours


VAERS ID: 1454828 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: Patient voiced she was anxious and asked for water. Patient voiced she felt warm then became unconscious for few seconds. Her head was protected from injury. 911 called. No medication given. Ice pack given for cooling measures. Patient said she felt fine and refused further treatments and hospitalization. O2 saturation 99% room air. Heart rate 90bpm. No shortness of breath and no other abnormal findings noted.


VAERS ID: 1454829 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

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

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

Write-up: Pt. c/o of feeling Lightheaded, Pt. vitals as follows: @ 12:41 pm B/P 130/70 HR 100 R 17 02 99% @ 12:56 pm Pt. was re- accessed , vitals as follows: B/P 120/68 HR 98 R 16 02 98% on RA Pt. stated she felt better , left with her mom in stable condition. Pt''s mom was advised to call Pcp if any new or worsening symptoms occur.


VAERS ID: 1454835 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: 1st dose of Pfizer covid 19 vaccine 07/07/21 15:30
CDC Split Type:

Write-up: After patient received vaccine they fell to one side of the chair while sitting down. The patient woke within 10 seconds of passing out. Patient did not report any signs of allergic reaction. Patient was given water and monitored for 15 minutes.


VAERS ID: 1454841 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

Administered by: Senior Living       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: Resident received a TST Mantoux on 7/2/21 and then received COVID Vaccine 7/7/21. There was not a 4 week time frame between the two administrations.


VAERS ID: 1454846 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza (significant swelling at injection site); varicella (unknown age/reaction)
Other Medications: Information not gathered
Current Illness: None
Preexisting Conditions: Allergies
Allergies: Nuts, influenza vaccine, varicella vaccination
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 1 minute after injection, patient began to experience swelling of tongue. Swelling moved to throat. Epinephrine was administered and paramedics were called. Patient took home supply of Benadryl (2 capsules of 50mg dose) . Patient refused care from paramedics and husband picked her up and she went home. Patient was alert, not experiencing difficulty breathing, and ambulating well under own power.


VAERS ID: 1454848 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Chest X-ray, Chest pain, Differential white blood cell count, Electrocardiogram, Full blood count, Metabolic function test, Palpitations, Troponin, Urine analysis
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies: Penicillin, sulfa
Diagnostic Lab Data: EKG 7/7/21 X-ray, chest 7/7/21 Basic metabolic panel CBC auto differential Troponin Hcg, urine
CDC Split Type:

Write-up: Pain in chest, burning in chest, racing heart beat lasting hours after vaccine


VAERS ID: 1454850 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-29
Onset:2021-07-07
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 RA / IM

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

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

Write-up: On 07/07/2021, a 2019 Coronavirus SARS-CoV-2 Rapid~2019 Coronavirus SARS-CoV-2 Rapid test was ordered and came back positive for the patient. Case investigation interview with patient has not been conducted at the time of this note.


VAERS ID: 1454851 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nervousness, Pain, Peripheral coldness, Presyncope
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient was very nervous about getting vaccine - she reported having rare side effects often ... she reported that about 2 minutes felt faint and dizzy and"pre-syncope ", about 10 minutes later felt legs were cold and body aches... Pt sat for 30 minutes and called a friend . .. she felt well enough to drive home with her friend following her ... the entire time patient was alert and was able to hold conversation Pt has an appointment with her doctor tomorrow morning already planned prior to receiving vaccine so she will follow up


VAERS ID: 1454864 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 OT / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Nausea, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Faint, both arms tingling, nausea, sweating profusely. Evaluated by EMS-Cleared


VAERS ID: 1454868 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient received his second dose two weeks to early. No adverse effects observed or reported


VAERS ID: 1454892 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dry skin, Dyspnoea, Hyperhidrosis, Immediate post-injection reaction, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient had taken a Muscle Relaxer the night previous to vaccination date.
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: None ordered.
CDC Split Type:

Write-up: Directly after vaccination administration, patients states, "Should I feel dizzy and sweaty?" Upon observation, patient was pale and diaphoretic. Nurse asked patient if he needed to lie down. Patient states, "I have multiple panic attacks a day, and i think I will be ok." Patient then stated that he wanted to lie down. Patient was placed in a wheel chair at 12:23 and taken to a private area for observation. Assisted patient to lie down, feet elevated, cool rags applied to forehead and anterior neck. Patient then continued diaphoretic, blood pressure 172/92. HR 78/PO2 / 98%. During this time, patient was accompanied by Uncle. Patient was continued to be observed with frequent vital sign measurements. 12:29 - 155/95, HR 72, PO2 - 99%, diaphoretic, and complaints / shortness of breath. 12:32 - 158/108, HR 76, PO2 98%. 12:35 - 166/111, HR 83, skin-dry, continues SOB. 12:42 - 171/114, HR 105, PO2 -98%. Patient consented to Ambulance for further evaluation in ER. (12:49) Fire-fighters arrived first w/ evaluation of patient w/ manual blood pressure / 162/114, and HR - 99, PO2 - 98%. Ambulance arrived at 12:52, and care was transferred to the hospital.


VAERS ID: 1454896 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: Fatigue
Preexisting Conditions: Patient has chronic fatigue due to his occupation
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: After 10 mins patient received Pfizer vaccine, he felt nauseated and got faint for about 5 seconds. After drinking water and apple juice he said he felt better but still nauseous. When 911 arrived, they checked his vital and it was normal. Upon checking up he got better and chose not to go to hospital.


VAERS ID: 1454913 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM

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

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

Write-up: Patient received her 2nd Moderna vaccine, no previous issue with any vaccinations. Waited 15 minutes, felt fine, but when she stood up quickly to leave she felt faint. She kneeled/sat down on the ground, and briefly fainted without injury and immediately regained consciousness without intervention. I gave her ice packs for her neck and had her wait another 15 minutes. After 15 minutes she was feeling better but a little "shaky" still, she had an orange juice and waited a little longer until she felt well. I had her walk around a little before leaving, she was feeling well.


VAERS ID: 1455098 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (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 that I am aware of
Current Illness: possible URI-pt states he has had some nasal congestion
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 minutes after administration pt returned to clinic with a nose bleed. states he has had nose bleeds before but none in past 6 mos. he did say he had been having some nasal congestion recently so unsure if related. no other medications he has been taking. no intervention wad needed. pts nose stopped bleeding by the time he returned to the clinic to be evaluated


VAERS ID: 1455103 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWC156 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Five minutes after dose my daughter began to feel dizzy, felt like fainting and blurry sight. We were still at the pharmacy, I asked the pharmacist about her symptoms, about 15 minutes later, she told me she was feeling better, so we left.


VAERS ID: 1455113 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site warmth
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: Pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy, rash near injection site, rash is warm to touch


VAERS ID: 1455115 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Dizziness, Pallor, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PT SAID HE LOST VISON AND GOT DIZZY AND HAD SYNCOPE. SKIN WAS EXTEMELY PALE AND THEN HE VOMITTED


VAERS ID: 1455118 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 RA / IM

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

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

Write-up: Syncope. Patient experienced Nausea, sweating, pain, and dizziness. Patient was told to sit down, given and ice pack, and water


VAERS ID: 1455121 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

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

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

Write-up: Patient was given first dose Moderna on 3/20/21 from spectrum health. Patient then came to get second dose Moderna on 7/7/21 and is outside the recommended 2nd dose vaccination window.


VAERS ID: 1455345 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM2, HTN, hyperlipidemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient arrived to vaccine clinic accompanied by her husband. Patient received her first dose of the Pfizer vaccine in left deltioid at 1517 and then waited the suggested 15 min in the waiting are post vaccine administration. More than an hour later, staff made RN aware that patient and husband returned and is sitting in vehicle. Upon opening patients door to her vehicle, large amount of vomit was visibly noted inside of vehicle. Patient answering some questions appropriately but then does not answer others. Patient''s husband mentioned patient does have mild dementia. No shortness of breath noted nor difficulty breathing. Patient was then transferred via wheelchair into clinic. Vital signs taken. Patient continues to vomit at this time. Ice pack provided. 911 called. Paramedics and Fire department arrived at approximately 1700. Medication administered via paramedics. Patient was then transferred out of clinic via stretcher accompanied by patients husband.


VAERS ID: 1455349 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: 11:24 when asked, voiced dizzyness and nausea, ambulated without assistance or event to cot and reclined. Vital signs taken were stable, Monitored longer and during periods she attempted to sit and stand under observation, Wheelchaired to vehicle under parental supervision at 12:14. No other complaints.


VAERS ID: 1455353 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Back pain, Headache, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Massive headache and joint pain mostly in back and legs.


VAERS ID: 1455360 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, Product preparation issue
SMQs:, Medication errors (narrow)

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

Write-up: Student drawn up vaccine without mixing with diluent. Patient got higher concentrated dose.


VAERS ID: 1455361 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Two to three minutes after patient received COVID vaccine. Patient had a seizure. He was sitting in a chair while it happened. After a couple seconds patient said he was feeling okay just a little dizzy. Paramedics came and took him to a hospital to be monitored.


VAERS ID: 1455362 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: On 7/07/21 received her second dose Pfizer COVID vaccine (LOT#: EW0191 EXP: 7/29/21) at 1502. Patient alerted EMT''s at 1503. Patient stated that she felt dizzy and nauseous. EMT took patients vital signs at 1500. BP: 110/60, HR: 72, O2: 99%. EMT reassessed and retook patients vital signs at 1508. BP: 100/60, HR: 80, O2: 99%. Patient stated that she had a headache 4/10 on the pain scale and was trembling. EMT reassessed and retook patients vital signs at 1513. BP: 116/60, HR: 79, O2: 99%. Patient stated that she no longer still had a headache but no longer felt dizzy anymore. EMT reassessed and retook patients vital signs at 1522. BP: 116/70, HR: 75, O2: 99%. Patient stated that her headache had gone down to a 1/10 on the pain scale. EMT reassessed and retook patients vital signs at 1530. BP: 110/60, HR: 78, O2: 99%. Patient stated that she was feeling better. Patient was educated by PHN on worsening signs and symptoms of covid vaccine and when to go to the emergency room/urgent care. Patient verbalized understanding of education. Patient left with mom and brother from vaccination site unassisted and with a steady gait at 1614.


VAERS ID: 1455366 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

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

Write-up: A 32 years old female present with nauseas in the recovery area. She pass with the paramedic and she vomit once and she tell to paramedic that she feels fine. Patient denies blurry vision, dizziness or headache. Patient vitals was Bp: 110/70mmhg, %O2 98%, Hr: 93bpm, Temp: 35.8C and Sugar: 111dl/mg


VAERS ID: 1455370 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Feeling hot, Loss of consciousness, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Glaucoma (broad), Lens disorders (broad), Retinal 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received dose 1 of Pfizer Covid vaccine on 7/7/21 at 1115AM. After two or three minutes, patient lost consciousness and fell off the chair in the waiting area and recovered a few seconds later. Patient felt very hot and vision became blurry. No airway restriction observed. 911 was called and paramedics transported patient (completely awake and coherent) to local hospital for further evaluation


VAERS ID: 1455373 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Mother wrote down the date of birth on the consent form is different than what the insurance company gave when claim was rejected.


VAERS ID: 1455375 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Eye movement disorder, Jaw disorder, Loss of consciousness, Vision blurred
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), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NO
Diagnostic Lab Data: BP:92/52 THEN 99/68 HT: 62 BG;90
CDC Split Type:

Write-up: PATIENT STARTED TO PASS OUT AND LOOSE CONSCIOUSNESS 2 MINUTES AFTER GETTING HIS JANSSEN & JANSSEN VACCINE. HE WAS KEPT OUT SITTING ON THE CHAIR. HE HAD HIS JAW TO LOCK BUT I WAS TRYING TO KEEP HIS MOUTH OPEN IN ORDER FOR HIM TO NOT BITE HIS TONGUE. HIS EYES WERE ROLOONG OUT. IN ABOUT 20 SECONDES HE RECIVERED BUT HE WAS COMPLAINING ABOUT BLURRED VISION. WE CALLED 911. I TOOK HIS BP. FIRFIGHTERS & PARAMEDICS CAME INSTANTLY AND TOOK OVER HIM. THEY OFFERED HIM TO BE TAKEN TO THE HOSPITAL , BUT HE SAID HE WAS OK AND LEFT WITH HIS GIRLFRIEND. I DID A FOLLOW UP CALL AFTER 2 HOURS WITH HIM. HE SAID HE WAS FEELING MUCH BETTER.


VAERS ID: 1455380 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: Seconds after receiving the vaccine the patient fainted while seated in the chair. Her father stood in front of her and held her head and rubbed her shoulders as he was aware this was going to happen as she always faints after receiving a vaccination. I was not made aware of this prior to giving the vaccination but she came to within approximately 4 seconds and regained color. She remained seated in the consultation room with her father and brother until the observing time was over and she felt strong enough to walk out with her dad.


VAERS ID: 1455381 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: pt stated his hand was swollen and started feeling tingly


VAERS ID: 1455542 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Face injury, Fall, Hyperhidrosis, Lip injury
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No known prescriptions, over-the-counter medications, dietary supplements or herbal remedies being taken at the time of vaccination
Current Illness: No other known illnesses.
Preexisting Conditions: No health conditions.
Allergies: No allergies to medications, food or other products.
Diagnostic Lab Data: No medical tests or lab.
CDC Split Type:

Write-up: Patient received the Jansen covid-19 vaccine today. he was fine when he received the vaccine but when he was sitting in the chair in the pharmacy lobby he fainted. I saw him fall out of chair and immediately ran out the door to assist him. He fell out of chair face down on the floor. When I reached him I rolled him over and spoke to him and he responded to me. I had him remain on the floor for several minutes before I had him sit in the chair. He bit his lip and there was a spot of blood and he hit his forehead on the floor. We called emergency number and emergency medical team arrived shortly and took his vital signs and they were normal. He was a little clammy and sweating a little. I gave him a bottle of cold water to drink while he was sitting. The emergency team checked him out and they ask him if he wanted to go to hospital and he declined going. The emergency medical team left and I had him wait a while longer. I had him call his mother to come and pick him up so he did not have to drive himself. His mother arrived about 20 minutes later and I went over with her what had happened. She took him home and I called to check on him after a few hours and he said he was doing fine. He also stated while talking with him that he had never passed out when getting other vaccines or the flu shots previously. He did state that he didn''t like needles but was not afraid to get the vaccine.


VAERS ID: 1455543 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / 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: Zyrtec, omeprazole and sodium bicarbonate, montelukast, advair, losinopril
Current Illness: None
Preexisting Conditions: Asthma
Allergies: No
Diagnostic Lab Data: NA - but I will go to the walk in clinic if the swelling doesn?t go down
CDC Split Type:

Write-up: My lymph nodes in my left armpit swelled up to the size of half a baseball and they are very tender to the touch


VAERS ID: 1455546 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient had Vasovagal reaction. V/S 130/70 MMhG, o2 sat @97% on room air, pulse 60 bpm. Patient''s family member requested for ambulance, endorsed to AMR with V/S 130/70 MMHG, Pulse 75, o2 sat @97% on RA. Denied any respiratory discomfort.


VAERS ID: 1455552 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Syncope, Thirst
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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: PT. APPEARED TO BE ALRIGHT IMMEDIATELY FOLLOWING VACCINATION, BUT APPROXIMATELY 10 MIN. LATER SHE FAINTED. APPROX. 1-2 MINUTES LATER SHE REGAINED CONCIOUSNESS. SHE WAS HOT AND SWEATY AND ALSO THIRSTY.


VAERS ID: 1455553 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-29
Onset:2021-07-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Rash, Skin irritation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen arm redness hard at injection site. Irration rash pain


VAERS ID: 1455744 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-07-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

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

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

Write-up: pt received 1st dose of moderna, 3 months after getting J&J, no actual adverse events, just reporting that it was given to patient, and per CDC guidelines we should not administer a different covid vaccine to a patient who has already received a different one


VAERS ID: 1455752 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-05
Onset:2021-07-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation irregular, Vaccine positive rechallenge
SMQs:, Fertility disorders (broad)

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

Write-up: After first dose in June, menstruation started 8 days early, which is highly unusual, a day or two after vaccination. This time menstruation started 14 days early, two days after vaccination.


VAERS ID: 1455754 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Dyspnoea, Frustration tolerance decreased, Heart rate increased, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: EMT Bustamante noted the client was splashing water on her face and hugging her caretaker in the observation area. EMT Bustamante approached the client and asked how she was feeling. The client reported anxiety to EMT Bustamante at 1:34PM. EMT Bustamante escorted the client and her caretaker outside the building and she was seated on a bench. Vitals obtained at 1:34 PM were as follows: BP 130/90, HR 110, and O2 99%. 2 RN''s responded at 1:40PM. The client at that time stated she was having "anxiety." 2 RN''s left the scene. At 1:49 PM the client stated she "couldn''t breathe." RN responded and provided an emesis bag to the client. The client started using the emesis bag to breathe into. RN counted with the client to slow her breathing down. At 1:50PM the client stated she was "starting to feel better." RN played a 3 minute meditation for the client. At 1:53 PM the client was provided an ice pack on the back of her neck. Vitals obtained at 1:55PM were as follows BP138/82, HR 115, and O2 99%. The client noted frustration about her anxiety and increased heart rate. The client also noted "weakness" in her right arm. At 2:03PM the client received emotional support from her caretaker via a hug. At 2:10 the client stated she was "feeling better and almost ready to leave." The client took 2 puffs of her Albuterol inhaler around 2:12. The client stated she uses the inhaler PRN for a history of asthma. The client also reports a history of anxiety which is not controlled with medication. At 2:14PM vitals obtained were as follows: BP 128/84, HR 127, and O2 99%. The client subsequently stood up and stood underneath a tree in the shade. The client received another emotional support hug, was provided a new ice pack, and continued to splash water on her face. RN offered to call EMS services, and the client declined. RN educated the client and her caretaker of s/s of anaphylaxis, when to seek EMS, and to follow up with PCP regarding anxiety symptoms, and V-safe. The client voiced understanding of this. RN escorted the client out of the vaccination site. The client ambulated unassisted with a steady gait. RN visualized the client entering the vehicle to be driven home by her caretaker at 2:27 PM.


VAERS ID: 1455757 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK LA / IM

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

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

Write-up: Dizziness and headache after receiving vaccine about 5 minutes after .


VAERS ID: 1455758 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient less than approved age of 12 yo.


VAERS ID: 1455760 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 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? 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 indicated
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient less than approved age of 18.


VAERS ID: 1455761 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Chest pain... have not seek treatment. Pain went away after 20 minutes


VAERS ID: 1455912 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Cystic fibrosis gene carrier
Allergies: unknown/not listed in medical chart
Diagnostic Lab Data: none as of now
CDC Split Type:

Write-up: No symptoms reported to me by the RN that gave the medication


VAERS ID: 1455914 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: None
Preexisting Conditions: None Pt AO4. States has received moderna first dose. However denies taking Pfizer as second dose. Unable to find able to see Pfizer vaccine. No information provided with lot number and location. Per MD, was to vaccinate with moderna second vaccine today.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Refer to previous note. No adverse rxn at this time while monitoring.


VAERS ID: 1455917 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: patient fainted for about 5 sec, 2 min after pfizer covid 1st shot. No symptom of allergic reaction. 911 was called and EMT check out and release patient home.


VAERS ID: 1455919 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-07-07
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Pain in extremity, Peripheral swelling, Weight increased
SMQs:, Cardiac failure (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B COMPLEX VITAMIN C 1000MG VITAMIN D3 5000IU MAGNESIUM GLYCINATE 500MG ZINC/COPPER 30/1MG FISH OIL OMEGA 3 ASPIRIN 81 MG LUTEIN/ZIATHANIN KYOLIC TURMERIC WITH FENGUGREEK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: CAT DANDER AROUND FACE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: JOINT PAIN HANDS FEET, KNEES AND ALL OVER, SWELLING IN UPPER AND LOWER EXTREMITIES, FATIGUE, WEIGHT GAIN


VAERS ID: 1455921 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ORAL CONTRACEPTIVES
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE KNOWN
Diagnostic Lab Data: NOT KNOWN
CDC Split Type:

Write-up: INCREASED HEARTRATE AND SWELLING OF THROAT. PATIENT CAME TO ME 15 MINUTES AFTER RECEIVING THE VACCINE AT APPROXIMATELY 5:01 PM. SHE STATED THE THROAT CLOSURE WAS GETTING WORSE AND HEART RATE FELT FAST. I TOOK BP TO FIND ELEVATION (DON''T REMEMBER THE EXACT VALUE). HEART RATE WAS 113 BPM AT APROXIMATELY 5:O2. (EMS WAS CALLED). 5:03 ADMINISTERED EPIPEN 0.3 MEDICS ARRIVED AT 5:05PM. PT TAKEN TO HOSPITAL BY MEDICS AT 5:10 PM


VAERS ID: 1456343 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Injection site rash, Injection site swelling, Injection site warmth, Lethargy, Malaise, Myalgia, Pain, Pain in extremity, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 100mg lamictal once daily for bipolar I disorder, 2mg ativan twice daily/as needed for c-ptsd/anxiety, 30mg adderall all twice daily/as needed for adhd, tylenol OTC 500mg two to four times daily for arthritic hip pain and menstrual cramps,
Current Illness: n/a; minor seasonal allergies
Preexisting Conditions: bipolar I disorder, c-ptsd, history of binge eating disorder & nutritional restrictions, add/adhd, vitiligo, hip dysplasia (corrected at birth), acute scoliosis, arthritis, low b12, low vitamin d, low thyroid activity
Allergies: severe reaction to azithromyacin (z-pak) antibiotic treatments causing red lesions along the trunk & chest, extreme upper gastrointestinal pain (feeling of ?acid? pouring over organs), coughing, metallic taste, raw itchy sores inside of mouth
Diagnostic Lab Data: n/a?unknown
CDC Split Type:

Write-up: started approx 12:30 am 7/7/2021, low grade fever ~99?F, accompanied with mild malaise, fatigue, sensitivity around injection site. tylenol taken approx 2 hours after vaccination. advil pm taken around bed time (3am 7/7/2021) symptoms continued throughout the day with increased tenderness and soreness in arm that received injection. OTC pain medication taken in morning 11:30am. once more at 3pm. spiked fever began around 10pm cst (22:00, 7/7/2021) of ~101.7?F, moderate to severe muscle aches, general overall feeling of ?unwell?, lethargic. ~11:30pm pain in left arm began to spread down towards elbow, painful to move or flex muscles in arm out of normal range, stinging sensation. ~1am 7/8/2021, noticed a rash approx 1.5inches-2.5inches from injection site on arm. arm is hot to touch, rash is inconsistent in size/shape & pattern, slightly raised, swollen, red & splotchy. mimicking the appearance of possible hives. advil pm taken 2am 7/8/2021, along with 25mg benadryl to help soothe rash.


VAERS ID: 1456758 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Heart rate increased, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: PCN
Diagnostic Lab Data: VS 72, 158/76, 98%
CDC Split Type:

Write-up: Tightness in throat and fast heart rate. No difficulty breathing. No swelling of tongue. No difficulty swallowing.


VAERS ID: 1456760 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

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

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

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


VAERS ID: 1456762 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

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

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Additional Details: patient fainted within 2 minutes after injection, EMT came and checked patient who came to within a few seconds


VAERS ID: 1456763 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Nausea-Medium


VAERS ID: 1456764 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Dizziness, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: none
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data: BP 105/71, P 84, O2 100%
CDC Split Type:

Write-up: Patient received 1st dose of covid vaccine and instantly felt dizzy. Client''s skin pale, patient eventually vomited. Patient stated they were very anxious over their 1st dose. Patient fully recovered. Symptoms no longer present.


VAERS ID: 1456765 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Syncope, Tinnitus, Unresponsive to stimuli
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hearing impairment (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Tinnitus-Mild, Additional Details: patient fint for 2 minutes but recovered consciousness


VAERS ID: 1456768 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (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: VS 84, 116/80, 99%
CDC Split Type:

Write-up: Chest tightness. No radiation to Arm. VS 84, 116/80, 99%


VAERS ID: 1456769 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 2 LA / IM

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

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

Write-up: Systemic: Allergic: Rash Generalized-Medium, Additional Details: metallic taste in mouth, hives/rash on chest, legs, and arms. red and a little itchy


VAERS ID: 1456770 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Headache, Hyperhidrosis, Paraesthesia, Tremor, Visual impairment
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Headache-Mild, Systemic: Shakiness-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Visual Changes/Disturbances-Medium, Additional Details: 10 minutes after 1st dose - tingling sensation, dizzy, sweating, blacked out vision for a minute. Was still able to move arms and body. Took BP 84/49 HR 79. Gave patient water and sat supported by the wall for over 30 minutes. Before leaving patient BP was taken again 121/71 78 HR.


VAERS ID: 1456772 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Headache, chills, low grade fever, lethargic


VAERS ID: 1456777 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1456781 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Systemic: Numbness (specify: facial area, extremities)-Mild


VAERS ID: 1456782 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypotension, Lethargy, Pallor, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Severe, Systemic: Shakiness-Medium, Systemic: Weakness-Medium, Additional Details: Patient found unresponsive to physical stimuli, staring up at ceiling, clammy pale skin, hypotensive (80/40), and Heart rate 49. EMS activated. Epinephrine given in Left thigh, patient responded. HR increased to 62bpm and Blood pressure 142/72 and 130/80. Patient stable and refused to leave store with EMS. Patient signed refusal to be transported via EMS and notified of importance of monitoring after Epinephrine administration. Patient verbalized understanding.


VAERS ID: 1456784 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Hypotension-Mild, Systemic: Nausea-Mild


VAERS ID: 1456789 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram normal, Fatigue, Gait disturbance, Injection site pain, Visual impairment
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Additional Details: After getting first moderna shot, patient was at the monitoring area. I came and checked up on patient. She said she felling fatigue, cant walk, and experience some vision changes. I called 911 and gave patient some orange juice to drink. EMD came and checked her vitals bp was 104/81 and ekg seems normal. EMD took her took the car to do more further test.


VAERS ID: 1456790 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope, Unresponsive to stimuli
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium


VAERS ID: 1456791 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Weakness-Medium


VAERS ID: 1456793 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 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? 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: Booster Given Too Early-


VAERS ID: 1456963 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Unknown  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Exhaustion / Lethargy-Mild, Additional Details: pt sat for 15minutes and felt better. rph left message on home phone


VAERS ID: 1456973 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 5 minutes after receiving shot patient complained of swelling tongue


VAERS ID: 1456975 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Gaze palsy, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (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: Headache, arm soreness and fatigue
Other Medications:
Current Illness:
Preexisting Conditions: Celiac Disease, IBS, Mild Depression and Anxiety
Allergies: Keflex, Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme body aches, chills, fever of 100.2, headache, fatigue, weakness, and extreme nausea


VAERS ID: 1456984 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Electrocardiogram, Feeling cold
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No prescriptions were give during this time
Current Illness: No other illnesses reported.
Preexisting Conditions: No Chronic or long-standing health conditions reported
Allergies: No history of allergies
Diagnostic Lab Data: Blood pressure was fine. EKG was abnormal on the day of vaccine.
CDC Split Type:

Write-up: Patient felt lightheaded, dizzy, clammy, cold. Described a feel like passing out. Rescue arrived on scene and had patient taken for medical care. EKG was abnormal for a possible precursor of heart block.


VAERS ID: 1456994 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A- NO ADVERSE REACTION/EVENT TOOK PLACE
CDC Split Type:

Write-up: Patient received 3 doses of Moderna. No adverse reaction noted. Facility notified and advised to monitor patient for signs and/or symptoms of adverse event. Aware to call 911 or go to nearest ER for treatment if needed.


VAERS ID: 1457002 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 3 RA / IM

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

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

Write-up: Patient reported he had never received a dose of COVID-19 vaccine before. Inadvertently, the Moderna COVID- 19 Vaccine EUA was adminsitered. When being entered into the computer, it was discovered he had received 2 prior doses of Moderna.


VAERS ID: 1457007 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 3 RA / IM

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

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

Write-up: Patient reported he had never received a dose of COVID-19 vaccine before. Inadvertently, the Moderna COVID- 19 Vaccine EUA was adminsitered. When being entered into the computer, it was discovered he had received 2 prior doses of Moderna.


VAERS ID: 1457008 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 3 RA / IM

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

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

Write-up: Patient reported he had never received a dose of COVID-19 vaccine before. He is incarcerated. Inadvertently, the Moderna COVID- 19 Vaccine EUA was adminsitered. When being entered into the computer, it was discovered he had received 2 prior doses of Moderna.


VAERS ID: 1457012 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 3 RA / IM

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

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

Write-up: Patient reported he had never received a dose of COVID-19 vaccine before. He is incarcerated at the Abuse Center. Inadvertently, the Moderna COVID- 19 Vaccine EUA was adminsitered. When being entered into the computer, it was discovered he had received a previous dose of the Janssen COVID019 Vaccine EUA.


VAERS ID: 1457013 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

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

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

Write-up: Patient had a seizure lasting about 1 minute. EMS was called. While waiting for the ambulance to arrive, we comforted the patient and gave him water to sip. By the time the EMTs arrived, he was alert and feeling better. He was evaluated by the EMT and it was suggested he go by ambulance to the emergency room; however, his father refused the ambulance. We do not know if he was taken to the hospital for evaluation.


VAERS ID: 1457014 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Feeling cold, Injection site pain, Injection site warmth, Lymphadenopathy, Mobility decreased, Pain, Sluggishness
SMQs:, Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Nicotine Polacrilex 4 mg,. acamprosate, vyvanse, propranolol, bupropion, sertraline
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I woke up in the middle of the night, around 2:30 AM (7/7) with throbbing pain at the injection site. The site was also very warm to the touch. I had the chills and could not get warm. My whole body ached, but the arm pain was the worst. :Later that morning, my arm still hurt and I felt very sluggish and very achy, not able to get out of bed. I had issues turning my head to the left. I took some Tylenol and started feeling better around 1:30 PM. I woke up today (7/8) with a very swollen armpit/lymphoid. I also have a very sick stomach.


VAERS ID: 1457022 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Diarrhoea, Head injury, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: over the counter claritan for seasonal allergies
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No tests or laboratory work was conducted.
CDC Split Type:

Write-up: Within three to four hours of receiving the Moderna vaccine my stomach started to become uneasy. I thought it might have been what I ate for lunch after the shot but I started to have diarrhea and vomiting. While I was in the bathroom experiencing both I passed out and hit my head on the floor. My wife called 911 and was checked by the responding paramedics; my vitals were good and I did not feel the need to be transported to the hospital. Throughout the night I had chills and continued to throw up and experience diarrhea.


VAERS ID: 1457041 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Nausea, Palpitations, Pharyngeal swelling, Swelling face, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Bad headache, 24, 7/25/19, 8/1/19, Japanese Encephalitis. Body aches, 24, 6/26/19, 7/3/19, 7/19/19, Rabies vaccination, Nausea,
Other Medications: Multivitamins, lung support vitamins, albuterol, symbicort
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Amoxicillin, gluten, pork, cats, most dogs, mold, cranberries
Diagnostic Lab Data:
CDC Split Type:

Write-up: Racing heart, highest recorded beat was 108, lasted from 7:45 to 8:45 pm Face/throat swelling, I treated with benedryl , lasted from about 8:15 PM to 8:45 PM Vomiting and nausea , I treated with anti-nausea med lasted from 7:15 pm to 9 pm Migraine-like headache , I treated with ibuprofen, started around 9 pm and finally decreased around 4:30 am. I still have a slight headache. Chills - started around 3 pm and lasted until around 6am this morning. Site pain - 10 Am until 3:30 am.


VAERS ID: 1457044 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

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

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

Write-up: Fever greater than 100 F despite antipyretics, severe body aches, chills, fatigues


VAERS ID: 1457048 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-05
Onset:2021-07-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Rash, Rash pruritic, Skin warm
SMQs:, Anaphylactic reaction (broad), 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:
Current Illness: None known
Preexisting Conditions: None known
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed a rash on her upper left arm. She noticed the rash appearing two days post-vaccination. She reported that the rash is itchy and warm to the touch, and her upper arm feels sore. No other adverse effects reported at this time. Recommended the patient take diphenhydramine for help with symptoms.


VAERS ID: 1457106 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Taste disorder
SMQs:, Taste and smell disorders (narrow)

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

Write-up: Metallic taste in mouth, odd sense of taste after


VAERS ID: 1457107 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2020-12-26
Onset:2021-07-07
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: positive Covid 19 PCR test
CDC Split Type:

Write-up: patient is fully vaccinated with 1st dose on Dec 26, 2020 / 2nd dose on Jan 15, 2021. patient tested positive for Covid 19 in clinic on July 7, 2021.


VAERS ID: 1457117 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Nurse inadvertently gave Pfizer Covid 19 vaccine dose that was beyond 6 hours from dilution.


VAERS ID: 1457125 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type: SNHD WebIZ # 1667058

Write-up: Nurse inadvertently gave Pfizer Covid 19 vaccine dose that was beyond 6 hours from dilution. Client will be notified to return for repeat dose.


VAERS ID: 1457134 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-05
Onset:2021-07-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hives, influenza vaccine, age 25, last received October 2007, unknown brand. Hives, Meningitis vaccine, age 18, August 2001, un
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Flu vaccine, varicella vaccine, hepatitis B vaccine, meningitis vaccine, sulfa, aspirin, morphine, cinnamon
Diagnostic Lab Data:
CDC Split Type:

Write-up: Delayed hives approximately 48 hours after shot. No other known causes for reaction. Took benadryl and zyrtec to cope with hives and reduce itching.


VAERS ID: 1457142 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-07-07
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/7/2021- SARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: tested positive for COVID 7/7/21. No other information available.


VAERS ID: 1457143 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Nausea, Oropharyngeal pain, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Client received second dose of COVID19 vaccine at 2:28pm. While sitting in observation room with her mom, she became dizzy, light headed and nauseous. Nursing staff evaluated client. She stated she had only had a muffin for breakfast. Staff provided juice, water and nutri-grain bar. Due to nausea, only able to drink a small amount of juice. Moved client to cot. EMS was called. Provided cold compress for forehead. She continued to drink the juice. Pulse ox was taken and was 98 continuously while she was on the cot. Nursing staff evaluated her for symptoms and improvement. She state she was still dizzy, lightheaded, and nauseous. She also stated her throat hurt/felt tight. EMS arrived. Interpreter used during event.


VAERS ID: 1457145 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Injection site pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: neurotic, benadryl, eliqust, protonix, tylenol
Current Illness: n/a
Preexisting Conditions: chronic back pain, high cholesterol
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 100.4, chills, aches, rash on right chest, arm pain at the injection site, took Tylenol. Fever lasted 24 hours. 7/8/21 noticed rash,


VAERS ID: 1457148 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-02-09
Onset:2021-07-07
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Hypoxia, X-ray abnormal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

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: Chronic kidney disease stage III moderate Long term current use of anticoagulants Acute kidney injury Other chronic pulmonary embolism without acute cor pulmonale
Allergies:
Diagnostic Lab Data: Patchy airspace infiltrates consistent with pneumonia on Xray
CDC Split Type:

Write-up: Patient admitted on 15L of O2 and placed on BiPAP at 100%. Shortness of breath with dry cough. Hypoxic on room air


VAERS ID: 1457155 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lymphadenopathy, Pain
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: Allegra-D, Flonase, Protonix, Multivitamin, Dicyclomine, Zoloft, Amlodipine, Lisinopril, Pepcid
Current Illness:
Preexisting Conditions: Anxiety, Nasal allergies, high blood pressure, GERD
Allergies: Penicillin, Naproxen, Septra
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches and pains. Swollen lymph nodes - Underarm


VAERS ID: 1457156 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-02-09
Onset:2021-07-07
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Hypoxia, Pneumonia, X-ray
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic kidney disease stage III moderate Long term current use of anticoagulants Acute kidney injury Other chronic pulmonary embolism without acute cor pulmonale
Allergies:
Diagnostic Lab Data: Patchy airspace infiltrates consistent with pneumonia on Xray
CDC Split Type:

Write-up: Patient hospitalized due to hypoxia, shortness of breath and dry cough. Arrived on 15L and put on BiPAP at 100%


VAERS ID: 1457157 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-07-07
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/7/2021- SARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: Developed s/s of COVID and tested positive 7/7/21


VAERS ID: 1457159 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood lactic acid increased, Dyspnoea, Hypotension, Intensive care, Stridor, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: gabapentin flexeril plaquenil lasix albuterol atarax meclizine singulair prazosin phenergan rizatriptan sertraline verapamil
Current Illness:
Preexisting Conditions: SLE MDD OSA obesity
Allergies: ASA Beef products carbamazepine NSAIDs penicillin pork products propoxyphene shellfish soy sulfa drugs trazadone wheat products
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 5 minutes of receiving dose upon return of vaccine patient indicated that she felt a scratchiness in the back of her throat. She presented to urgent care where she received 1 dose of IM epinephrine with some mild improvement. Patient continued to have scratchiness in the back of the throat and began to describe shortness of breath. She received 50 mg of Benadryl and additional dose of IM epinephrine. EMS was then called and the patient was given another dose of epinephrine on the way to hospital. Upon arrival to hospital she continued to describe shortness of breath and feeling as if her throat was closing up. On evaluation she was satting appropriately had no signs of significant swelling. Stridor was reported on the ED however this was not corroborated on intake exam by admitting team. Patient was placed on epinephrine drip for presumed hypotension, though this is not recorded in the record, and admitted. Patient had an elevated lactate and response to her epinephrine which resolved with fluids and discontinuing the epinephrine. She was transferred out the following morning to the floor for further observation.


VAERS ID: 1457168 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-30
Onset:2021-07-07
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/7/2021- SARS Coronavirus-2, PCR detected
CDC Split Type:

Write-up: Tested for COVID per protocol prior to surgery. Tested positive thus surgery delayed. Pt has "head cold" type symptoms.


VAERS ID: 1457170 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Eye movement disorder, Loss of consciousness, Muscle rigidity
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), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patients eyes rolled back, turned very red, and his arms became rigid for about 30 seconds, then he passed out. He came to about 30 seconds later. We called 911 - paramedics assessed the patient and concluded that he was feeling ok.


VAERS ID: 1457186 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Hallucination, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Implanon
Current Illness: Respiratory infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever with confusion/hallucinations


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