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From the 1/14/2022 release of VAERS data:

Found 1,031,637 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 470 out of 10,317

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VAERS ID: 1894194 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: MA administered 0.2 mL undiluted pediatric Pfizer vaccine (double the normal dose) Pt''s parents were immediately informed. Pt was monitored for 30 minutes without incident.


VAERS ID: 1894197 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 1 LA / IM

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

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

Write-up: Fever 101. Body aches. Headache. Fatigue


VAERS ID: 1894228 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Immediate post-injection reaction, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: The patient became pale and unresponsive to his name and physical touch immediately after receiving the vaccine at 11:45am. The patient''s eyes remained open but not tracking and he slumped back in the chair. Patient remained unresponsive for approximately 10 seconds before regaining consciousness. The patient was sweaty and hot but stated he otherwise felt fine and was aware of what happened. He remained seated for approximately 25 minutes with a cool rag, soda, and water. The patient does not have a history of reactions to vaccines or allergy shots (gets regularly). The patient felt comfortable to leave by himself after observation outside of the pharmacy.


VAERS ID: 1894248 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3SE27 / N/A RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immunisation, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: The Pfizer vaccine was mixed incorrectly (too much diluent). The patient had to return to clinic for correct dose.


VAERS ID: 1894265 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 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: pt received monoconal antibody 30 day before and now got his booster dose 30 after not 90 days


VAERS ID: 1894277 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-13
Onset:2021-11-23
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / SYR

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

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

Write-up: Light rash developed on left arm near the injection site. Not raised and no itching. First noticed when dressing on 11-23-21 at 7:00 a.m. By 1:00 p.m. on 11-23-21 the rash has spread (about double size) on top of left arm and is raised and itching. Called pharmacy to report and was told that CDC recommends Benadryl. Not taken yet at 1:57 p.m.


VAERS ID: 1894279 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 - / IM

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

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

Write-up: Mobile gave recipient booster dose too early. Last dose 11/9/2021. Language barrier. Consider invalid dose. Pt education given.


VAERS ID: 1894287 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-11-23
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9261 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

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

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

Write-up: Covid positive 11/23/21


VAERS ID: 1894289 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-06
Onset:2021-11-23
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07621A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neuralgia, Pain in extremity, Pyrexia, Seizure
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amitriptyline, keppra, lisinopril, topiramate,
Current Illness:
Preexisting Conditions: epilepsy, anxiety, depression, hypertension
Allergies: adverse reactions to vaccinations, antibiotics. large range of reactions
Diagnostic Lab Data:
CDC Split Type:

Write-up: sore arm described as nerve pain, fever, increased seizure activity


VAERS ID: 1894301 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

Administered by: Other       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: Verapamil HTCZ Acetaminophen w/ Codeine Lisinopril Pantoprazole
Current Illness:
Preexisting Conditions: HA GERD Asthma HTN
Allergies: Omeprazole ASA Lansoprazole Rosuvastatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient given Pfizer booster dose 1 day too early. No AE noted. Pt aware.


VAERS ID: 1894312 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Clonic convulsion, Malaise, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Seizure-Mild, Systemic: Shakiness-Mild, Additional Details: Prior to vaccine, patient reported fainting after injections in the past. Following administration of Pfizer covid vaccination (within first minute), patient said he was not feeling well. Upon examination, he was found to be experiencing a clonic seizure. The seizure lasted approximately 30 seconds, during which time patient was monitored for continued breathing. When patient regained consciousness, he was given water, had vitals checked, and examined by paramedics. Declined hospitalizion.


VAERS ID: 1894315 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anaphylactic reaction, Erythema, Pruritus
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Itchy arms and throat at first, which turned into anaphylactic reaction and facial redness. Facility nursing staff was present during observation. 25mg of Benadryl administered orally. Then epi-pen given in left thigh after symptoms worsened and 911 called. She was transported to local ER and facility RN was present until after patient left for ER.


VAERS ID: 1894332 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler, Cetrizine, Epi pen, Pepcid, Hydroxyzine, Montelukast, Multivitamin, Nystatin Topical, Olopatadine eye drops, Polyethylene Glycol, Triamcinolone Acetonide Topical.
Current Illness: NA
Preexisting Conditions: Seizure disorder, seasonal allergies
Allergies: Bee stings, Cats, Dogs, Grapes, Molds, Pollens
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient that was 11 years old was given 0.2 ml of adult Pfizer COVID vaccine.


VAERS ID: 1894336 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3P3TY / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 50 mg daily
Current Illness: none
Preexisting Conditions: ADHD
Allergies: No know allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: As of 11/23/21 only a sore arm


VAERS ID: 1894348 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lymphadenopathy, Neurological symptom, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Visible and significant swelling to lymph nodes in left armpit associated with occasional neurological symptoms (feels like someone poked me with a thumb tack), nerve symptoms resolved with children''s Advil.


VAERS ID: 1894349 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling hot, Malaise, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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. Patient did not indicate anything on the Vaccine Informed Consent form.
Allergies: Patient checked off NO to any allergies or allergic reactions on the Vaccine Informed Consent form
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the Janssen vaccine in the left arm in the immunization room. She then got up and walked over to chair to stay for observation. Within 5 minutes she walked to pharmacy counter and stated she did not feel well. Immediately myself and one technician ran over to help. She stated she felt hot and like passing out. We elevated her feet initially, she did become unresponsive for 1-2 minutes. Other technician called 911 at this time. We then put her flat on the floor and monitored her blood pressure, heart rate and O2. She did begin to talk. A nurse was in the store and offered her assistance. Patient never stopped breathing but was hot, clammy and slight gray in color. Ambulance arrived within 10 minutes from call.


VAERS ID: 1894361 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

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

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

Write-up: Patient received moderna booster. He had pfizer primary series. Per technician at check in and vaccinator, and per our documentation, patient wanted to switch to moderna booster.


VAERS ID: 1894380 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: hypertensive episode with headache 160/89 then 135/100


VAERS ID: 1894383 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Injection site pain
SMQs:, Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (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: HCTZ Topamax Losartan
Current Illness:
Preexisting Conditions: Hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: As soon as I received the injection, my deltoid started stinging, I thought that this was just because the person administering the vaccine gave it pretty quickly without identifying the acromion process, however after leaving over an hour later, my arm is now on fire. I?m not sure if she hit a nerve or not.


VAERS ID: 1894390 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-27
Onset:2021-11-23
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 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 received 1st dose on 5/27/2021 and the second was on 6/10/21 after 14 days


VAERS ID: 1894403 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Johnson and Johnson covid vaccine
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Bee Venom, Eggplant, Figs, Tylenol #3, SULFA, Clindamycin, grass and yeast
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt complaining of tongue swelling, throat itchy 6 minutes after of getting Moderna Booster vaccine. Benadryl 50 mg po given per Dr order. Pt stated she was also having difficulty swallowing water. Pt remains alert, oriented, denies any sob nor wheezing. !o to 15 minutes after the Benadryl pt able to swallow liquids without difficulty but tongue still feels swollen. Dr came and second dose of Benadryl 50 mg given as ordered. 30 minutes after second dose of Benadryl, pt stated her tongue swelling and all symptoms were resolved. Dr came and examined pt, okay to go home. Pt left in stable condition.


VAERS ID: 1894414 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 RA / IM

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

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

Write-up: Vaccine booster dose administered to patient less than 18 years of age.


VAERS ID: 1894428 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: Error: Wrong Route (SC, IM, etc.)-


VAERS ID: 1894439 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hypoaesthesia, Nausea, Paraesthesia, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: yes prescription
Current Illness: Leiomyosarcoma stage 3
Preexisting Conditions: Leiomyosarcoma stage 3
Allergies: yes medication and seasonal
Diagnostic Lab Data: unknown transferred to ED
CDC Split Type:

Write-up: Patient developed body wide tremor, lightheaded, dizzy, diaphoretic, nausea, vomiting, numbness and tingling bilateral hands and feet.


VAERS ID: 1894452 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / N/A RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Injection site pruritus, Nervousness
SMQs:, Anaphylactic reaction (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: NA
Current Illness: NA
Preexisting Conditions: nonepileptic seizures
Allergies: Wool
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complaint of itchiness on the injection site on his right deltoid, per patient itchiness spread throughout the same arm. Vital signs taken, stable. Benadryl 25 mg was given orally at 11 am, per patient itchiness was subsiding. Per patient he was feeling chest heaviness, and he was feeling nervous. Respiration rate was 18, lungs were clear at the time. Patient was monitored for further 30 minutes after medication was given. Per patient he was feeling better and patient teaching regarding any further reaction to seek 911, patient verbalized understanding.


VAERS ID: 1894489 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

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

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

Write-up: Administration error, patient receives boosters dose one month before corresponding date. Patient was administered her second dose on 06/26/2021 which indicates she would get the booster on 12/26/2021 and was administered on 11/23/2021. Patient had no adverse effects.


VAERS ID: 1894490 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-19
Onset:2021-11-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Erythema, Fatigue, Feeling of body temperature change, Malaise, Pain in extremity, Peripheral swelling, Tachycardia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol HFA, chlorthalidone, trulicity, jardiance, advair diskus inhaler, lisinopril, metformin ER, omeprazole, crestor, imitrex, topamax
Current Illness: Unknown
Preexisting Conditions: Reactive airway disease, asthma, mild intermittent asthma, essential HTN, hyperlipidemia, AUB, thyroid nodule, thyromegaly, Type 2 DM, Obesity, GERD without esophagitis, biliary calculus, IIH, OSA
Allergies: demerol, black flies, "unknown pain med possibly IV"
Diagnostic Lab Data: Patient was advised to report to ER
CDC Split Type:

Write-up: Day after she felt fatigued, hot cold chills, unwell Sxs then began on 11/23 as follows: swollen, red, painful L arm, tachycardia (HR 130)


VAERS ID: 1894498 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Pain in jaw
SMQs:, Osteonecrosis (broad)

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

Write-up: Directly aver receiving the vaccine, pt c/o HA and jaw pain. Observation only with VS and gave pt juice box. No medications or other interventions required, symptoms resolved within 20 minutes. Observation for 30 minutes prior to leaving with parent. no s/s distress on leaving.


VAERS ID: 1894502 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Dysphonia
SMQs:, Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

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: Synthroid
Current Illness:
Preexisting Conditions: Hypothyroid
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Difficulty swallowing, Hoarse voice


VAERS ID: 1894506 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / UNK LA / IM

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

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

Write-up: On 11/22/21, a Pfizer vial was reconstituted at 10:45 AM. All doses were kept in the vial. On 11/23/21, patient received the reconstituted vaccine from 11/22/21 at 10:29 AM.


VAERS ID: 1894508 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ISOSORBIDE MONONITRATE 60MG 1/2 TABLET PO DAILY AMLODIPINE 10MG ONE TAB PO DAILY NEXIUM 20MG ONE PO DAILY LISINOPRIL 40MG ONE TABPO DAILY ATORVASTATIN 40MG TWO TABS PO AT BEDTIME PLAVIX 75MG ONE TAB PO DAILY METOPROLOL TARTRATE 50MG ONE T
Current Illness: NAUSEA/VOMITING X2 DAYS WITHOUT FEVER (DOCUMENTED 11/23/21)
Preexisting Conditions: HYPERTENSION DIABETES SMOKER ELEVATED SERUM CALCIUM
Allergies: HEPARIN
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PT WAS GIVEN MODERNA AS THE 2ND DOSE IN HIS COVID VACCINE SERIES INSTEAD OF PFIZER (WHICH HE HAD RECEIVED FOR HIS FIRST DOSE)


VAERS ID: 1894521 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

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

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

Write-up: On 11/22/21, a Pfizer vaccine vial was reconstituted at 10:45 AM. All doses were kept in the vial. On 11/23/21, patient received the reconstituted vaccine from 11/22/21 at 10:08 AM.


VAERS ID: 1894532 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 RA / IM

Administered by: Pharmacy       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: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: imz was given 8hrs10mins after diution. pfizer was called to let them know


VAERS ID: 1894540 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 1 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Burning sensation, Dizziness, Erythema, Pruritus, Rash, Vertigo
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular 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: none
Current Illness: none
Preexisting Conditions: Fibromyalgia I don''t take medication for this interstitial Cystitis
Allergies: Erythomycin, adhesives, Methylpredisolone, Bupropion Hydrobromide
Diagnostic Lab Data: I had no lab done I went and ask what I need to do I was told to try Benadryl and drink fluids.
CDC Split Type:

Write-up: I felt very Dizzy and head spinning off balance. Mainly the main problem as of now is have a rash all over my face and neck and itchy all over my face and neck. I am also very bright red and in spot in my face is burning.


VAERS ID: 1894553 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

Administered by: Private       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: Administration error: a full 0.5mL dose was administered when a booster half dose (0.25mL) should have been administered. Patient was notified of the error.


VAERS ID: 1894572 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac stress test, Echocardiogram, Electrocardiogram, Full blood count, Hypertension, Liver function test, Thyroid function test
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: none
Current Illness: Hashimotos disease
Preexisting Conditions: see 11
Allergies: none
Diagnostic Lab Data: Liver/hepatic function, thyroid test, CBC, EKG, stress echo 11/2021
CDC Split Type:

Write-up: new onset hypertension requiring medication


VAERS ID: 1894597 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21 / UNK RA / IM

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

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

Write-up: Patient here to have a a Pfizer booster. A Janssen COVID-19 given in error. At first, patient was given 0.3mL of Janssen because it was thought to be the Pfizer vaccine. After consulting MD, an additional 0.2mL was given. Patient aware he received Janssen vaccine booster instead of Pfizer.


VAERS ID: 1894600 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Eye movement disorder, Mydriasis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient was in the observation room following her first dose of the COVID-19 vaccine. Approximately 5 minutes after receiving the vaccine, patient''s father was talking to RN, when Pt''s eyes rolled back and she began experiencing a syncopal event. Pt was lowered to the floor, and her feet were elevated, and she quickly came to. She was assisted back into a chair to begin an assessment, when her eyes rolled back a second time. She was again moved to the floor and feet were elevated. Vitals were taken, BP was 98/55, Pulse - 78, O2 - 96% on room air. At this time patient was pale and eyes were dilated. Father was agreeable to calling EMS and pt was transported to Medical Center. She was already looking improved when leaving on a stretcher. She did not hit her head or otherwise hurt herself during these two syncopal events.


VAERS ID: 1894605 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-03
Onset:2021-11-23
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Ill-defined disorder, Vaccine breakthrough infection
SMQs:, COVID-19 (narrow)

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

Write-up: Fully vaccinated with COVID breakthrough infection. Inpatient admit for a non COVID issue, asymptomatic positive


VAERS ID: 1894620 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: Pediatric formulation given to 13 year old


VAERS ID: 1894624 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vaccine administered to a 17-year-old.


VAERS ID: 1894627 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Extra dose administered
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), 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 known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came back to the pharmacy counter approximately 10 minutes after getting his 3rd dose of Pfizer and reported that he was feeling dizzy and light-headed. He was encouraged to wait 30 minutes and was given a water and said he was starting to feel better after that time frame. Asked him to report back any further side effects.


VAERS ID: 1894634 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received 2 moderna booster shots on same day (equal to full dose). along with flu vaccine. There was miscommunication when patient decided they wanted to receive flu shot as well. Moderna booster had already been given and second person came out to give Flu and also gave another moderna booster as well not knowing she had already received it.


VAERS ID: 1894635 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, 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: Xeloda, Ativan, Namenda, Remeron, Apresoline, Aricept
Current Illness: ESSENTIAL HTN Other HX OF CA BREAST CANCER METASTATIC TO LN CANCER METASTATIC TO RIGHT LUNG CANCER METASTATIC TO BONE MALIGNANT PLEURAL EFFUSION ATHEROSCLEROSIS OF AORTA OSTEOPOROSIS DEMENTIA CHRONIC FATIGUE SYNDROME MAJOR DEPRESSIVE DISORDER, RECURRENT EPISODE, IN FULL REMISSION FEMALE URINARY STRESS INCONTINENCE URGE INCONTINENCE CYSTOCELE. PLEURAL EFFUSION MULTIPLE PULMONARY NODULES AXILLARY LYMPHADENOPATHY INSOMNIA FEMALE BREAST CANCER, UNSPECIFIED SITE OF LEFT BREAST NEAR SYNCOPE MILD COGNITIVE IMPAIRMENT PRESENCE OF PESSARY SYNCOPE
Preexisting Conditions: ESSENTIAL HTN Other HX OF CA BREAST CANCER METASTATIC TO LN CANCER METASTATIC TO RIGHT LUNG CANCER METASTATIC TO BONE MALIGNANT PLEURAL EFFUSION ATHEROSCLEROSIS OF AORTA OSTEOPOROSIS DEMENTIA CHRONIC FATIGUE SYNDROME MAJOR DEPRESSIVE DISORDER, RECURRENT EPISODE, IN FULL REMISSION FEMALE URINARY STRESS INCONTINENCE URGE INCONTINENCE CYSTOCELE. PLEURAL EFFUSION MULTIPLE PULMONARY NODULES AXILLARY LYMPHADENOPATHY INSOMNIA FEMALE BREAST CANCER, UNSPECIFIED SITE OF LEFT BREAST NEAR SYNCOPE MILD COGNITIVE IMPAIRMENT PRESENCE OF PESSARY SYNCOPE
Allergies: NKDA
Diagnostic Lab Data: family and patient refused
CDC Split Type:

Write-up: is a 74 year old female who has completed a 45-minute observation period with the following signs and symptoms of an adverse reaction: loss of consiousness. Pfizer-BioNTech COVID-19 vaccine #3 in series administered. o Action(s) taken: Recommended transfer to higher level of care, risk and benefits explained to patient, patient declined With daughter , Family declined Per family, patient always has episodes of fainting whenever she "enters" the hospital premises Blood sugar checked 94 o Allergy to COVID-19 vaccine documented in Allergies activity: No, Vitals: 11/23/21 1050 11/23/21 1051 11/23/21 1102 11/23/21 1110 BP: (!) 201/95 (!) 203/110 (!) 191/87 (!) 175/86 BP Patient Position: SITTING SITTING BP Location: RA-RIGHT ARM RA-RIGHT ARM LA-LEFT ARM Pulse: 91 95 66 76 Resp: 18 18 18 15 SpO2: 99% 100% 100% 100% family and patient refused to go to ER or urgent care. signed


VAERS ID: 1894645 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-16
Onset:2021-11-23
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Tested NAAT positive for COVID 11/23/21 after being fully vaccinated.


VAERS ID: 1894692 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, 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: Patient was administered Moderna vaccine but she is under 18 years old.


VAERS ID: 1894702 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5217 / 1 LA / IM

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

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

Write-up: Patient experienced syncope immediately following the vaccine injection. Patient quickly regained consciousness. Had patient lay down for observation. Patient was offered water and a blanket and was able to respond appropriately to questions. Observed and spoke with patient for 15 minutes with father present. Patient reported no dizziness or lightheadedness at the end of 15 minutes and was allowed to go home under the care of her father.


VAERS ID: 1894708 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 RA / IM

Administered by: Private       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: None
Current Illness: None. Seen in clinic on 10/14/21 for a stuffy nose and cough. Covid test was negative.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Incorrect Pfizer vaccine given to patient. Patient was given 0.2mL dose out of the 12+ Pfizer Vaccine (Comirnaty). Patient is 7 years old and dose not qualify for this vaccine. No reactions at this time. No treatment needed at this time. Doctor aware and has communicated to pt.''s parent the vaccine error and what to watch for.


VAERS ID: 1894713 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Fatigue, Headache, Injected limb mobility decreased, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (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: Women''s one a day multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Penecillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, body aches, headache, pain in my left arm where I can barely lift my arm, fatigue, upset stomach, fever. My whole body hurts. It started the morning after.


VAERS ID: 1894718 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-11-16
Onset:2021-11-23
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor 20mg daily
Current Illness:
Preexisting Conditions: No history listed
Allergies: No known allergies
Diagnostic Lab Data: 11/23/21 SARS-CoV-2 PCR -detected Abnormal
CDC Split Type:

Write-up: 11/23/21 Reported fever, seen by PCP 11/23/21 Regeneron infusion given


VAERS ID: 1894723 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 LA / IM

Administered by: Public       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: Patient received Booster shot for Moderna 2 months earlier than 6 month recommendation


VAERS ID: 1894785 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site hypoaesthesia, Injection site paraesthesia, Injection site reaction
SMQs:

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

Write-up: patient experienced numbing and tingling in her left arm (same arm she received the vaccine) after receiving the pfizer covid shot. she went home and the numbing and tingling went away but now she feels like her muscles around the injection site is tight.


VAERS ID: 1894795 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan
Current Illness: Positive COVID-19 test October 24, 2021.
Preexisting Conditions: Connective tissue disease, angioid streaks (right eye), unruptured brain aneurysm, heart surgery at 1 year old.
Allergies:
Diagnostic Lab Data: Blood pressure and oxygen levels.
CDC Split Type:

Write-up: Approximately 30 minutes after receiving the COVID-19 vaccine, my daughter started experiencing trouble getting a good breath. She was taking lots of deep breaths and holding her chest area. She said it felt tight like she couldn''t breathe right. About 10 minutes later, she had a headache. She seemed very uncomfortable. I took her back to the hospital where she received the COVID-19 vaccine and they immediately walked us to the ER. Her blood pressure and oxygen levels checked immediately before taken back to a room. A doctor came in and suggested trying some Benadryl and just watching/monitoring her. About 30 minutes after receiving Benadryl, her headache subsided. Within an hour, her breathing was much easier. She was monitored for a total of 4 hours. During that time, her blood pressure was checked periodically and oxygen levels monitored.


VAERS ID: 1894803 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Extrasystoles, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: L-Carnitine, L-Arginine, L-Taurine, Ubiquinol, Aspirin 81mg, Calcium Citrate, Magnesium, Zinc, Vitamin C, Krill Oil, Alpha Lipoic Acid
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A - Patient self reporting symptoms; waiting to see if it gets worse
CDC Split Type:

Write-up: Palpitations, Skipped Heartbeats, Shortness of Breath... Possible indication of mild Myocarditis?


VAERS ID: 1894806 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoPROLOL succinate (TOPROL-XL) 50 MG amLODIPine (NORVASC) 5 MG tablet Breo Ellipta 100-25 MCG/INH inhaler olmesartan (BENICAR) 40 MG tablet
Current Illness:
Preexisting Conditions:
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to clinic for COVID-19 booster vaccine. Vaccine was not diluted and given to the patient. Patient received just under 0.3ml of non-diluted vaccine. Patient was monitored for 20 mins before patient decided they wanted to leave and they were fine. Were instructed to seek medical attention if an adverse event started to occur.


VAERS ID: 1894851 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 10 mg Montelukast 10 mg Cetirizine 5 mg aspirin 81 mg Albuterol 90 mcg
Current Illness: OSA, osteopenia, HTN, asthma, atherosclerosis or aorta. thyroid nodule, reflux laryngitis
Preexisting Conditions: Asthma, HTN, OSA
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came into vaccine clinic this afternoon to receive booster shot. A few minutes after receiving the shot, the patient began to complain of coughing and "her tongue swelling". RN laid patient down. Assessed mouth, mouth was not swollen or red. Able to drink bottle of water. VS were all normal on RA. RN called MD. Dr. verbally ordered 20 mg of PO zyrtec and to keep patient for 20 minutes to ensure she was feeling ok. The patient refused Zyrtec at first, RN was able to convince pt to take it after a few minutes. At 1355 pt took 20 mg of PO zyrtec per MD order. RN messaged PCP, and notified of patient condition, MD aware and will be seeing patient after 1430 today. At 1415, RN re took VS, VS remained normal on RA, messaged MD, MD ok for patient to leave vaccine clinic


VAERS ID: 1894853 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: She became dizzy and hot 15 minutes after the injection. Later vomited and had nausea and vomited several times. Dr came in to evaluate and pt was given Zofran. BP elevated in the 150''s/ 90''s. States that BP usually runs okay. Does not have PCP. She will follow up as new pt in a week and will come in earlier if needed. She was kept for 2 hours and discharged home. Stated that she felt better and nausea/vomiting had resolved.


VAERS ID: 1894856 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

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

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

Write-up: Pt received Janssen vaccine at 1404, pt felt lightheaded, sweating, and had syncope episode. 2 LVNS and 1 RN assisted pt until pt regained consciousness. Assisted pt to lie down in recumbent position. Ice pack, water and apple juice given. V/S done and WNL. Pt back to baseline with no complaints. Pt left at 1440.


VAERS ID: 1894861 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dyspnoea, Flushing, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: 11:45 am: Patient received his first pediatric dose of the Pfizer vaccine. 12:15 pm: Patient complaint of shortness of breath and "tickly in the throat," then moved to a gurney for closer observation. 12:16 pm: Pulse ox 100%, Pulse 97, BP of the left arm 134/87. Appeared flushed in the face, and appeared to be without increased work of breathing. 12:19 pm: Doctor arrived at patient''s side and evaluated him. 12:20 pm: Pulse ox 100%, Pulse 94. 12:25 pm: Another doctor arrived at patient''s side and evaluated him.Temp Oral 96.0 F. 12:30 pm: Doctor ordered patient to receive 10mL oral of Zyrtec, and continued to monitor for 15 minutes more. 12:33 pm: Pulse 97% and HR 94. 12:36 pm: Patient complained of slightly "tickly throat," pulse ox 96%; then pulse ox discontinued. 12:38 pm: BP of the left arm 123/72 pulse 83. Patient appeared stable enough to go home with family. Recommended mother of patient to go to ED if his conditions worsen, and to make a follow-up appointment with primary physician.


VAERS ID: 1894864 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient had taken pain medication for an infected tooth / ear infection. He was unsure of the name of the medication.
Current Illness: Tooth infection/ ear infection
Preexisting Conditions: N/a
Allergies: No allergies reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received his first COVID vaccination and was waiting his 15 minutes following his vaccination. He reported feeling light headed and sweating about 10 minutes after receiving vaccination. We had him sit down and continued to monitor him in the vaccination booth. We did ask if he would like us to call 911 so we did. He then informed us that he had not eaten all day and had also taken a pain pill (unaware of name) for a possible tooth/ear infection. He was triaged by the paramedics at the store and then released. We did give him one dose of Benadryl prior to the arrival of the paramedics due to symptoms.


VAERS ID: 1894890 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OX5F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Muscle spasms, Musculoskeletal stiffness, Nausea, Pain, Pyrexia, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: -Sprintec birth control -high BP medication (Dont know name) -levothyroxine - Rosuvastatin - Claritin - Adderall - Buproprion
Current Illness: None
Preexisting Conditions: Overweight, high BP, high cholesterol, low thyroid
Allergies: Allergic to metal (earrings, braces, etc)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden and severe nausea and vomiting. Vomiting continued (dry heaving) off and on for hours, even though nothing left in stomach. Then uncontrollable muscle spasms in my arms, neck, back, and core. That lasted for about 45 minutes. Fever, sweating, body aches, stiffness in neck.


VAERS ID: 1894906 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Tic
SMQs:, Dyskinesia (broad), Dystonia (broad)

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

Write-up: Extreme facial tics. Almost like Tourette''s but from the neck up


VAERS ID: 1894908 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 LA / IM

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

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

Write-up: Patient was administered vaccine one month early (11/23/21 instead of 12/23/21). Pt has not yet reported experiencing any adverse event related to early administration.


VAERS ID: 1894914 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Incorrect 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: Atorvastatin and Omeprazole
Current Illness: Denies
Preexisting Conditions: Elevated Cholesterol
Allergies: NKDA, NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient arrived to the clinic to receive a Moderna Booster. The Moderna Booster is a dose of 0.25 mL, but the vaccination was charted as 0.5 mL given. There is no way to know if the correct dose was given, as it was charted as a 0.5 mL dose. The patient did not have any abnormal reaction while waiting for their 15 minutes wait time in the clinic lobby.


VAERS ID: 1894915 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Feeling hot, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that he was going to faint, was sweating, felt hot, stated he was having difficulty breathing


VAERS ID: 1894916 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness and fainting


VAERS ID: 1894919 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ694AA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Laboratory test, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), 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: Unknown
Current Illness: Unknown
Preexisting Conditions: DM, HTN
Allergies: NKDA
Diagnostic Lab Data: Currently in the ER at the time of this report. Has had a battery of labs done, IV of LR going, has been given Metoclopramide and Ondansetron.
CDC Split Type:

Write-up: Patient had monoclonal antibodies on November 13, 2021. She then received both a flu shot and her COVID booster yesterday (9 days after monoclonal antibodies). Approx 24 hours after receiving the 2 shots she has having nausea and vomiting and her blood sugar was running high. Triage nurse asked that patient go to the ER to be evaluated.


VAERS ID: 1894923 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Hypoaesthesia oral
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: The patient reported that her chest was feeling tight and she was feeling dizzy. The tightness in the chest persisted and got worst. The patient then reported that her tongue went numb. Vital signs were taken (BP: 129/90; HR: 98; R: 17; T: 99.1; O2: 100% RA). EMS were called, Paramedics assessed the patient and heart monitoring and then transported the patient to ER for further treatment and observation. the patient remained alert and consciousness during the entire time.


VAERS ID: 1894925 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt was given booster to early. Pt was notified and did not have an adverse event.


VAERS ID: 1895055 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

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

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

Write-up: 5-11 Pfizer Vaccine inadvertently, given to client today. I called and spoke with her mother and informed her of the error. Client has no chronic health conditions.


VAERS ID: 1895056 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: calcium supplements
Current Illness: hives on October 18, 2021.
Preexisting Conditions:
Allergies: Pseudoephedrine-Guaifenesin
Diagnostic Lab Data:
CDC Split Type:

Write-up: hives around 1 am on November 23rd. Later that morning, around 9:00 am on November 23rd, I noticed a rash was also present on my neck and stomach/chest area. doctor advised I take Allegra and Benadryl for 1 - 2 weeks.


VAERS ID: 1895057 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Dizziness, blurred vision with previous vaccine per patient report no additional details provided
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: No known
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: At 1059 patient reported to RNs that he was feeling dizzy following administration of Janssen vaccine at 1053. RNs assisted patient to cot where VS were taken, and juice given. 1101 BP 94/60, HR 72, SPO2 96% while patient was supine on cot. Pt reported he had not eaten prior to vaccine visit and that he has had this reaction with all vaccines due to his fear of needles. Patient reported improvement of symptoms @ 1103. Patient sat at bedside without further symptoms. At 1110 patient able to stand and ambulate without residual symptoms and at 1115 left clinic independently.


VAERS ID: 1895058 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2004-04-30
Onset:2021-11-23
   Days after vaccination:6416
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

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

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

Write-up: Pt is not 18y/o yet and received booster (3rd dose) of Pfizer vaccine with parental consent. Mom is a physician and wanted pt to have vaccine booster.


VAERS ID: 1895061 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient got their scheduled 0.25 milliliters Moderna booster (3rd dose) administered on November 23, 2021 around 03:35 PM. Approximately five minutes after the shot the patient started to feel lightheaded, hot, and feel like fainting. My pharmacist colleague helped me dial emergency services as agreed from the patient when asked. The paramedics arrives approximately at 03:53 PM. After some initial assessment by the paramedics, patient states she feel nausea and the paramedics suggest she go get and check it out at the hospital. Patient agrees and left with the paramedics.


VAERS ID: 1895064 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-09
Onset:2021-11-23
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP753 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Lung opacity
SMQs:, Interstitial lung disease (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad)

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

Write-up: Recent CAT scan shows ground glass opacities not seen in 4q19. No previous COVID infection.


VAERS ID: 1895066 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

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

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

Write-up: The patient received a pediatric dose of 10ug lot FK5618 due to vaccinator error. vaccinator noticed the error immediately. We communicated with the patient, nurse lead, pharmacist, operation clinic manager. We completed the full adult booster dose with adult Pfizer lot FJ 1620 by administering 20ug more. Total of 30ug was given to the patient on the same left arm but different site.


VAERS ID: 1895069 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Eye pain, Fatigue, Feeling abnormal, Headache, Hyperhidrosis, Malaise, Myalgia, Sensitive skin, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Moderate to severe headache; mild full body muscle aches, including around eyes; cloudy/foggy mind; alternating chills and sweats; skin hypersensitivity; stomachache; vomiting; fatigue; general malaise.


VAERS ID: 1895070 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip pruritus, Oral pruritus
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: NONE
Allergies: CODEINE, MUSHROOMS, PENICILLIN, CONTRAST DYE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT STATED SHE STARTED NOTICING ITCHING IN THE ROOF OF HER MOUTH AND THEN A FEW MINUTES LATER STATED SHE STARTED NOTICING ITCHING ON HER LIPS. STATED SHE DID NOT HAVE ANY TROUBLE BREATHING OR ITCHING IN THROAT. ALL HAPPENED OVER THE COURSE OF 15 MINUTES FOLLOWING VACCINATION.


VAERS ID: 1895085 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 OT / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device connection issue, Headache, Lacrimation increased, Occupational exposure to product, Sinus operation, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Lacrimal disorders (narrow), Medication errors (broad), Hypoglycaemia (broad)

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

Write-up: I am the immunizing pharmacist. I was giving a child a Pfizer COVID vaccine. Another person drew the dose up and the needle was not on tight. When I gave the injection, a portion of the vaccine sprayed into my left eye. It left my eye blurry, and watery. I had a headache and drainage in my sinus shortly after the exposure.


VAERS ID: 1895088 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Patient started to experience chest pain, difficulty breathing, and light-headedness approximately 5 minutes after receiving their first dose of the Pfizer COVID-19 vaccine. 10-15 minutes after dose administration, patients blood pressure was 108/56 mmHg which they stated was normal for them. I continued to observe and a few minutes later the patient stated their chest pain and light-headedness was worsening. I called 911 emergency personnel at 17:40 to the scene for further care, they arrived at 17:48 and took him to the hospital for evaluation.


VAERS ID: 1895093 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, 5-HTP, and several herbal supplements (unable to recall all of the product)
Current Illness: N/A
Preexisting Conditions: Depression & ADHD
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever , shivering, very weak/fatigue, & headache


VAERS ID: 1895095 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was given an adult dose of Pfizer. Patient is the size of an adult. Patient and parent made aware of the dose mix-up. Parent notified of the improper dose given. Patient and family stayed and was able to be observed for 15-30min. Patient showed no signs and symptoms of an adverse reaction and stated that he was fine and had no issues. Writer will follow-up with patient on the next business day.


VAERS ID: 1895105 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device connection issue, Syringe issue, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Non-luerlok needle/syringe combination malfunctioned such that an unknown qty of dose escaped at the connection point between needle and syringe.


VAERS ID: 1895109 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33026BD / 3 LA / IM

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

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

Write-up: patient received a 3rd dose which is not currently approved for less than 18 years


VAERS ID: 1895115 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Chills, Headache, Lymphadenopathy, Pain
SMQs:, Peripheral neuropathy (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: Duloxetine, spironolactone, hydroxyzine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling and burning in armpit, previous evening chills, aches, headache


VAERS ID: 1895322 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8758 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: factor 5 leidin
Allergies: amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: numbness and tingling in the pinky. same arm as vaccination site


VAERS ID: 1895334 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Blood test, Chest X-ray abnormal, Chest pain, Dyspnoea, Hypertension, Pericarditis, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None.
Preexisting Conditions: None.
Allergies: N/A
Diagnostic Lab Data: Blood work and chest x-way. Determined to be pericarditis. No prior cardiac history or other medical complications.
CDC Split Type:

Write-up: Shortness of breath, stabbing/burning chest pain, tachycardia of 150+, hypertension, fever, back aches. Treatment in ED with NSAIDs.


VAERS ID: 1895340 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: patient stated they felt this way when receiving a previous vaccine elsewhere
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: administered patient 1st dose of janssen vaccine. patient stated they have a phobia of needles and immunizations. administered vaccine and had patient wait outside pharmacy for 15 min. went to check on patient a few minutes later and they stated they were feeling light headed but this was normal for them because they get so nervous. had patient move to bench in front of pharmacy to be able to monitor them and went out again a few minutes later to check on patient. they stated they still felt light headed and dizzy so had technician sit with them on bench for remainder of time to be monitored


VAERS ID: 1895349 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted briefly after getting the vaccine. The pharmacy called the paramedics. She became conscious a few minutes after and was fine. She did not go with the paramedics. I called her later in the day to check on her. She was fine.


VAERS ID: 1895361 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Dizziness, Dyspnoea, Electrocardiogram, Hypertension, Laboratory test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Heart transplant 2018 with no complications or recent illness
Allergies:
Diagnostic Lab Data: EKG, labs, chest xray
CDC Split Type:

Write-up: Approx 6 hours post vaccine patient states she felt dizzy and short of breath with chest tightness/heaviness. EMS found her to be hypertensive with SBP greater than 200. Pt brought to ER, cardiac work up completed, Pt admitted for further observation


VAERS ID: 1895364 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: no adverse events at the time of this report Medication error - 11 y/o child received adult dose of pfizer COVID-19 vaccine.
CDC Split Type:

Write-up: no adverse events at the time of this report. Medication error - 11 y/o child received adult dose of pfizer COVID-19 vaccine.


VAERS ID: 1895542 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspepsia, Dyspnoea, Hyperhidrosis, Hypoaesthesia, Nervousness, Pallor, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, guanfacine, trazadone
Current Illness: she denies other illness
Preexisting Conditions: diabetes, ADHD, anxiety
Allergies: she denied allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT received a Moderna booster dose lot #027H21B Exp 12/22/2021 at 0923am. The client denied history of allergies or previous vaccine reactions. The client reported a history of diabetes, ADHD, and anxiety and said she was taking metformin, trazadone, and guanfacine to treat these conditions. The client has a primary care provider at clinic. The client completed her observation period after receiving her booster but returned to the nursing area at 1012am stating, ?My fingers feel numb and tingly. This didn?t happen with my other Moderna vaccines.? RNs asked the client to sit down. She appeared pale and sweaty but denied feeling dizzy or faint. She denied feeling itchy. RN checked the clients left arm where the vaccine was given. There were no signs of redness, rash, or swelling. The client said she felt ?nervous? but that the feeling was different than her usual anxiety symptoms. At 1014 she said ?My chest feels tight like it?s hard to breath. It feels like I have indigestion. It feels like I need to burp.? Her respiratory rate was 16 regular and unlabored, SpO2 97%, HR 80 and regular, BP 130/90 and she rated her chest pain a 4 out of 10 on the pain scale. She was alert and oriented x 4. The client was given a snack because she said she had not eaten in 3 hours. At 1019 the client said the numbness and tingling in her left hand/fingers was ?gone,? and the pain in her chest decreased to a 2 out of 10 on the pain scale. She denied difficulty breathing and said the feeling of ?indigestion? was going away. Her RR was 15 regular and unlabored, SpO2 96%, HR 78 and regular, BP 138/94. She remained alert and oriented x 4. Her color returned to normal, her skin appeared dry, and she appeared calmer. At 1022 the client said her chest pain was ?not as bad as before? and rated it a 1 out of 10 on the pain scale. At 1024 the client said her chest pain was ?gone? and she no longer had numbness or tingling in her left hand/fingers. Her respiratory rate was 16, BP 134/86, HR 83 and regular, SpO2 96%. Her breathing appeared regular and unlabored. She was alert and oriented x 4. RNs observed the client until 1033, then asked her to try standing up. The client stood up without symptoms. She walked away with a steady gait and returned to work on site with her colleagues. The client was educated to call 911 if symptoms resumed.


VAERS ID: 1895556 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Fall, Nausea, Pallor, 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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: "A shot a few years ago" Patient did not remember details
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient received vaccine at 09:45 am, at 9:50 am he fainted and fell out of chair that he was seated in. Within seconds he recovered. He appeared pale, nauseous, disoriented briefly. His blood pressure at 10 am was 88/45. He drank some orange juice and put his head between legs. By 10:10 am his blood pressure was 117/74.


VAERS ID: 1895558 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Dyspnoea, Hypertension, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Sexual dysfunction (broad)

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

Write-up: sharp back pain with numbness of both legs difficult of breathing high blood pressure of 171/120 no fever called emergency and paramedics came : pt did not receive any treatment or medication but all the symptoms resolved after 20 minutes and bp was normal pt wanted to go home by herself


VAERS ID: 1895560 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Severe flu with hospitalization
Other Medications: Synthroid Omeprazole Vitamin D3 Iron Cetirizine Diclofenac Tylenol
Current Illness:
Preexisting Conditions: Hypothyroidism GERD IBS Fibromyalgia DJD/DDD/Osteoarthritis Frequent urination Cystitis Hematuria Iatrogenic Liver Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling in tongue, lips, hands


VAERS ID: 1895567 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 LA / IM

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

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

Write-up: Pt fell over in chair and became unconcious.


VAERS ID: 1895568 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Headache, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Son fainted a couple minutes after getting the Pfizer vaccine. He is complaining of a headache and bad tummy ache.


VAERS ID: 1895712 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: UNKNOWN
Current Illness:
Preexisting Conditions:
Allergies: CEFDINIR
Diagnostic Lab Data:
CDC Split Type:

Write-up: AFTER RECEIVING PFIZER PEDIATRIC VACCINE - PT FELT DIZY AND LIGHT HEADED. TOOK PT''S BP - BP WAS LOW 80/60. GAVE PT SNACK AND WATER AND RETOOK BP 3 MINUTES LATER. BP WAS RISING TO 90/80. WAITED ANOTHER 5 MINUTES AND TOOK THE BP AGAIN - BP WAS 108/75. TOLD PARENT THAT THIS WAS A GOOD BLOOD PRESSURE. THE CHILD STATED THEY WERE NOT DIZZY OR LIGHT HEADED ANYMORE - HAD PT WAIT A HALF HOUR BEFORE LETTING THEM GO BP WAS NORMAL - TOLD PARENT THAT IT WAS UP TO THE IF THEY WANTED TO TAKE THERE CHILD TO THE ER OR URGENT TREATMENT CENTER. THEY STATED THEY WOULD GO HOME AND IF HE STARTED TO GET DIZZY AGAIN THEY WOULD TAKE HIM TO EMERGENCY ROOM. TOLD PARENTS TO GIVE CHILD LOTS OF FLUIDS AND FOOD. CALLED PARENTS 3 HOURS LATER. THEY SAID THE CHILD WAS DOING WELL. TOLD PARENTS TO GIVE US A CALL IF ANYTHING CHANGED.


VAERS ID: 1895713 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

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

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

Write-up: Patient administered booster dose of Pfizer vaccine at the age of 16 years. Current guidelines only allow 18 years and older.


VAERS ID: 1895716 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-23
Onset:2021-11-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Generalised tonic-clonic seizure, Incoherent, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Cluster seizure 4 weeks after first Covid-19 vaccine (4/12/2021)
Other Medications: Trokendi, 300mg once per day
Current Illness: Cold
Preexisting Conditions: Nocturnal epilepsy
Allergies: Penicillin, morphine, levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue and fever for most of the day. Then a major tonic clinic seizure at 7:58pm on 11/23. Lasted around 2 minutes. Difficult to return to coherence. Ambulance called and evaluated by EMTs. Did not require hospital transport at that time.


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