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From the 11/19/2021 release of VAERS data:

Found 894,019 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 474 out of 8,941

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VAERS ID: 1876379 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-21
Onset:2021-09-26
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW4815 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210926; Test Name: COVID-19 PCR test; Test Result: Positive ; Comments: Variant PCR-based: B.1.617.2; Variant Sequenced; n501y-positive: No
CDC Split Type: ATPFIZER INC202101508457

Write-up: SARS-CoV-2 infection; Variant PCR-based: B.1.617.2; Variant Sequenced; n501y-positive: No; SARS-CoV-2 infection; Variant PCR-based: B.1.617.2; Variant Sequenced; n501y-positive: No; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority (RA)-WEB. Regulatory authority number is AT-BASGAGES-2021-053130. A 76-year-old female patient received BNT162B2 (COMIRNATY; Lot Number: EW4815), intramuscular on 21Apr2021 as dose 2, single and BNT162B2 (COMIRNATY; Lot Number: ET7205) intramuscular on 31Mar2021 as dose 1, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient experienced SARS-CoV-2 infection; Variant PCR-based: B.1.617.2; Variant Sequenced; n501y-positive: No on 26Sep2021. Outcome of event was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1876382 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-22
Onset:2021-09-26
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC0681 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210926; Test Name: COVID-19 PCR test; Test Result: Positive ; Comments: Variant PCR-based: B.1.617.2 Variant Sequenced: n501y-positive: No
CDC Split Type: ATPFIZER INC202101523585

Write-up: Vaccination failure; SARS-CoV-2 infection; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB AT-BASGAGES-2021-053143. This is a report from regulatory authority. This is the first of two reports concerning the same patient. An 82-year-old female patient received bnt162b2 (COMIRNATY), dose 2 intramuscular on 22May2021 (Lot Number: FC0681) as dose 2, single, dose 1 intramuscular on 10Apr2021 (Lot Number: EW2246) as dose 1, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced vaccination failure (as reported) and sars-cov-2 infection on 26Sep2021. The events were serious as medically significant with outcome of unknown. The patient underwent lab tests and procedures which included COVID-19 PCR test: positive on 26Sep2021 (Variant PCR-based: B.1.617.2 Variant Sequenced: n501y-positive: No). No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : AT-PFIZER INC-202101554179 The same patient, different events, second dose


VAERS ID: 1877753 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-23
Onset:2021-09-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SCJU6 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Hemiplegia
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: DEPFIZER INC202101509342

Write-up: One-sided physical paralysis when getting out of bed in the morning. Duration: Seconds to minutes; This is a spontaneous report from a non-contactable consumer downloaded from the Regulatory Authority-WEB DE-PEI-202100215178. A 31-year-old female patient received BNT162B2 (COMIRNATY), intramuscular on 23Sep2021 (Lot Number: SCJU6) as dose number unknown, single for COVID-19 immunization. Medical history and concomitant medications were not reported. On 26Sep2021, the patient experienced one-sided physical paralysis when getting out of bed in the morning. Duration: seconds to minutes. The outcome of the event was recovered on an unspecified date. Sender'' s comment: no further clarification takes place. Source of assessment by PEI was reported as D. Unclassifiable. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1877761 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-04
Onset:2021-09-26
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SCJU6 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEPFIZER INC202101508373

Write-up: Facial nerve palsy (peripheral) on the left; This is a spontaneous report from a non-contactable consumer or other non hcp downloaded from the Regulatory authority. A 15-year-old female patient received bnt162b2 (COMIRNATY), dose 2 intramuscular on 04Sep2021 (at the age of 15-years-old) (Batch/Lot Number: SCJU6) as DOSE 2, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient received first dose of COMIRNATY vaccine on 11Aug2021 for COVID-19 immunisation (FF3318). On 26Sep2021, the patient experienced Facial palsy. The patient was hospitalized for the event. The outcome of the event was not recovered. Relatedness of drug to reaction(s)/event(s): Source of assessment: Regulatory authority Sender''s comments: Exclusion of other etiologies (Borrelia, Measles, Rubella, Varicella zoster virus (VZV)) in the cerebrospinal fluid. First vaccination with Comirnaty FF3318 on 11Aug2021 No follow-up attempts are possible. No further information is expected.


VAERS ID: 1734455 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nikki (birth control)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None. Literature online says it should reduce in 7-10 days
CDC Split Type:

Write-up: Left sided supraclavicular swollen lymph node


VAERS ID: 1734456 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Upper lip swelling over 24 hrs after shot.


VAERS ID: 1734478 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Headache
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Diarrhea, Headache


VAERS ID: 1734527 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Immediate post-injection reaction, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), 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: Shot one was nearly as bad, but not quite.
Other Medications: None
Current Illness:
Preexisting Conditions: Obese
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate dizziness at the time of injection that lasted about 20 minutes. Extremely painful injection site with swelling (a lump), redness, and heat. Intermittent muscle pain rotating from thigh to calf, to arms, and so on. Slight headache could be muscle in neck. We are applying ice to the injection site.


VAERS ID: 1734531 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

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

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


VAERS ID: 1734544 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple vitamin
Current Illness: None
Preexisting Conditions: Arthritis; post mastectomy pain syndrome
Allergies: Amoxicillin; gadolinium
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches headache tired dizzy


VAERS ID: 1734579 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-31
Onset:2021-09-25
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

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

Write-up: Pt got hospitalized yesterday


VAERS ID: 1734597 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Eye pain
SMQs:, Glaucoma (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Pantoprazole, Vitamin D, fishoil
Current Illness: none
Preexisting Conditions: removed thyroid, GERD
Allergies: none known
Diagnostic Lab Data: Eye exam by dr.
CDC Split Type:

Write-up: Pain behind and including Left Eye. Tx: Prednisone (acetate) eye drops. return to normal, but see 2nd shot ( have not returned to normal)!


VAERS ID: 1734608 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Chills, Dizziness, Fatigue, Migraine, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Migraine since 2 hours after 2nd vaccine, nausea, stomach pain, fatigue, chills, muscle & joint pain, dizziness.


VAERS ID: 1734626 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

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

Write-up: Patient fainted when sitting in waiting room after getting the vaccine. She had been sitting in tripod stance looking at her phone and thinks she fainted and rolled to the ground from the chair. She was sitting on the floor when my assistant walked by after hearing her phone drop. We helped her to the exam table where she lay with head elevated, talking normally and oriented x4. Drank water and ate a granola bar since she said she had not eaten yet today. About 30 min after receiving the shot she felt like she could leave and felt normal. No head injury noted and no bleeding noted. She did say she may feel a little tender on upper right forehead and hairline.


VAERS ID: 1734632 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Smallpox immunization
Other Medications: Centrum one a day vitamin 150mg buproprion XL 30mg duloxetine
Current Illness: Common cold concluded 10days prior to vaccine. Non Covid (tested during course of illness)
Preexisting Conditions: N/A
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen left deltoid above and below injection site. 1.5? by 6? in surface area and approximately 1/2? (a half inch) in elevation.


VAERS ID: 1734646 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK - / -

Administered by: Other       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: Acetaminophen Amlodipine Besylate Aranesp (Billable) Aranesp (Billable) Calcitriol Calcium Acetate Clonidine HCl Clonidine HCl Covid-19 Pfizer-BioNTech Addl dose Gentamicin 320mcg/ml in 4% Citrate Gentamicin 320mcg/ml in 4% Citrate Heparin
Current Illness:
Preexisting Conditions: ESRD
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1734648 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Other       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: Acetaminophen Aranesp (Billable) Aspirin Calcitriol Calcitriol; Covid-19 Pfizer-BioNTech Addl dose Diltiazem HCl ER Heparin bolus Heparin hourly Hydralazine HCL Insulin Lispro (Human) Lovastatin Nepro/Carb Steady Normal Saline
Current Illness:
Preexisting Conditions: ESRD Diabetes, currently on insulin
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1734649 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Acetaminophen Aranesp (Billable) Calcitriol Covid-19 Pfizer-BioNTech Addl dose Divalproex Sodium Docu Soft Engerix-B (Hepatitis B Vaccine) Furosemide Gentamicin 320mcg/ml in 4% Citrate Gentamicin 320mcg/ml in 4% Citrate Heparin bolus Hepar
Current Illness:
Preexisting Conditions: ESRD Diabetes, currently on insulin History of hypertension
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1734655 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK - / -

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

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

Write-up: patient came in stating for first dose of COVID-19 vaccine. reflected 1st dose. Provider gave pfizer dose. When support staff looked up pt. eligibility for incentive program in record showed pt. had J&J 3/28/21. Pt. admitted to doing this because he heard pfizer was a better vaccine. incentive was not given.


VAERS ID: 1734656 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Acetaminophen Aranesp (Billable) Calcitriol, Covid-19 Pfizer-BioNTech Addl dose Divalproex Sodium Docu Soft Engerix-B (Hepatitis B Vaccine) Furosemide Gentamicin 320mcg/ml in 4% Citrate Gentamicin 320mcg/ml in 4% Citrate Heparin bolus Hepar
Current Illness:
Preexisting Conditions: ESRD Diabetes, currently on insulin History of hypertension
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1734657 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen Aranesp (Billable) Calcitriol
Current Illness:
Preexisting Conditions: ESRD Diabetes, currently on insulin History of hypertension
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1734663 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Acetaminophen Amlodipine Besylate Aranesp (Billable) Aspirin; Calcitriol Carvedilol Clonidine HCl Covid-19 Pfizer-BioNTech Addl dose Glipizide Heparin bolus Hydralazine HCL Normal Saline Oxygen Tums
Current Illness:
Preexisting Conditions: ESRD
Allergies: Metformin
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1734664 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Acetaminophen Aranesp (Billable) Calcitriol Divalproex Sodium Docu Soft Engerix-B (Hepatitis B Vaccine) Furosemide Gentamicin 320mcg/ml in 4% Citrate Gentamicin 320mcg/ml in 4% Citrate Heparin bolus Heparin hourly Losartan Potassium Mirtaza
Current Illness:
Preexisting Conditions: ESRD Diabetes, currently on insulin History of hypertension
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1734666 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

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

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


VAERS ID: 1734681 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-04
Onset:2021-09-25
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

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

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

Write-up: Patient miscarried in the 11 days following vaccine administration. Patient does have a history of miscarriage.


VAERS ID: 1734682 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 309614 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none known to patient
Diagnostic Lab Data: Fire Department and ambulance arrived and was helping patient.
CDC Split Type:

Write-up: After 5 to 10 minutes of receiving vaccines, she lost consciousness, woke up and went into seizures for duration less than a minute. Emergency Medical Services was contacted; however, patient refused to go to the hospital.


VAERS ID: 1734685 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / SYR

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

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

Write-up: Vaginal Bleeding 2 days after the shot


VAERS ID: 1734709 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Neck pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The lymph node in my collar bone area is very swollen and tender to touch. My neck hurts, and my arm hurts .


VAERS ID: 1734714 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 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? 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: dizziness


VAERS ID: 1734716 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Acetaminophen Acetaminophen Albuterol Amlodipine
Current Illness:
Preexisting Conditions: ESRD Amputation Congestive heart failure Diabetes History of hypertension
Allergies: Codeine almonds
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1734718 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Other       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: Aranesp (Billable) Aranesp (Billable) Aspirin Auryxia; Calcitriol Cetirizine HCl Covid-19 Pfizer-BioNTech Addl dose Degludec insulin (Tresiba) Dialyvite 800 Famotidine Furosemide Gabapentin Gentamicin 320mcg/ml in 4% Citrate Gentamicin 320
Current Illness:
Preexisting Conditions: ESRD Congestive heart failure Diabetes, currently on insulin History of hypertension
Allergies: Amoxapine
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1734719 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

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

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

Write-up: L arm pain, swelling-- lymphedema L arm


VAERS ID: 1734721 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen Aranesp (Billable) Aranesp (Billable) Aspir-81, B-Complex Calcitriol Covid-19 Pfizer-BioNTech Addl dose Dialyvite 800 Effexor EMLA, Heparin bolus, Normal Saline, Oxygen, Sevelamer Carbonate EMLA Heparin bolus Normal Saline Oxy
Current Illness:
Preexisting Conditions: ESRD
Allergies: Codeine Penicillin Sulfa
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1734726 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Injection site pain, Vaccine positive rechallenge
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: injection site soreness, generalized arthragias after doses 1 and 2 of Pfizer Covid-19 vaccine.
Other Medications: levothyroxine, atorvastatin, finasteride
Current Illness: none
Preexisting Conditions: hypertension, hypothyroidism
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: injection site soreness, generalized arthralgias (bilateral wrists, elbows, shoulders, and knees)


VAERS ID: 1734740 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

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

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

Write-up: On Saturday, September 25, 2021 client came to vaccination POD for a Covid-19 Janssen dose. Client stated to ancillary staff during check-in process that he was vaccinated with Covid-19 vaccine 7 months ago in February, without proof of vaccination. At this time Covid-19 vaccine is not a vaccine approved. Elevated to Medical team & Vaccine Operations Lead and approved client to get the Janssen vaccine as it has been more than 28 days since receiving the one dose of non-FDA-authorized Covid-19 vaccine. Client has no history of allergies or previous adverse reactions to other vaccines. Client was to be a 15 minute wait in the Observation Area. Client received his Covid-19 Janssen (LOT #: 211A21A) at approximately 10:32 AM in his left arm. Client experienced no adverse reaction while waiting in Observation Area and left vaccination site with a steady gait at approximately 10:50 AM.


VAERS ID: 1734769 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: Bells Palsy to left side of face


VAERS ID: 1734780 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Fall, Hyperhidrosis, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient became disoriented, light headed, briefly lost consciousness, and fell out of the chair. He then got up and began sweating profusely and began vomiting. 911 was called and patient was taken to the hospital by EMS.


VAERS ID: 1734786 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-22
Onset:2021-09-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain, Injection site warmth, Lymph node pain, Lymphadenopathy
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOWN
Current Illness: NOT KNOWN
Preexisting Conditions: NOT KNOWN
Allergies: NONE
Diagnostic Lab Data: NOT KNOWN
CDC Split Type:

Write-up: 9/22/21 PATIENT STATES 4 HOURS AFTER INJECTION SITE WAS SORE / WARM . THE NEXT DAY PATIENT STATES LYMPH NODES UNDER VACCINATED ARM AND NECK ARE SWOLLEN AND TENDER. PATIENT STATES "HER LEFT SIDE FELT NUMB" WAS CONCERND WENT TO EMERGENCY ROOM TO GET SYMPTOMS CHECK OUT. AT HOSPITAL PATIENT SAYS DOCTORS OBSERVED HER FOR 2 HOURS THEN SENT HER HOME AND TOLD HER THAT WAS A NORMAL SIDE EFFECT FROM THE COVID VACCINE.. SHE WAS INSTRUCTED TO USE TYLENOL AND APPLY ICE TO SWOLLEN AREAS . 9/24/21 PATIENT SAYS FEELING A LITTLE BETTER BUT NOT YET FULLY RECOVERED


VAERS ID: 1734805 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Influenza like illness
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: General fatigue, flu like symptoms, diarrhea, headache.


VAERS ID: 1734870 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Feeling abnormal, Lethargy, Lymphadenopathy, Nausea, Pallor, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, tingling arms/hands/face, pallor, brain fog, confusion, lethargy, axillary and right cervical lymphadenopathy developed 40 hours after injection


VAERS ID: 1734887 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Muscle twitching, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FINISHED ANTIBIOTICS COURSE COURSE 3 WEEKS AGO, TREATED PNUEMONIA
Current Illness: PNUMONIA
Preexisting Conditions: NO
Allergies: ASPIRIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: IN THE FIRST 15 MINS THE PT EXPERIENCED DIZZINESS, SENSED HER NERVES AT BACK OF NECK TINGLY, AND LIPS WERE QUIVERING. PT STAYED SEATED FOR ANOTHER 15 MINS AND SAYS SYMPTOMS HAS LESSENED AND STATED SHE WAS OK TO LEAVE.


VAERS ID: 1734896 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 RA / IM

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

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

Write-up: Tingling on tongue, headache, pressure on back. EMS attended and cleared patient.


VAERS ID: 1734904 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Oxygen saturation decreased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: Fever and low oxygen saturation


VAERS ID: 1734905 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

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

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

Write-up: patient had an episode of syncope, nausea, emesis, pallor and diaphoretic around 11:27am after vaccine administration. Ammonia inhalant used pt brought into clinic triage room where provider came to assess . Pt had normal vitals that were taking a total of 3x during his monitoring in clinic and was alert and oriented x4. Pt given juice and water per provider and monitored for an extra 20 min until provider and pt felt comfortable releasing home with strict ER precautions for worsening symptoms.


VAERS ID: 1734906 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood glucose decreased, Confusional state, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypertension, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (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: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Hypertension-Medium, Systemic: Nausea-Medium, Systemic: Weakness-Severe, Additional Details: HER COMPANION NOTICED SHE "STIFFENED UP" PRIOR TO FAINTING. PARAMEDICS WERE CALLED AND FOUND HER BLOOD GLUCOSE LEVEL CLOSE TO HYPOGLYCEMIC AND HYPERTENSIVE ABOUT 15 MINUTES AFTER EPISODE. PATIENT REQUIRED A LITTLE OVER AN HOUR TO RECOVER TO THE POINT SHE FELT WELL ENOUGH TO STAND UP, BUT WAS STILL WEAK. PATIENT DECLINED TO BE TAKEN TO HOSPITAL FOR OBSERVATION AND TOOK A RIDE SHARE HOME WITH HER COMPANION. PATIENT IS REQUESTING DOCUMENTATION OF INCIDENT BE AVAILABLE TO HER FOR HER RECORDS.


VAERS ID: 1734909 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypertension, Musculoskeletal stiffness, Nausea, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Hypertension-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Mild, Systemic: Weakness-Severe, Additional Details: PATIENT "STIFFENED UP" PRIOR TO FAINTING. HER COMPANION WAS ABLE TO CATCH HER AND PROTECT HER FROM HEAD TRAUMA. PARAMEDICS WERE CALLED AND FOUND HER CLOSE TO HYPOGLYCEMIC AND HYPERTENSIVE. I ADMINISTERED AID IN THE FORM OF JUICE AND A COLD PACK. SHE REFUSED TRASNPORT TO HOSPITAL INSTEAD RESTING IN OUR WAITING AREA. SHE EXHIBITED WEAKNESS AND NAUSEA AND FELT WELL ENOUGHT TO STAND AFTER RECOVERING FOR ~75 MINUTES WHEN SHE TOOK A RIDE SHARE HOME WITH HER COMPANION. PT WOULD LIKE DOCUMENTATION.


VAERS ID: 1734911 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Seizure, Syncope, Tension, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Nausea-Mild, Systemic: Seizure-Medium, Additional Details: Pt received 2nd dose Covid19(pfizer-biontech) on 9/25/2021 at 10:30AM. Pt was with mom, appeared nervous. Pharmacy Intern sat with pt for several minutes prior to vaccine administration. Vaccine given and pt felt lightheaded, had full conversation with intern. After 3-4 minutes, pt appeared to have a seizure, body tensed up, possibly loss of consciousness for about 1 min. Pt recovered, was fully alert for remainder of time at pharmacy.


VAERS ID: 1734917 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Head injury, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NONE
CDC Split Type:

Write-up: Patient was given 2nd dose Pfizer IMZ, 10 minutes after administering patient passed out and hit his head on another chair. EMSA was called took him to hospital for evaluation because he continued to feel dizzy multiple times, along with having a pain in his upper abdomen.


VAERS ID: 1734919 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS X9A9B / 1 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. 1780867 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received three vaccines (Havrix, Gardasil, Pfizer COVID-19) and passed out while remaining seated for about 5 seconds. She regained consciousness quickly and was given water. She remained seated for another 15 minutes with no concerns. She did note afterwards that she had not eaten anything yet today. Called the patient 30 minutes later after she left store and she was feeling back to perfectly normal.


VAERS ID: 1734926 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

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

Write-up: Patient verbalized feeling nausea, stated not new occurrence; she takes Synthroid 112 mg before breakfast and feels nausea in afternoon. Vitals taken at 1:50PM: O2 99%, RR 17, Pulse 75, BP 118/74 2:10PM vitals retaken: o2 98%, RP 19, Pulse 71, BP 120/72. Patient felt better, water was given to her, denies any distress. Patient educated on self care post vaccine. Verbalized understanding.


VAERS ID: 1734937 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 RA / IM

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

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

Write-up: During an injection, the needle came apart from the syring. Additional dose was then given after.


VAERS ID: 1734959 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Flushing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)

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

Write-up: Patient complained of flushing after vaccination. Patient denied chest pain, headache, dizziness and no shortness of breath. Cold pack applied.


VAERS ID: 1734969 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Feeling cold, Hot flush, Hypoaesthesia oral, Paraesthesia oral, Swollen tongue, Tremor
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID-19 Pfizer Dose 1 given on 9/3/2021. Details listed above.
Other Medications: Daily multivitamin, garcinia, apple cider vinegar
Current Illness: None
Preexisting Conditions: Neurocardiogenic syncope- well controlled with no recent episodes
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 5 minutes of receiving the first COVID vaccine, Patient felt swelling and tingling in her tongue. She did not have any issues with her breathing, but her tongue felt heavy, swollen, and tingly for roughly an hour. She did not take any medication after this reaction. Within 5 minutes of receiving her second COVID vaccine, she felt swelling, tingling, and numbness in her tongue. She also felt a flash of heat in her head that went away quickly. Following the flash of heat, her arms, legs, and fingers were ice cold and she had an internal tremble. I gave her 12.5mg of liquid diphenhydramine at 9:21am. This was 8 minutes after her vaccine. After several minutes, she started to feel better. Her tongue still felt heavy and she was still cold, but she could tell the reaction was going away.


VAERS ID: 1734979 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 RA / IM

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

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

Write-up: Patient reported feeling dizzy and numbness in the right arm. EMS was called , he was able to walk away with EMS out of the pharmacy / store.


VAERS ID: 1734983 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Fear of injection, Hyperhidrosis, Memory impairment, Neck pain, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Patient had noted on consent forms that he had previously fainted after getting blood drawn. We spoke about this and he stated that he gets nervous with needles. After giving him his vaccine, he moved into our waiting area and within 2 minutes he fainted. His head was snapped back and his legs were out straight. I tapped him on the shoulder and shouted his name. He was unresponsive for approximately 30-45 seconds and in that time the ambulance was called. He came to and didn''t have memory of what had happened, but stated that he was warm and began profusely sweating. The front store manager got him a bottle of water and when the paramedics arrived they took him on the stretcher to get vital laying down in the ambulance. I called the patient approximately 4 hours after the incident and he stated that the paramedics allowed him to leave on his own and he wasn''t transported to the hospital. He noted a sore neck from when he head snapped back in the chair, but he was otherwise feeling fine.


VAERS ID: 1734994 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 1 LA / IM

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

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

Write-up: patient is 17 years old and was given moderna vaccines which is approved for use by 18 years and older


VAERS ID: 1735009 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

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

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

Write-up: pt fainted about 5 minutes after the injection was given. Technician was with him and helped lay him flat on floor. 911 was called but patient was awake when they arrived to assess him.


VAERS ID: 1735033 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK - / -

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reports not taking any medications.
Current Illness: Patient reports not suffering from any illness.
Preexisting Conditions: NKDA
Allergies: Patient reports not having allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: ADMINISTRATION ERROR: Patient for booster dose of PFIZER without 6 months between second and third dose. Male patient 60 year old needs third dose and vaccine card replacement. At the time of confirming his information in the system. Nurse, proceeds to vaccinate the patient without the patient corroboration.


VAERS ID: 1735037 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-13
Onset:2021-09-25
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Depression
SMQs:, Depression (excl suicide and self injury) (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: Lexapro, Buspar, propranolol, gabapentin, famotidine, pantoprazole, levocitirazine, monteleukast, nabumetone, tramadol, prometrium. Allergy shots, B12 (pernicious anemia).
Current Illness: Cold with cough within the month.
Preexisting Conditions: Depression, anxiety, migraines, neck pain, pernicious anemia, high pulse. Gynecological problems and perimenopause.
Allergies: Tricyclic antidepressants. Many environmental allergens (I take allergy shots).
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had an unusual few days of unexplained deep depression. I think it may be a side effect. It''s better now.


VAERS ID: 1735039 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205B21A / 1 LA / IM

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

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

Write-up: Patient received J&J vaccine , was told to wait 15 min for observation. Patient felt dizzy and asked for a cup of water. Patient passed out right after for about a min. Myself and my staff pharmacist who was helping me tried to make the patient gain conscious. Patient came back right away with full memory, no head injuries, Patient refused ambulance and any medical assistance. patient was given 3 gatorade drinks and fruit snacks, was also asked to perform leg and hand muscle contractions to help stabilize the blood pressure. Patient was asked to stay 30 min for more observation, Patient felt better and was able to walk away when 30 min were up. . Patient was thankful for the attention he got .


VAERS ID: 1735041 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

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

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

Write-up: Patient fainted 8 minutes after vaccine. Was checked out and proven to be unharmed by EMS


VAERS ID: 1735042 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 Pfizer COVID-19 vaccine today after having completed the Moderna series in July. The personal information given by the patient at the pharmacy was different than the information submitted in system. The patient refused to wait for the 15 minutes after the vaccine for observation, and has not received her Vaccination Record Card. It cannot be confirmed if she actually received both Moderna and Pfizer, but the name and date of birth match in system.


VAERS ID: 1735050 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Asthenia, Cold sweat, Mydriasis, Tremor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: none
Preexisting Conditions: ADHD
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Several seconds after the first dose the patient stopped talking, had tremors in hands and feet and slumped to the right. Developed cold sweat, pupils dilatated and was non-responsive but breathing normally (not labored and steady). 911 was contacted immediately and the patient began to speak very weakly but could not respond in full words or sentences and remained very weak, she maintained an open airway and was placed on the floor to aid in perfusion to her brain, the paramedics arrived in roughly 5 minutes and transported her to the Hospital. No history of any seizures/panic episodes etc reported by mother.


VAERS ID: 1735058 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, 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: HCTZ, ramipril, atorvastatin, amlodipine
Current Illness: no known illnesses
Preexisting Conditions: unknown
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient did not have an adverse event, but received Pfizer for the third/booster dose after he originally received 2 doses of Moderna. Patient did not have adverse event in the 15 minute monitoring period after receiving the vaccine, nor did he have any to report later in the day ~2 hours after administration.


VAERS ID: 1735083 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-22
Onset:2021-09-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Eye swelling, Periorbital swelling, Pruritus, Skin lesion
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid 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: Itchy and swelling of the eyes after receiving the yellow fever vaccine, Hep A and another travel vaccine I can?t remember at th
Other Medications: Wixela Advair, albuterol
Current Illness: None.
Preexisting Conditions: Psoriasis, eczema, asthma, endometriosis
Allergies: Doxycycline HYC, food allergies including : Bananas, Avocados, peanuts, fish, shellfish, corn, eggs, etc.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Puffy swelling eyes, accompanied with severe itchiness and small lesions under eyes. I took 25 mg of Benadryl and swelling stopped and receded within the hours only to return in 4 hours.


VAERS ID: 1735098 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation, 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: Gave 1st shot with no vaccine by error. Called patient back and gave 2nd shot with vaccine.


VAERS ID: 1735101 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Eye swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PFIZER VACCINE ON 2/16/21 AND 3/19/21, THE SAME Adverse event of swelling eyes occurred with the Pfizer vaccine and it was repor
Other Medications: N/A
Current Illness: N/a
Preexisting Conditions: n/a
Allergies: Last allergic reported to COVID-19 vaccine with swelling underneath eyes on 2/16/21 and 3/9/21
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient reported swelling underneath her eyes after the 3rd COVID booster Pfizer vaccine. It started immediately after vaccination and lasted for about 30 minutes. Pt was monitored for 40minutes and it reduced afterwards. These symptoms occurred before with her previous doses. No treatment wasa given.


VAERS ID: 1735103 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: A few minutes after receiving the vaccine, patient started feeling light headed and dizzy. Then patient stated that she was having trouble breathing. We called 911. During evaluation by EMS, patient seemed fine but said she still experienced trouble breathing. She as taken to the hospital for further evaluation.


VAERS ID: 1735121 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3102 / 1 LA / SYR

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

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

Write-up: Grand Mal seizure


VAERS ID: 1735141 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Drain of cerebral subdural space, Dysarthria, Dysgraphia, Gait disturbance, Haemorrhage intracranial, Laboratory test normal, Speech disorder
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: d3 cetirizine hydruchoride metroprolol pregabalin amlodopine losartin triamterene/hctz ezetimibe magesium tumeric
Current Illness: none
Preexisting Conditions: left lung removed brain tumor removed
Allergies: statins
Diagnostic Lab Data: Had full testing done and they find nothing wrong
CDC Split Type:

Write-up: head filled up with blood - Doctor drained. Over 3 months have had trouble walking, talking. writing and typing. I slur my words. I have had pt, st, and ot.


VAERS ID: 1735153 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Patient was received a COVID vaccination and during her 15 minute waiting period, patient told pharmacist that she wanted the EMS called because she was having severe heart palpitations. Patient''s BP was checked by 2nd pharmacist and the reading was 168/86/122. EMS was called to check out the patient. Patient''s vitals were taken by EMS and subsequently released. Patient left the pharmacy area about 30 minutes following the incident stating that she felt better.


VAERS ID: 1735160 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: unknown
Current Illness: unknown
Preexisting Conditions: asthma
Allergies: penicillin, clindamycin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient''s arm begin to swell during 15 min waiting period. No pain was reported, only swelling and redness


VAERS ID: 1735165 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

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

Write-up: Patient came to receive the Pfizer booster shot. He presented his COVID vaccination card and it stated that he received the first two doses on 1/6/21 and 1/27/21. A booster was indicated and administered to the patient. Upon billing the vaccine, a rejection showed that he also received the Janssen vaccine on 8/13/21 at a different pharmacy chain. Patient had no reaction at time of administration.


VAERS ID: 1735168 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-05
Onset:2021-09-25
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not aware of
Current Illness: not aware of
Preexisting Conditions: not aware of
Allergies: not aware of
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient said he experience many side effects, especially vomiting, fever, severe body aches and pains.


VAERS ID: 1735173 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Feeling hot, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: States had reaction 12 hours after first dose but wanted 2nd dose
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Flushed,hot,sweaty clammy


VAERS ID: 1735177 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site hypoaesthesia, Vaccination site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Patient reported numbness and rash on arm around vaccine site. EMS attended and cleared patient.


VAERS ID: 1735181 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Public       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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose Pfizer covid vaccine by an IM injection without vaccine present in syringe. Patient called to back to clinic and arrived at 1248. Left arm assessed with no redness, no pain, no swelling, no tenderness to site. Patient given vaccine filled syringe in right arm.


VAERS ID: 1735184 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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

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

Write-up: The injection site became red, about 1 1/2? in diameter circle that is very itchy/warm and slightly raised.


VAERS ID: 1735203 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

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

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

Write-up: Patient began feeling nauseated about 5 minutes after her dose. She started feeling a little better at about 15 minutes post dose but still some nauseousness.


VAERS ID: 1735208 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / 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: Per patient she has heart disease and was advised by her cardiologist to get the booster dose as soon as possible
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: During event day, Patient came and completed form attesting that it has been six months since 2nd dose was administered to receive booster dose. Booster dose was given. After returning from event to enter data and submission to insurance, claim was rejected for not covered since it has not been 6 months since last dose. After checking system, record shows last dose was April 26, 2021. Spoke to patient over the phone, and she stated that her cardiologist said her husband and her both have heart disease and need to get booster dose as soon as possible.


VAERS ID: 1735209 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 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? 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: None
CDC Split Type:

Write-up: Pt claimed dose given today was his first dose of Pfizer, Actually was his second dose given at 11 days from his first.


VAERS ID: 1735214 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Lethargy, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), 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: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT fainted & held in seat by boyfriend after receiving #2/2 Pfizer vaccine at 1613. PT received vaccine at 1600 to L Deltoid & tolerated shot well. Boyfriend stated PT had a history of anxiety, but doesn''t take medications. 1 ammonia inhalant used to revive PT with success but continued to be very lethargic & stated that her fingers felt numb. VS taken 1615 O2 Sat 99%, RR 24, BP 100/70, HR 76 EMT called and arrived at 1620. O2 Sat 99% HR 72,k RR 20 prior to PT leaving with EMT to ambulance. PT more alert and talking with boyfriend & staff prior to leaving. Boyfriend, mother and sister present when taken into ambulance for evaluation. Boyfriend reported that PT had a history of anxiety and fainting and that he carries a bottle of alcohol to sprinkle on nose to revive her. No fainting reported at 1/2 vaccine. EMT assessed her in the ambulance & cleared her to leave with family at 1637hrs.


VAERS ID: 1735215 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO185-H / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PT here for 2nd dose of Pfizer, received at 1440. At approximately 1450, PT presented with diaphoresis, pallor, and reported that he felt hot and had slight nausea. No LOC noted. PT was able to walk to cot without difficulty, laid down on cot at 1451. VS at 1452: BP 102/68 laying, HR 94, SPO2 100% RA, RR 18. No respiratory distress noted. PT accepted and drank juice, reported he felt ?a little better? laying down. PT reported that his first dose went well and he doesn?t have a history of similar reactions after vaccine. VS at 1458: BP 104/84 laying, HR 83, SPO2 99% RA. Education provided to PT and mother on vasovagal reactions, when to seek out medical care. At 1500, PT sat up, reported that he ?feels good? and self-transferred to chair without difficulty. Pt reported the nausea is resolved, color is visibly improved, diaphoresis is resolved. VS at 1500: BP sitting is 112/88 sitting, HR 89, SPO2 99% RA. PT was able to stand at 1509, reports he felt ?great?, was talking with RNs and mother with affable demeanor. VS at 1509: BP 98/72 standing, HR 88, SPO2 99% RA, RR 18. PT denied dizziness, stood without difficulty and walked with steady gait. At 1513, PT exited facility with mother. Mother reported that she will stay with PT today to monitor him.


VAERS ID: 1735218 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Fatigue, Headache, Insomnia, Lethargy, Pain, Seizure, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Body Aches Generalized-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Headache-Medium, Systemic: Seizure-Severe, Systemic: Shakiness-Severe, Systemic: Unable to Sleep-Severe


VAERS ID: 1735227 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

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

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

Write-up: Should have received Moderna and got Pfizer instead.


VAERS ID: 1735234 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / 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: Per patient heart disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: During store wellness event day, Patient came and completed form attesting that it has been six months since 2nd dose was administered to receive booster dose. Booster dose was given. After returning from event to enter data and submission to insurance, claim was rejected for not covered since it has not been 6 months since last dose. After checking immunization records, record shows last dose was April 26, 2021. Spoke to patient''s wife over the phone, and she stated that their cardiologist said her husband and her both have heart disease and need to get booster dose as soon as possible.


VAERS ID: 1735256 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

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

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

Write-up: Pt did not give complete information. Received a 3rd dose of Pfizer


VAERS ID: 1735260 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: SAME, FIRST COVID VACCINE
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT STATED THAT SHE PASSES OUT EVERY TIME SHE GETS A VACCINE. HER MOM SAID IT WAS VASAL VAGAL. I GAVE HER THE VACCINE AND THE PATIENT, HER MOM AND I ALL SAT IN THE ROOM FOR 5 MINUTES AND THE PATIENT DID PASS OUT. AFTER SHE PASSED OUT SHE APPEARED TO HAVE A SEIZURE. HER MOM INSISTED IT WAS JUST VASAL VAGAL, BUT IT DID NOT LOOK LIKE THAT TO ME.


VAERS ID: 1735282 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-21
Onset:2021-09-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site lymphadenopathy
SMQs:

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: na
Current Illness: unkown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: swollen lymph nodes on arm where vaccine administered


VAERS ID: 1735288 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Dysstasia, Pain, Sleep disorder
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Lipodystrophy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, Losartin, Xarelto, Synthroid, ZryTec
Current Illness: None
Preexisting Conditions: A fib Low Platelets Leaking Valves Heart Murmur
Allergies: Cleocin,Duricef, Keflex,Vancomycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Woke up at a out 4:00 am to Severe pain mid left breast around side to mid back. Woke with pain, could not turn to side or get out of bed due to pain. When could get up after one hour, used ice back and took one muscle relaxer pill, TIZANidine. At about 10:00 am pain was subsiding.


VAERS ID: 1735313 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Hypersensitivity, Petechiae
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient has allergic reaction in the area of the arms and abdomen area. Allergic reaction red Petechiae.


VAERS ID: 1735350 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7315LA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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: None known
Current Illness: Unknown
Preexisting Conditions: Asthma and allergy injections
Allergies: Allergy injections are given
Diagnostic Lab Data: None as of now
CDC Split Type:

Write-up: The patient as of now has no adverse reaction. This is being reported because we discovered that the vaccine given was not diluted correctly.


VAERS ID: 1735396 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Anxiolytic, name of prescribed medication unknown.
Current Illness: Very anxious after vaccinated, patient started getting very anxious and scared about the vaccine.
Preexisting Conditions: unknown.
Allergies: no allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: -12:13- patient received COVID-19 vaccine and grew very anxious after receiving it. Staff recommended patient to lie down on the cot to relax and do some deep breathing. Parents stated she is taking a prescribed medication to help with anxiety, but did not remember the name of it. -12:15- patient had a panic attack and was very worried, anxious and scared and stated "my heart hurts, its beating fast." Vital signs taken: Blood pressure 163/86, HR 145, Sp02 99%. We called 911 and requested EMS. About 3 minutes later, the patient felt nauseous and stated "I feel sick, I need to throw up" and patient threw up in trash can. We provided continued to monitor the patient closely, water and deep breathing techniques to help relax the patient. -12:23- EMS arrived, handoff report provided and EMS took vitals signs and was provided consent by patient''s parents to transport the patient to the Hospital.


VAERS ID: 1735397 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

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

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

Write-up: Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: Patient was in the observation phase and stated he was not feeling well, that he felt a little bit of tingling. We asked if he had had any issues with the first dose he recieved on 9/3/21. He said he did not asked him to stay for an additional observation for at least 30 minutes. He began to say he was having difficulty swallowing - HCP told him we were calling 911 and to please sit next to the pharmacy. I called 911, came back to the patient. ambulance came admin epipen and took to ER


VAERS ID: 1735446 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait disturbance, Hypoaesthesia, Motor dysfunction, Paraesthesia, Speech disorder, Symptom recurrence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Light guillon barre symptoms after the first shot.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness and tingling in feet and legs. Walking becoming challenging. Speech requires greater focus. Hands are becoming less nimble. I had guillon barr? syndrome October 2010 and recovered. Symptoms are reoccurring.


VAERS ID: 1735447 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-24
Onset:2021-09-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3013SBA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal behaviour, Extra dose administered, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Medication errors (narrow)

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

Write-up: 36 hours after third(booster) shot, my husband is throwing up and very nauseous. This is extremely abnormal behavior for him and has not happened in the 21 years I have known him. It has lasted about eight hours. On and off.


VAERS ID: 1735450 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Fatigue, Gastrooesophageal reflux disease, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Arm pain, nausea, fatigue, chest pain, acid reflux


VAERS ID: 1735462 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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: None
Current Illness: Denies
Preexisting Conditions: Denies
Allergies: Augmentin - N/V
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 12:29PM/Janssen vaccine 0.5ml administered to L deltoid 12:36PM/patient reported while in observation area he "was feeling dizzy, like he was about to pass out" 12:36PM/patient was assisted to the ground with 2 EMT''s , patient feet elevated Patient vitals 111/68, 58,22,96%02 SAT. patient diaphoretic, able to answer questions, NO LDC, patient reports left pinky finger numb which resolved quickly (approx 2 minutes) 12:39PM/cool water bottle placed under patient head, alcohol pad waved under patient nose, patient alert and oriented x 4. Decreased disphoresis, increase in patient color, patient reports feeling much better vitals 109/77, 71, 24, 95%O2 SAT. Cap refill 3 seconds. patient declined 9-1-1 or beevaluated by paramedics. pupils equla and reactive 12:45PM/ patient reports history of fainting with pain, patient reports mother also does this 12:48PM/patient assisted to sitting position on the ground. Vitals: 129/102, 86, 20, 95% 12:52pm/patient able to get up and sit in chair with standby assist if needed. patient able to perform independently vitals: 136/92, 78, 18, 96% O2 At 12:58PM/patient reports feeling good, continues to drink water. Patient agrees to stay another 10 minutes to assure he feels ok to drive 13:05PM/Vitals: 115/60, 55, 18, 96% Patient reports feeling good and reports he is fine to drive. Encouraged patient to contact PCP or go to Urgent Care if he develops further symptoms that are concerning. Discussed SOA, chest discomfort. If he develops these to seek emergency care. patient verbalized understanding and agrees with plan patient departed immediately after discussion.


VAERS ID: 1735478 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3952 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 9339N / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Last covid vaccine similar symptoms but much more mild.
Other Medications: Luvox Gabapentin Depakote Nasal sprays
Current Illness: Oral hsv 1 week prior
Preexisting Conditions: Anxiety, depression, ocd
Allergies: Ceclor- rash
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe bilateral arm pain right greater than left, severe arthralgias, fever 101.9, headache, dizziness. Much more severe symptoms with booster than either other shot.


VAERS ID: 1735479 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-09-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb injury
SMQs:, Accidents and injuries (narrow)

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

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


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