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

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



Case Details (Reverse Sorted by Onset Date)

This is page 48 out of 5,069

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VAERS ID: 1490815 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-07
Onset:2021-07-07
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Hypersensitivity, Joint stiffness, Muscular weakness, Pain in extremity, Seasonal allergy
SMQs:, Rhabdomyolysis/myopathy (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Conjunctival disorders (narrow), Hypersensitivity (narrow), 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:
Other Medications: Synthroid, Metaprolol, baby aspirin, Eliquis, Azathioprine, Crestor, multi vitamin, calcium with D, B complex, D3, biotin
Current Illness: None
Preexisting Conditions: Cogan''s Syndrome, hypothyroidism, coronary arteritis, bilateral sensorineural hearing loss in 2009,
Allergies: Penicillin, pseudoephedrine, benadryl, doxycycline, Lipitor, Zocor.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 2 months later. Pain at right thumb joints, stiff, weak, strength loss. Started July 7 to present. Also one and a half month after had seasonal allergy attack, never had one in all my life. Late June for 2 straight weeks.


VAERS ID: 1490823 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Appendicitis, Back pain, Breast feeding, Endometrial thickening, Nausea, Polymenorrhoea, Ultrasound scan abnormal, Vaginal haemorrhage, Vaginal odour
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: pre-natal, stool softener, Breo, albuterol PRN
Current Illness: Pfizer #1 6/15/2021, delivered baby via c-section 6/9/2021
Preexisting Conditions: Moderate persistent asthma, uterine fibroids, seasonal allergies
Allergies: wheat, corn, soybean, seasame seeds, peanut per SN testing
Diagnostic Lab Data: Vaginal sono done with OB/midwife on 7/13/2021 (we do not have the physical record, just report from patient had thickened endometrial stripe and no retained POC)
CDC Split Type:

Write-up: Patient had child via c-section on 6/9/2021. Received dose #1 of Pfizer 6/15/2021. Had normal post-partum bleeding. Second dose 7/6/2021. Approximately 7/7/2021 she started having increased vaginal bleeding, darker and with an odor following by intermittent generalized abdominal pain. Pain progressed to become constant and included low back pain and some nausea. OBgyn ruled out other causes of increased increased post-partum bleeding, suspected having early menses (though is breastfeeding) vs AE of recent Pfizer vaccines. On 7/14/2021 she had sudden severe abdominal pain, and was diagnosed with acute appendicitis in the ER (Presbyterian Dallas).


VAERS ID: 1490863 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-01-12
Onset:2021-07-07
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Fatigue, HIV antibody
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: blood pressure heart eye nose back pain
Current Illness: unknown
Preexisting Conditions: heart/back pain
Allergies: unknown
Diagnostic Lab Data: Blood Test
CDC Split Type:

Write-up: Exhaustion and was given blood test, and given test for HIV, Eventually was told he had the Antibodies for HIV.


VAERS ID: 1490940 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-23
Onset:2021-07-07
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chills, Erythema, Fatigue, Palpitations
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: valsartan 160mg, norvasc 2 1/2mg, prolec 15mg
Current Illness: no
Preexisting Conditions: high blood pressure, osteopenia
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: had pink cheeks and tired, a week later woke up with chills and shivering, had heart palpitations, and tightness in upper chest


VAERS ID: 1491030 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site infection, Pustule
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Puss shooting out after 10 days from date of vaccination. Wound infected, redness around injection site.


VAERS ID: 1491255 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1080 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cubital tunnel syndrome, Erythema, Pruritus, Respiratory tract congestion, Secretion discharge
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tylenol and ibuprofen as needed (not taken day of vaccine)
Current Illness: n/a
Preexisting Conditions: fibromyalgia
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Itching started around 40 minutes after vaccination (arms, face, head, neck, back, legs, ears, eyes, and nose) and lasted 5 hours, then came and went through 7/10 with milder intensity. Took allergy medicine 7/10. Face redness for 3 hours after vaccination. Slight cough with clear mucus a handful of times and felt chest congestion on 7/10.


VAERS ID: 1491449 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-10
Onset:2021-07-07
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 into the hospital for second dose Pfizer. Patient was told to check in with lead RN''s to have BP checked due to high BP at last second dose appointment. RN took patients BP at 1320. BP: 160/118. RN retook patients BP at 1327. BP: 150/120. RN called 911 at 1329. Paramedics arrived on scene at 1340. EMS took patients BP at 1342. BP: 142/122. Patient was recommended to go to emergency room. Patient denied going to emergency room and signed AMA form. Patient was educated by RN on worsening signs and symptoms of a hypertensive crisis. RN recommended that patient go see PCP regarding high BP readings. Patient verbalized understanding of education and reason to go to PCP. Patient was denied second dose Pfizer due to high BP. Patient verbalized that he would go see PCP soon. Patient was told to see Lead RN''s before coming back for second dose appointment so BP could be checked before vaccination. Patient verbalized understanding of instructions. Patient received second dose Pfizer on 7/20/21 (LOT#: EW0183) at 1415. RN stated to another RN that she had seen patient in the observation area at 1416. RN''s went up to patient and confirmed that it was the correct patient. Patient stated that he had gone into another hospital on 7/08/21 at 1800 to get BP checked. BP reading at clinic was 125/82. Patient stated that all tests came back normal. Patient was not given any new medications during visit. Patient was discharged from clinic. Patient stated that he feels good. Patient left vaccination site unassisted with a steady gait at 1430.


VAERS ID: 1491455 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Abdominal rigidity, Diarrhoea, Frequent bowel movements, Inflammation
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Iron Supplement mixed with vitamins C, B12 and calcium, Women''s Probiotics
Current Illness:
Preexisting Conditions: Endometriosis
Allergies: Codeine cough syrup, Augmentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Abdominal cramping approx 2 hours after first shot was taken. Followed by bloating, inflammation and frequent bowel movements for a week. Then exactly 1 week later from day of first vaccine shot had diarrhea with abdominal spasms. Then 2 days later had diarrhea again with continued abdominal spasms, extra bloating, and inflammation in locations of endometriosis. This happened with menstrual cycle for that same week. For a total of 2 weeks of abdominal inflammation and spasms continue as of 7/21/21. Consulting with doctors.


VAERS ID: 1492898 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       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? Yes
Birth Defect? Yes
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: USMODERNATX, INC.MOD20212

Write-up: Next day 8July2021 she started spotting/Then the day after 9July2021, she started bleeding more/she had a miscarriage; At the time of the shot she was 7 weeks pregnant; This spontaneous prospective pregnancy case was reported by a consumer and describes the occurrence of ABORTION SPONTANEOUS (Next day 8July2021 she started spotting/Then the day after 9July2021, she started bleeding more/she had a miscarriage) in a 39-year-old female patient (gravida 1) who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 07-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Last menstrual period and estimated date of delivery were not provided. On 07-Jul-2021, the patient experienced EXPOSURE DURING PREGNANCY (At the time of the shot she was 7 weeks pregnant). On 08-Jul-2021, the patient experienced ABORTION SPONTANEOUS (Next day 8July2021 she started spotting/Then the day after 9July2021, she started bleeding more/she had a miscarriage) (seriousness criteria medically significant, life threatening and congenital anomaly). On 07-Jul-2021, EXPOSURE DURING PREGNANCY (At the time of the shot she was 7 weeks pregnant) had resolved. On 09-Jul-2021, ABORTION SPONTANEOUS (Next day 8July2021 she started spotting/Then the day after 9July2021, she started bleeding more/she had a miscarriage) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication use information was not provided by reporter. The laboratory exams performed to further understand the event included were ultrasound a week prior to the shot to show the babies heart rate. Treatment medication use information was not provided by reporter.; Sender''s Comments: This case concerns a 39-year-old female patient gravida 1 who received mRNA-1273 at 7 weeks of pregnancy and experienced spotting one day post vaccination and spontaneous abortion 2 days post vaccination. Last menstrual period and estimated date of delivery were not provided. Spontaneous abortion show temporal association with product use and a causal relationship cannot be excluded. The event of exposure during pregnancy is assessed not applicable


VAERS ID: 1493215 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-02
Onset:2021-07-07
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / OT

Administered by: Work       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: 20210707; Test Name: Rapid Covid Test; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC2021868037

Write-up: Covid Positive; Covid Positive; This is a spontaneous report from a contactable other hcp. A 43-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot Number: EL3248), via intramuscular route, administered in left arm on 02Feb2021 15:30 as DOSE 2, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was unknown if the patient received other vaccine in four weeks. It was unknown if patient had covid prior vaccination. The patient''s historical vaccine included bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE via intramuscular route, administered in left arm on 14Jan2021 15:30 as DOSE 1 single for covid-19. On 07Jul2021, the patient was covid positive. On 07Jul2021, the patient underwent sars-cov-2 nasal swab test which was positive. The outcome of the event was not recovered.; Sender''s Comments: Based on the reported information, a causal association between the reported events of vaccination failure, covid-19 and suspect drug bnt162b2 cannot be excluded.


VAERS ID: 1493705 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

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


VAERS ID: 1494030 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 - / IM

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

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

Write-up: Pt received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the pt will need to be re-vaccinated. Pt received replacement dose on 7/21/2021


VAERS ID: 1494125 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-28
Onset:2021-07-07
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO181 / 1 LA / SYR

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

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

Write-up: minor rash, acene sized, started roughly a week and half after 1st does of vaccination sometimes a couple appeared throughout the day and sometimes it does not occur, itching


VAERS ID: 1494150 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

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


VAERS ID: 1494162 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / UNK LA / IM

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

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

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


VAERS ID: 1494258 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unable to get complete list due to lost to f/u
Current Illness: abdominal pain, constipation
Preexisting Conditions: mental health
Allergies: adhesive, Daytrana
Diagnostic Lab Data:
CDC Split Type:

Write-up: PCP received records related to patient ER visit for chest pain after COVID-19 vaccine. Was seen in the local ER.


VAERS ID: 1496136 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-22
Onset:2021-07-07
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site pruritus, Sleep disorder
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: One-a-Day multivitamin for women over 50; OTC pain relievers because of dental work; antibiotics because of bad dental work; irregular usage of horse chestnut seed and glucosamine chondroitin
Current Illness: negligent dental work, otherwise healthy
Preexisting Conditions: some stress-related conditions
Allergies:
Diagnostic Lab Data: No tests were conducted.
CDC Split Type:

Write-up: Several weeks ago I started having an extreme and painful itch in my upper left arm. I tried to ignore it, but it is so extreme it keeps me from sleeping. Finally, as the severity and area of my arm affected increased, I went to the Emergency Room. The ER doctor thought that it must be symptoms of a bug bite. That had not occurred to me before, because I had not noticed being stung or bitten, and there have been no visible bite or sting marks on my arm. However, I have always had a more severe reaction than the average person to bees, mosquitos and sting rays. The doctor prescribed prescription steroids and OTC Benadryl. I have been taking these two medicines for the past 5 days but my symptoms have NOT alleviated. Even considering my normal bad reactions to bites and stings, I should be seeing improvement if that diagnosis were correct. Today after I was reviewing the current status of the COVID pandemic, I got my "v-safe check-in" on the phone, and it suddenly occurred to me that I am having these symptoms at the site of my COVID vaccination shots. So I''m wondering...if it could be relevant...


VAERS ID: 1496327 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-25
Onset:2021-07-07
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram, Facial paralysis, Hypertension, Magnetic resonance imaging, Neurological examination
SMQs:, Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypertension (narrow), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Olmesartan 40mg daily, Coreg 12.5 mg bid, Plexus supplements - BioCleanse and Slim drink
Current Illness: None
Preexisting Conditions: History Stroke 2016; HTN,
Allergies: No known allergies
Diagnostic Lab Data: Facial exams, neurology exam, CT and MRI
CDC Split Type:

Write-up: 7/7 - about 9am or 10 am in morning, his face on the right side began to droop. He felt as though he may be having stroke, as known from prior event. Yet, he drove himself to the ER. A stroke event was ruled out. He was diagnosed with Bell''s Palsy syndrome with numbness and paralysis on the right side of his face. Treatment include high dose steroid Prednisone for 5 days. Adjustment with increase in this blood pressure medication, as his blood pressure was running in the 210s/110s. (extremely high). Prior to this event - pt traveled under the false security that he was okay to mingle since he had been vaccinated. (Currently, the place he traveled to is showing a COVID surge). Now today on 7/22 -patient still is suffering from the Bell''s Palsy side effect. Slowly he is regaining feelings and very slight movement of his face.


VAERS ID: 1497430 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Agitation, Arthralgia, Asthenia, Back pain, Fatigue, Headache, Malaise, Musculoskeletal chest pain, Musculoskeletal stiffness, Nerve injury, Neuralgia, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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: TRAZODONE; CYMBALTA; LIPITOR [ATORVASTATIN]; ADDERALL; ZENACOR
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Shingles (I had shingles a long time ago)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021861065

Write-up: Severe pain in all of my joints/ all over my joints down to my toes are probably sore; didn''t feel good and went to sleep; I have like some nerve pain, started in my, is like tingly; like nervy on my right. I don''t know, if it''s connected or not on my right arch of my foot,; I just felt ''lack'' of any energy; My back feels like every nerve is on fire, there is electricity; my rib and the front of my upper abdomen and all over my joints down to my toes are probably sore; my rib and the front of my upper abdomen and all over my joints down to my toes are probably sore; I am so agitated; Fatigue; My back feels like every nerve is on fire, there is electricity; Severe headache; Stiff neck; This is a spontaneous report from a contactable other health care professional (nurse). A 58-year-old female patient (nurse) received bnt162b2 (BNT162B2, Solution for injection, Lot Number: EW0164), via an unspecified route of administration, administered in left upper arm on 07Jul2021 11:00 (at the age of 58-year-old), as Dose 1, single for Covid-19 immunization. Medical history included the patient had shingles a long time ago. Patient did not report any other medical conditions. The patient did not receive any other vaccine in four weeks prior to vaccination. Concomitant medications included Trazodone; Cymbalta; atorvastatin (LIPITOR [ATORVASTATIN]) (referred as generic cholesterol medicine); amfetamine aspartate, amfetamine sulfate, dexamfetamine saccharate, dexamfetamine sulfate (ADDERALL) and coffea canephora (ZENAC), mild daily. On 07Jul2021 patient had first shot at about 11 o''clock and within hour she just felt lack of any energy and was started getting massive/severe headache and stiff neck, severe pain in all of my joints but also my back feels like every nerve were on fire, there is electricity (serious as medically significant event), the back of her left side of her head and neck and just feeling a lot of fatigue. Patient came home and got in bed, she took two Tylenol 1000 milligrams at 3 o''clock (Intent: treatment) and went to bed and she immediately went to sleep and slept for 4 hours straight. She thought what woke her up like her back was on fire and for some reason, she felt very agitated (patient did not mean to be personally agitated to anybody) that she could not stand it and that was not her. The patient further stated, "severe pain in all of my joints, I can''t stand it and that''s not me, didn''t feel good and went to sleep, all over my joints down to my toes are probably sore; on an unspecified date, she stated that "I have like some nerve pain, started in my, is like tingly, like nervy on my right and she don''t know, if it''s connected or not on my right arch of my foot". When probed for the permission to ask further questions, Nurse stated, "That''s okay because like I said like is it normal and my back is on fire, I just feel very agitated and I don''t know why, I just woke up that way. I don''t usually feel that way, so I don''t mean to be personally agitated to anybody, you see what I mean." When probed for clarification if consumer wants to know the side effects are normal, Nurse stated, "Well, I am just reporting. I don''t think, it might be, it might not be. I don''t know but I just wanted to report it because in all the literature, it doesn''t say anything about it." The patient received treatment for events Headache, stiff neck, nerve pain in back and joints to upper abdomen, fatigue, with Tylenol, 1000 milligrams. Causality for the events "My back feels like a campfire like the nerve endings are electric; it''s actually coming around to the like sides of my rib and the front of my upper abdomen and all over my joints down to my toes are fore ably sore; It''s feels like nerve pain in my back and then in my joints to my upper abdomen; horribly agitated; ''I have like some nerve pain, started in my, tingly like, nervy on my right. I don''t know if it''s connected or not. on my right arch of my foot when I just got up and walk. Since I pressure on it''; and Like sides of my rib and the front of my upper abdomen and all over my joints, down to my toes are probably sore'', was reported as related by the reporter. The outcome of all events was reported as unknown. Causality: Nurse stated, "Well, I would say, yeah, because I never had this. Well, I have never. Yeah, that''s definitely. I just feel like my joint hurts, my muscle ache, you know, I got that weird. I had shingles a long time ago in my back and that what if feels like shingles pain in my back and then in my rib and then my head, like I said, very, I don''t usually have headache and stiff neck so, yeah, I think it''s as far as the foot thing. I have no idea (As the Nurse was not sure about this hence not captured in tab) but yeah." Nurse was informed about Pfizer Medical Information and telephone number was shared. ; Sender''s Comments: Considering a plausible temporal relationship, a causal association between the reported event of neuralgia and suspect drug bnt162b2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1497432 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Insomnia, Oral pruritus, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Fruit allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021861598

Write-up: couldn''t sleep; a lot of itching in throat and mouth; a lot of itching in throat and mouth; This is a spontaneous report from a contactable consumer (patient). A 27-year-old non-pregnant female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot Number was not reported), via an unspecified route of administration, administered in Arm Left at the age of 27-year-old on 07Jul2021 16:15 as single dose for covid-19 immunization. Medical history included Biotin, Y cranberry''s from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. Historical vaccine included BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Solution for injection, Lot number and expiration date were not reported), via an unspecified route of administration on an unknown date as single dose for covid-19 immunization. On 07Jul2021 23:45, at night after receiving the second dose of the vaccine the patient almost couldn''t sleep, with a lot of itching in throat and mouth. She would like to know if that event was normal. The patient did not receive treatment for the events. The clinical outcome of events was recovering. Information on the lot/batch number has been requested.


VAERS ID: 1497476 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021869901

Write-up: anaphylaxis; This is a spontaneous report from a contactable Nurse reported for (patient). A 13-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number and Expiration date was not reported), via an unspecified route of administration on 07Jul2021(age at vaccination 13 years) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient was not pregnant at the time of vaccination. The patient visited emergency room for reported events. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient experienced anaphylaxis on 07Jul2021. The outcome of event was unknown. Information about lot/batch number is requested.; Sender''s Comments: There is a reasonable possibility that the event Anaphylactic Reaction was related to the use if suspect product BNT162b2 based on known drug safety profile and the close temporal relationship.


VAERS ID: 1497521 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Headache, Neck pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021881317

Write-up: potential not to get the second shot; headache; neck ache; fever; throwing up; This is a spontaneous report from a contactable consumer (grandparent). This consumer reported for a 12-year-old male patient (grandson). A 12-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, formulation: Solution for injection, Batch/Lot number was not reported), dose 1 via an unspecified route of administration, administered in Arm Left on 07Jul2021 11:30 (At the age of 12 year old) as dose 1, single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Caller called on behalf of his grandson (12-year-old) who received the first dose of the Pfizer Biontech COVID-19 vaccine and on the same day he got the shot, he experienced headache, neck ache, fever, and throwing up on 07Jul2021. Stated that the headache gets better and comes better. Stated that it was tolerable and comes back. Stated that the fever comes and goes. Started throwing up 2-3 days ago. She wanted to know if those side effects were related to the COVID19 vaccine and if she needed to go to the doctor and if he could get the second dose. Caller also stated that the side effects outweigh the COVID shot, I do not want my grandchild to suffer like that. Vaccines were supposed to make you feel better, not sick. Caller asked if the vaccine was tested on children and if they had side effects. Wanted to know if she needed to go the doctor because he cannot live throwing up all the time. Stated that he had never been sick before. Stated that he was only 12 years old. Does not think that vaccine was adequate for children. Therapeutic measures included Ibuprofen for his headache and fever. Stated that he had cold compresses for the neckache. Stated that he had ginger ale and Pepto Bismol for throwing up. Outcome of the event headache and throwing up was reported as not recovered at this time of the time. Outcome of the event neck ache was reported as recovered on 11Jul2021. Outcome of the event fever was reported as recovering and outcome of the event potential not to get the second shot was reported as Unknown. Information about the lot/batch number has been requested.


VAERS ID: 1497562 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-07-07
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / OT

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, COVID-19, Chills, Cough, Diarrhoea, Fatigue, Headache, Nasal congestion, Pain, Pyrexia, SARS-CoV-2 test, Vaccination failure
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LIPITOR [ATORVASTATIN]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lymphoma
Allergies:
Diagnostic Lab Data: Test Date: 20210710; Test Name: Nasal Swab; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC2021887071

Write-up: Contracted COVID 19; Contracted COVID 19; Extremely tired and fatigued; Cough; Congestion; Headache; Fever; Chills; Body aches; Diarrhea; Loss of taste; This is a spontaneous report from a contactable consumer (Patient). A 58-years-old male patient received second dose bnt162b2 (BNT162B2, Solution for injection, Batch/Lot Number: EW0158) via intramuscular route of administration in Arm Left on 09Apr2021 17:00 as DOSE 2, SINGLE, patient received first dose bnt162b2 (BNT162B2, Solution for injection, Batch/Lot Number: EP7534) via intramuscular route of administration in Arm Left on 19Mar2021 17:00 as DOSE 1, SINGLE for covid-19 immunisation. Patient didn''t received other vaccines within 4 weeks prior to vaccination the patient received other medications within 2 weeks of vaccination was Lipitor. Medical history included lymphoma from an unknown date and unknown if ongoing. Concomitant medications included atorvastatin (LIPITOR [ATORVASTATIN]) taken for an unspecified indication, start and stop date were not reported patient was not diagnosed with COVID-19 prior to vaccination patient was tested to COVID-19 to post vaccination. On 07Jul2021 the patient experienced contracted covid 19, contracted covid 19, extremely tired and fatigued, cough, congestion, headache, fever, chills, body aches, diarrhoea, loss of taste patient had physician office visit for the events. The patient received treatment for rest all events was unknown and for vaccination failure, covid-19 did not received any treatment. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 10Jul2021. The outcome of the events vaccination failure, covid-19, fatigue, cough, nasal congestion, headache, pyrexia, chills, pain, diarrhoea, ageusia was recovering.


VAERS ID: 1454702 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-30
Onset:2021-07-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Injection site mass, Pain in extremity, Pruritus, Rash erythematous, Skin discolouration, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: ? itching (intense) ? a red or discolored rash that is an apple big ? some light itching in hands and fingers ? lots of swelling ? pain (pain in left arm and below armpit) ? skin feels warm to the touch ? hard lump under skin where the injection took place (left arm)


VAERS ID: 1464365 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Headache, Immediate post-injection reaction, Loss of consciousness, Migraine, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: 1) Right after injection: weakness, breath difficulties, faint (till complete loss of consciousness). Recovery in about half an hour after drinking some water and rest. Weakness persisted till the end of day. 2) On the 2nd and 3rd days after injection: strong headache/migraine in various parts of head. Temporary relief for several hours after taking Paracetamol pills.


VAERS ID: 1466348 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-07-07
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Fatigue
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CAJNJFOC20210723120

Write-up: TIRED AFTER THE SHOT; FELT WEAK FOR AN HOUR; This spontaneous report received from a parent concerned a 26 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: not reported) dose was not reported, administered on 07-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 07-JUL-2021, the subject experienced tired after the shot. On 07-JUL-2021, the subject experienced felt weak for an hour. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from felt weak for an hour on 07-JUL-2021, and the outcome of tired after the shot was not reported. This report was non-serious.


VAERS ID: 1468652 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Pallor, SARS-CoV-2 test, Syncope, Vaccination site pain
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), COVID-19 (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: Medical History/Concurrent Conditions: Suspected COVID-19 (Unsure when symptoms stopped)
Allergies:
Diagnostic Lab Data: Test Date: 20201223; Test Name: COVID-19 virus test; Test Result: Inconclusive
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: sweaty; lost of facial colour; vaccination site pain; Fainting; This regulatory authority case was reported by a consumer and describes the occurrence of SYNCOPE (Fainting) and HYPERHIDROSIS (sweaty) in an 18-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Suspected COVID-19 (Unsure when symptoms stopped) on 21-Dec-2020. On 06-Jul-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 07-Jul-2021, the patient experienced SYNCOPE (Fainting) (seriousness criterion medically significant). 07-Jul-2021, the patient experienced PALLOR (lost of facial colour) and VACCINATION SITE PAIN (vaccination site pain). On an unknown date, the patient experienced HYPERHIDROSIS (sweaty) (seriousness criterion medically significant). At the time of the report, SYNCOPE (Fainting) was resolving and HYPERHIDROSIS (sweaty), PALLOR (lost of facial colour) and VACCINATION SITE PAIN (vaccination site pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 23-Dec-2020, SARS-CoV-2 test: Inconclusive. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. The reporter stated that got up , had a sore arm, came down stairs, lost all facial color, went sweaty and gainted patient has not tested positive for COVID-19 since having the vaccine adverse reaction did not occur as a result of an exposure during pregnancy. Concomitant medications were not reported No treatment information was provided. Company Comment Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1468666 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-04
Onset:2021-07-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Electrocardiogram, Fatigue, Pericarditis, Pyrexia, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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: Test Date: 20210707; Test Name: ECG; Result Unstructured Data: ST elevation; Test Date: 20210707; Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: chest pain; arthralgia; vomiting; fever; fatigue; Pericarditis; This regulatory authority case was reported by a physician and describes the occurrence of PERICARDITIS (Pericarditis), CHEST PAIN (chest pain), ARTHRALGIA (arthralgia), VOMITING (vomiting), PYREXIA (fever) and FATIGUE (fatigue) in an 18-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 04-Jul-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) 1 dosage form. On 07-Jul-2021, the patient experienced PERICARDITIS (Pericarditis) (seriousness criteria hospitalization and medically significant). On an unknown date, the patient experienced CHEST PAIN (chest pain) (seriousness criteria hospitalization and medically significant), ARTHRALGIA (arthralgia) (seriousness criteria hospitalization and medically significant), VOMITING (vomiting) (seriousness criteria hospitalization and medically significant), PYREXIA (fever) (seriousness criteria hospitalization and medically significant) and FATIGUE (fatigue) (seriousness criteria hospitalization and medically significant). At the time of the report, PERICARDITIS (Pericarditis) was resolving and CHEST PAIN (chest pain), ARTHRALGIA (arthralgia), VOMITING (vomiting), PYREXIA (fever) and FATIGUE (fatigue) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 07-Jul-2021, Electrocardiogram: st elevation (abnormal) ST elevation. On 07-Jul-2021, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication information was provided by the reporter. No treatment information was provided by the reporter. Based on the current available information and temporal association between the use of the product and the start date of the event Pericarditis, a causal relationship cannot be excluded. Very limited information regarding the reported events of Fatigue, Chest pain, Arthralgia, Vomiting and Pyrexia has been provided at this time, however, a causal relationship cannot be excluded. No further information is expected.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event Pericarditis, a causal relationship cannot be excluded. Very limited information regarding the reported events of Fatigue, Chest pain, Arthralgia, Vomiting and Pyrexia has been provided at this time, however, a causal relationship cannot be excluded. No further information is expected.


VAERS ID: 1485854 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-07-07
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperpyrexia, Injection site pain, Malaise, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210707; Test Name: Hyperpyrexia; Result Unstructured Data: Fever 40.5 to 42 degrees Celsius
CDC Split Type: NLJNJFOC20210734266

Write-up: HEADACHE; FATIGUE; FEVER: 40.5 TO 42 DEGREES CELSIUS; FEELING UNWELL; COLD CHILLS; MUSCLE PAIN; NAUSEA; REACTION AT OR AROUND THE INJECTION SITE: PAIN; This spontaneous report received from a consumer via a Regulatory Authority [RA NL-LRB-00615634] concerned an 18 year old male of unspecified race and ethnicity. The patient''s weight was 68.8 kilograms, and height was 181 centimeters. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) 1 dosage forms, 1 total, administered on 07-JUL-2021 for covid-19 immunization. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 07-JUL-2021, the patient experienced fever (40.5 to 42 degrees Celsius), feeling unwell, cold chills, muscle pain, nausea, reaction at or around the injection site: pain and fatigue. On 08-JUL-2021, the patient experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from cold chills, muscle pain, and nausea on 08-JUL-2021, was recovering from reaction at or around the injection site: pain, fatigue, fever: 40.5 to 42 degrees celsius, and headache, and had not recovered from feeling unwell. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210734266-covid-19 vaccine ad26.cov2.s- fever: 40.5 to 42 degrees celsius. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1486513 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002615 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Thrombosis
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Fainting; Fear of needles
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: blood clots; Felt faint; This regulatory authority case was reported by an other health care professional and describes the occurrence of THROMBOSIS (blood clots) in an 18-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3002615) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Fear of needles and Fainting. On 07-Jul-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 07-Jul-2021, the patient experienced DIZZINESS (Felt faint). On an unknown date, the patient experienced THROMBOSIS (blood clots) (seriousness criterion medically significant). On 07-Jul-2021, DIZZINESS (Felt faint) had resolved. At the time of the report, THROMBOSIS (blood clots) had resolved. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown Route) was unknown. For mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown Route), the reporter did not provide any causality assessments. After having the vaccine the patient said they felt faint. Was made to lie on the floor with the legs elevated and then made a full recovery. No concomitant medication was reported. No treatment information was provided. No laboratory data was provided Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information is not expected.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information is not expected.


VAERS ID: 1489363 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PTPFIZER INC2021861379

Write-up: fever, headache, chills, nausea, fainting; fever, headache, chills, nausea, fainting; fever, headache, chills, nausea, fainting; fever, headache, chills, nausea, fainting; fever, headache, chills, nausea, fainting; This is a spontaneous report from a contactable consumer (patient''s father). A 16-year-old female patient received second dose of BNT162B2 (COMIRNATY, Solution for Injection, Batch/Lot number was not reported), via an intramuscular route of administration in the left arm on 06Jul2021 at 16:00 (at the age of 16-years-old), as dose 2, single for Covid-19 immunization. The patient medical history and concomitant medications was not reported. Historical vaccine included first dose of BNT162B2 (COMIRNATY, Solution for Injection) via an unspecified route of administration on 15Jun2021 at 15:00, as dose 1, single for Covid-19 immunization. The patient had no known allergies and prior to vaccination, the patient had not been diagnosed with COVID-19. The patient had not received any other vaccines within 4 weeks prior to the COVID vaccine. The patient had not been tested for COVID-19 since vaccination. On 07Jul2021 at 15:00, the patient experienced fever, headache, chills, nausea, and fainting. Therapeutic measures were taken as a result of fever, headache, chills, nausea, and fainting and included treatment with paracetamol. The clinical outcome of the events was resolving at the time of this report. Information on bnt162b2 (COMIRNATY) batch number has been requested.


VAERS ID: 1493561 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Heart rate, Laboratory test, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Insulin dependent diabetic; Insulin pump therapy; Type 1 diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210707; Test Name: tachycardia; Result Unstructured Data: Test Result:122; Comments: approximately 2 hours; Test Date: 20210707; Test Name: lab tests; Result Unstructured Data: Test Result:normal
CDC Split Type: COPFIZER INC2021867528

Write-up: tachycardia for approximately 2 hours of 122 maintained; This is a spontaneous report from a contactable consumer (patient''s mother). A 15-year-old female patient received bnt162b2 dose 1 via an unspecified route of administration on 07Jul2021 (at age of 15-year-old) as single dose for covid-19 immunisation, vaccine was administered at a hospital. Medical history included type 1 diabetes, insulin dependent, under control with insulin pump, all ongoing. The patient''s concomitant medications were not reported. The reporter informed that on the day before the time of reporting (07Jul2021) they went to a hospital for the 1st dose of the Covid vaccine, patient received 3 ml of the Pfizer vaccine (as reported, pending clarification), however the patient had an adverse reaction with tachycardia for approximately 2 hours of 122 maintained that required attention in emergency room, at the hospital the patient underwent all the lab tests and was discharged 4 hours later because the lab tests were normal. The reporter informed that she provided this information due to the very severe response of the patient. The outcome of the event was recovered. Information on the lot/batch number has been requested.


VAERS ID: 1447345 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.... normally take a low dose aspirin every day, but did not take it for the last 2 days prior to the covid inoculation (per the CDC recommendation to not take Tylenol or aspirin)
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Post menopausal bleeding? I have not had a menstrual cycle for 2 plus years


VAERS ID: 1449749 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-05
Onset:2021-07-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Pain
SMQs:, Arthritis (broad)

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

Write-up: Body Aches, Joint Pain


VAERS ID: 1449975 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Klonopin, Paxil, Estrovan, Norco, Atorvastatin
Current Illness: none
Preexisting Conditions: Dysthymic Disorder, Hyperlipidemia, Low back pain
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was reconstituted with only .8mL


VAERS ID: 1449986 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Confusional state, Dizziness, Headache, Hot flush, Presyncope, Seizure like phenomena
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: After vaccine, went to car, she felt a hot flash and reported dizziness, she then for about 15-20 seconds had seizure like activity, pharmacist aware and pediatrician notified to which it is believed it was a vasovagal response. felt confused after the event with a headache, otherwise no other reaction at this time.


VAERS ID: 1449992 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009021A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: According to my log, 20 minutes after I administered the vaccine to her and her son who was accompanying her, she stopped me in the hall while I was returning to the pharmacy from another injection. She told me that her neck felt swollen (she was rubbing the area of the lymph nodes) but that she was swallowing fine. She didn''t appear an any distress, no breathing difficulty, splotching or rashes, but we decided that she should see one of the nurses on site. I told her to get her BP in the case something was happening there. She left to go to the nurse. The rest was relayed to me that she saw the nurse and then proceeded to the hospital where she subsequently broke out in a rash and received an epi pen.


VAERS ID: 1450004 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

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

Write-up: Pt observed for 15 minutes per recommendations, left with no concern and returned 5 minutes after with Hives located on the upper chest. Notified task force of event and immediately advised to report to ER for continuation of care.


VAERS ID: 1450019 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Malaise, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Per RN, patient "almost immediately" after receiving vaccine, stated she wasn''t feeling well. Patient became diaphoretic and pale. Patient assisted to supine position. Vitals at 1227 BP 113/78. 100% O2Sat, 61 HR. Placed cool compress on forehead. Continued to monitor. At 1235 BP 115/65, 99% O2Sat, HR 59. Offered Gatorade and given pretzels. Color improving, continued to lay supine. At 1240 BP 114/68, 99% O2Sat, HR 65. Patient slowly assisted to sitting position and assisted to chair. Remains slightly pale, awake & alert. Sipping Gatorade and eating pretzels, conversive with Mom and sister. Patient left Observation at 1:00pm, ambulatory with Mother and sister.


VAERS ID: 1450041 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 2 LA / 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? 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 (Female, DOB 07/09/1972) received Janssen COVID vaccine (Lot #1808980) on 04/29/2021. On 07/06/2021, patient reporting to vaccine station. RN looked patient up, issued mobile device to see if patient received dose of COVID vaccine. On first inspection, patient did not appear to have her first dose of COVID-19 vaccine. Patient received Janssen vaccine (Lot #205A21A Exp 8/7/2021) at 11:10 am by RN. RN recognized patient from previous outreach events and notified RN that patient had been vaccinated previously. RN looked up patient in and noted additional record at bottom that could only be found on larger mobile screen. RN instructed patient to stay in observation for full 30 minutes. Patient denies shortness of breath. Patient alert and oriented x4, able to answer questions. RN instructed patient to not received any additional COVID-19 vaccines. RN provided patient with education related to when to seek medical care. Patient completed full 30 minutes of observation. Patient remained at focused outreach event, walking around with steady and balanced gait.


VAERS ID: 1450057 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-30
Onset:2021-07-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan Cardol Synthroid
Current Illness:
Preexisting Conditions: HBP Hypothyroidism Arrhythmias
Allergies: Caffeine, Codeine, Acetaminophen, Bread, Pasta.
Diagnostic Lab Data:
CDC Split Type:

Write-up: A 68-year-old female patient oriented in time and space refers to the EMT feeling dizzy 26 minutes after her second dose of MODERNA. At 10:56a.m. we proceed to take the s/v are: B/P. 240/100 mmHg, P. 72 beats/min. and Sat. 98%. She is transported to the Hospital at 11:40a.m.


VAERS ID: 1450070 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 OT / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Oropharyngeal discomfort
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: pressure in throat. Evaluated by EMS -Cleared


VAERS ID: 1450125 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / N/A 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 had a syncope and recovered in few seconds, emergency response team was called to make no other adverse reaction


VAERS ID: 1450131 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: General physical condition abnormal, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient slumped over almost immediately after receiving her first covid vaccination. She was unresponsive but breathing and hearbeat for 30-45 seconds. At that point she became responsive and asked for water. We gave her bottled water and some candy. She sat for about 20 minutes and appeared alright. Her mother was present and said that the patient has had this type of reaction before. She also said that the patient hadn''t eaten or drank much previously during the day. It was in the high ninties outside. The mother said that she would make sure that the patient ate something when she got home and she would be home with her all day.


VAERS ID: 1450155 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Uncontrolled coughing fit and shortness of breath


VAERS ID: 1450157 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Denies
Preexisting Conditions: None
Allergies: Remote history of hives after eating a Korean meal, was not disclosed prior to receiving vaccine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: About 25 minutes after vaccine was administered, the patient developed erythematous patches bilateral deltoid muscles, bilateral forearms, upper back, and bilateral shins/ankles. He denied itching. He did not experience any additional symptoms. His vital signs were stable and he was breathing comfortably and speaking in full sentences. He received 25 mg capsule of Benadryl with some improvement seen in rash on arms and shins. He was discharged to home after being monitored in the health center for about 90 minutes after vaccination. Vital signs remained normal. He was accompanied by his mother who was going to be able to watch him closely and with a prescription for Benadryl to take prn every 6 hours. Mom was instructed to call 911 for any worsening including difficulty breathing.


VAERS ID: 1450160 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 arrived at the pharmacy with daughter and another patient to receive their first doses of the Pfizer vaccine. While answering the pre-vaccine questionnaire the patient''s daughter asked a question regarding first dose side effects the patient made a vague comment about have no side effects herself. I then asked the patient directly if this was their 1st dose of the vaccine and they stated that it was. After giving the vaccine I then went to report the vaccination to OSIIS and saw that the patient had already completed a sequence of the Moderna vaccine back in JAN/FEB. I then asked the patient if they had received the Moderna vaccine already to which she admitted that she had. Patient told me she had seen in the news that it was recommended to get the other two dose series then you already had to help protect against the delta variant. As I was unsure of the recommendations in this scenario I contacted the Health Department Covid Hotline, who recommended to report the incident to VAERS. As of this writing the patient has had no side effects, but I did recommend that the patient inform her PCP that she had received 3 doses of the vaccine now.


VAERS ID: 1450168 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: 24-year-old female patient oriented in time and space. She refers to feeling dizzy to EMT. Within 4 minutes of your first dose of Pfizer. At 12:32 p.m. the EMT obtains his vital signs are: B / P. 80/50 mmHg, P. 85, R. 18, Sat. 99% and Temp. 35.5 Celsius. The case is consulted with Doctor. His recommendation was to observe for 30 minutes and elevate his legs. Upon reevaluation of the patient after 30 minutes, her vital signs were B/P. 100/70 mmHg, R. 18, Sat 99% and Temp. 35.5 Celsius.


VAERS ID: 1450191 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Work       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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: denies
Current Illness: denies
Preexisting Conditions: denies
Allergies: denies
Diagnostic Lab Data:
CDC Split Type:

Write-up: lost consciousness


VAERS ID: 1450200 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6680 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: No s/s


VAERS ID: 1450212 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: gave pt Janssen shot at about 3:05 pm 7/6/21. after 5 minutes pt asked for water. Staff saw that the pt was pale and alerted me to that. Pt told me he was feeling dizzy. Had pt put his head down to his knees while I questioned him about other symptoms. Pt reported no nausea, no feeling of fullness, no itching, no headache, no other signs/symptoms. Dizziness abated after pt had his head down for 2-3 minutes. BP taken at 3:13 pm was 133/106 pulse 59. Explained to pt that I needed to continue observing him for signs of adverse rxn for a total of 30 minutes though he indicated that he was feeling better. pt agreed. Let pt go after the 30 minutes was up. counseled pt to mention the dizziness if ever he needs a Janssen "booster" in the future.


VAERS ID: 1450218 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received first dose moderna and received second dose pfizer.


VAERS ID: 1450220 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

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

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

Write-up: No Adverse reactions or outcomes. Administered Janssen to 17 years old female patient. observed for first 15 mins no reactions. will follow up with the patient in few days again.


VAERS ID: 1450235 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Chills, Dizziness, Fall, Nausea, Paraesthesia oral
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, Trazodone, bupropion, Duloxetine, Topiramate, Atorvastatin, Gabapentin,
Current Illness: none known
Preexisting Conditions: GERD, Depression, Migraine Head Aches, Hyperlipidemia, Insomnia, Atopic Dermatitis.
Allergies: Aspirin, Latex Gloves
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient was staying in store for mandatory 15 min wait period. patient fell in the back of the store complaining of severe dizziness. fall was not seen by store personel. I (pharmacist was called) 911 was immediately called as injuries were unknown from both fall and the nature of the reaction to the vaccination. patient complained of some tingling of the lips but refused epinephrine shot. as dizziness subsided, patient experienced severe nausea and some shivering. EMS arrived shortly after. patient refused transport, yet did allow monitoring in the Ambulance. Results unknown.


VAERS ID: 1450311 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-01
Onset:2021-07-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 3 LA / IM

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

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

Write-up: The patient did not have an adverse event. The patient lied to us stating that she had not received the vaccine even though she had already received dose 1 and 2 in March and April of 2021. She was informed to lie to us in order to get the vaccines again as she was told she did not have any antibodies. As of today she has received a total of 3 doses of Moderna. Per company policy it is required for us to report this to VAERS.


VAERS ID: 1450319 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: vaccine vial punctured and administered and left in fridge overnight. next morning same vial was used to administer vaccine. rph phoned patient who said she was fine. rph phoned md who said they made note and will call if they have further questions.


VAERS ID: 1450358 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-05
Onset:2021-07-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20mg/day, Lipitor 20mg/day, hydrochlororothiazide 25mg/day, multivitamins
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood pressure at 10:20am = 134/117 pulse 86


VAERS ID: 1450376 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient received vaccination that had been left out at room temp for roughly 2 weeks on accident, rather than a dose from our new appropriately stored vial.


VAERS ID: 1450377 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: She had an asthma attack 5 days after taking her first dose of Pfizer.
Other Medications:
Current Illness:
Preexisting Conditions: HBP
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: A 30-year-old female patient, oriented in time and space, refers to the EMT feeling pain in the sternum 8 according to the numerical scale, 22 minutes after being administered her second dose of Pfizer. EMT proceeds to take his vital signs which were: 140/90 mmHg, Pulse 93 beats/min., Temp. 35.7 Celsius and Dext. 88 mg/dL. The case is consulted with Doctor. His recommendation was that the patient be transported to the Emergency Room. Patient was transported to the Hospital.


VAERS ID: 1450379 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient received a dose from a vial that was not stored appropriately. The vial had been stored at room temp for about 2 weeks. My technician accidently drew up a dose from the bad vial rather than the good vial.


VAERS ID: 1450380 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A: Patient Indicated previous history of fainting with vaccinations, but had not had an incident in years.
Allergies: N/A
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient fainted, had difficulty breathing, was transported to hospital.


VAERS ID: 1450384 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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: Fainted HPV vaccine 16 yrs
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Pineapple kiwi mango
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fainted & blacked out Dizziness nausea headache


VAERS ID: 1450393 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthma, Condition aggravated
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: did not take Albuterol and Advair today
Current Illness: Asthma
Preexisting Conditions: Asthma
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: First, sever Asthma, following immunization person had Asthma. Epinephrine injection, USP 0.3mg X2. Oxygen, Ems care has Transport


VAERS ID: 1450405 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: No adverse reaction. Patient has not reported any symptoms as of now.


VAERS ID: 1450406 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fall, Head injury, Musculoskeletal stiffness, Tonic clonic movements
SMQs:, Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 32 yr male without Preexisting history, observed with stiffening, tonic/clonic response 2 minutes within vaccination; fell out of chair, hit head. Attendee self awoke, alert, oriented x 2 within one minute. EMS called, declined ER trip, monitored and d/c from EMS after speaking with ER MD(phone). Walking independently.


VAERS ID: 1450409 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

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

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

Write-up: Patient received second shot 165 days after first shot


VAERS ID: 1450414 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second shot 43 days after first shot


VAERS ID: 1450419 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO PRESCRIPTIONS ON FILE BESIDE COVID VACCINE, FIRST AND SECOND DOSE. AND A VYVANSE RX IN 2019
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT GOT THE SECOND DOSE AND TOLD TO HAVE A SEAT FOR ABOUT 15 MINUTES FOR POST-VACCINE SURVEILLANCE. HE STOOD UP FROM A SITTING POSITION AND APPROACHED THE PHARMACY COUNTER, THAT''S WHEN HE COLLASPED HEAD-FIRST IN THE LOBBY. WE IMMEDIATELY CALLED 911, EMS, AND HIS FATHER. HE WAS HELP AND REGAIN CONSCIOUSNESS WITH ORANGE JUICE, PRETZELS, AND WATER. EMS CAME TO CHECK HIS VITALS AND HIS BLOOD SUAGRS WAS IN THE LOW 70S, ABOUT 73. HE STATES HE DID NOT EAT ANYTHING ALL DAY. EMS ALSO FOUND THAT HIS HEARTBEAT WAS IRREGULAR AND THEN PATIENT CONFIRMS THAT HE MIGHT HAVE AN IRREGULAR HEART BEAT BUT HAS NOT BE DIAGNOSED. PATIENT FAILED TO MENTION THAT ON HIS VACCINATION ADMINISTRATION RECORD FORM WHICH WE USE TO HELP DETERMINE PATIENT ELIGIBILITY FOR THE VACCINE TODAY.


VAERS ID: 1450424 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Face injury, Swelling face, Syncope, Tenderness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: A few minutes after immunization, patient stood up from chair and fainted after he fell to the ground on knees; then hitting left cheek on the ground. He quickly regained conscious in 3 seconds and was oriented to person, place and date. He was able to move all extremities and neck well and 5/5 strength; no misalignments, asymmetry or defects. Left cheek was slightly swollen and slightly tender. Breath sounds clear and abdomen soft and non-tender. He remained lying on the ground for 15 minutes BP 100/70 HR 120. An ice pack placed on his cheek. After sitting in the chair for 15 minutes and drinking approximately 12 oz of water, he stood for 2 minutes and was without dizziness BP 100/80. Patient declined going to the ER at this time; discussed warning signs and when to go to the ER and when to f/u. Patient walked out of the clinic in a stable condition with father.


VAERS ID: 1450425 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Fear, Feeling abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: About 2 minutes after vaccianation, pt fainted, father caught her. Her eyes were open but appeared to be '' out of it'', had some body movements associated with it. After about a few seconds when I got to her, her vision focused on us and she came back to, started crying out of fear/scared/didn''t realize what happened.


VAERS ID: 1450432 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

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

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

Write-up: The patient was given the shot and within several minutes he became lightheaded and had a mild seizure. This lasted approx. 3-5 minutes.


VAERS ID: 1450433 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

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

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

Write-up: Patient received 1st dose of Moderna at the Health Department even though patient was under 18 years of age. Patient care services coordinator advised to give the patient 2nd dose to complete the series based on clinical guidance. Patient''s parent was aware vaccine not indicated for under 18 years of age. NO adverse reaction @ time of vaccination.


VAERS ID: 1450434 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / UNK LA / IM

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

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

Write-up: Patient vomited after approximately 5 minutes he had received Pfizer 1st dose vaccine. Patient left by ambulance at the mother''s request for further observation. Pt left in no distress. Patient went to Hospital by ambulance unit.


VAERS ID: 1450437 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-05
Onset:2021-07-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), 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: sulfur
Diagnostic Lab Data:
CDC Split Type:

Write-up: diarrhea and throwing up after breakfast/ antimodium


VAERS ID: 1450439 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (broad)

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

Write-up: patient presented about 30 minutes after receiving her second dose of Pfizer covid vaccine with sharp pain in the left elbow. Patient was provided with a cold compress and rested for about 10 to 15 minutes and reported improvement in symptoms. patient left.


VAERS ID: 1450452 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Irritability, Malaise, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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 were disclosed
Current Illness: None were disclosed
Preexisting Conditions: None were disclosed
Allergies: None were disclosed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately post vaccination patient indicated that she was not feeling well. She started trembling and exhibited mild confusion and irritation, but patient remained aware of self and surroundings. Patient expressed some anxiety over the long term effects of the vaccination prior to administration. Upon arrival of the ambulance and until they left with the patient, the patient continued with symptoms.


VAERS ID: 1450459 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 2 LA / IM

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

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

Write-up: Patient came in as a walk in for COVID-19 vaccination stating that he has never received any COVID-19 vaccination prior. After administering the vaccination, I noticed in the immunization record that the patient received a COVID-19 vaccination on May 25, 2021. Upon reviewing the vaccination injection note, he did receive a Janssen COVID-19 vaccination on May 25, 2021. Reported to charge nurses. Patient was monitored and had no adverse effects. Pharmacist notified ID and stated to report to VAERS. Patient stated he doesn''t remember receiving any COVID-19 vaccination previously.


VAERS ID: 1450468 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin warm, 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: H1N1
Other Medications: Nothing
Current Illness: None
Preexisting Conditions: No known health conditions
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received the vaccine and 5 minutes later stated he became warm to touch, and walked to the cooler to get a bottle of water and fainted. He was found on the ground with no pain or injuries per patient. He stated he still felt warm. Patient refused 911 transport. Patient stated he had a history of fainting with a previous H1N1 vaccine. Patient did not have any difficulty breathing or itching.


VAERS ID: 1450475 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

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

Write-up: Patient experience sharp jabbing pain in left lower chest below the nipple line after vaccination. Patient reported that pain was coming and going


VAERS ID: 1450477 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:
CDC Split Type:

Write-up: The patient was thoroughly informed that there are no studies regarding the benefits and risks of mixing different vaccines from different manufacturers. Though the clinical team and the patient came to an understanding that the patient is in a "high-risk" situation whereas he cannot afford to risk any delay in care due to being a PEH that we had to give the patient a second dose not of moderna but of pfizer


VAERS ID: 1450482 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Private       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: None
Current Illness: none
Preexisting Conditions: Depression
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt received Moderna (1st dose) on 6/7/2021 and received Pfizer (2nd dose) on 7/6/2021. Pt had no allergic or adverse reaction. Pt was notified at time of even and mandatory reporting done through Kaiser reporting system.


VAERS ID: 1450483 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-30
Onset:2021-07-06
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Diabetes mellitus, Myocardial infarction
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: heart attack and got diabetes


VAERS ID: 1450490 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

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

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

Write-up: The patient was thoroughly informed that there are no studies regarding the benefits and risks of mixing different vaccines from different manufacturers. Though the clinical team and the patient came to an understanding that the patient is in a "high-risk" situation whereas he cannot afford to risk any delay in care due to being a PEH that we had to give the patient a second dose not of Moderna but of Pfizer


VAERS ID: 1450492 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl 25 mg 1-2 tablets every 6-8 hours
Current Illness: cellulitis of right lower extremity
Preexisting Conditions: BMI pediatric, greater than or equal to 95% for age
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was administered expired Pfizer vaccine. Initial manufacturer''s expiration date was 09/30/21, expiration date based on vaccine''s transport date from freezer to refrigerator was 07/03/21. Vaccine was administered after this date on 07/06/21. Pt did not have an adverse reaction to vaccine in clinic.


VAERS ID: 1450504 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Nausea/vomiting


VAERS ID: 1450508 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-05
Onset:2021-07-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Feeling hot, Injection site pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (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:
Other Medications: Metoprolol Succinate, Pantoprazole, Adderall XR, Clonazepam, Gabapentin, Famotadine, Thiamilate, Pyridoxine HCL, Folic Acid, Cholecalciferol, Methylcobalamin, Multivitamin, Calcium Carbonate, Magnesium Oxide, Zinc Sulfate Monohydrate
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 100.1, fatigue, slight injection site pain, mild joint pain, mild muscle pain, feeling hot.


VAERS ID: 1450513 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / SYR

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

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

Write-up: Called back to get his shot and there were 2 patient. Patient came back with his mom. I gave Moderna and then as I was explaining when to come back for Moderna mom realized he was under 18 and it was the wrong patient


VAERS ID: 1450520 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Heart rate increased, Immediate post-injection reaction, Loss of consciousness, Refusal of treatment by patient, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: ONCE VACCINE WAS ADMINISTERED, THE PATIENT IMMEDIATELY STATED THAT HE FELT DIZZY. SKIN WAS CLAMMY, PULSE WAS ELEVATED. HE FELT LIGHTHEADED AND HE DESCRIBED HIS VISION AS "WHITE". I GAVE HIM AN ICE PACK, AND THEN WAS PREPARING TO LAY HIM ON THE GROUND. HE PASSED OUT, BUT DID NOT FALL AS WE LEANED HIM BACKWARD IN THE CHAIR.HE WAS UNCONSCIOUS FOR ABOUT 30 SECONDS. HE THEN BEGAN TO REGAIN CONSIOUSNESS AND WAS RESPONSIVE AND ANSWERED QUESTIONS APPROPRIATELY. WE GAVE HIM ORANGE JUICE AND BOTTLED WATER AND OBSERVED HIM FOR 40 MINUTES. HE REFUSED MEDICAL TRANSPORT, BUT REMAINED IN THE VICINITY FOR ABOUT 30 MINUTES LONGER. PULSE RETURNED TO 78bpm, AND COLOR WAS NORMAL BEFORE PATIENT LEFT THE PHARMAC AREA.


VAERS ID: 1450535 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Cardiac monitoring normal, Dizziness, Fall, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient was vaccinated at 8:48. Her sister was vaccinated at 8:52. The patient was sitting next to her sister when her sister started feeling faint. The sister was evaluated and provided water. It was then reported to the healthcare providers that the sister feels anxious when she gets vaccines and does pass out. While evaluating the sister and providing her water the patient became limp in her chair, dropping her personal items and laid head on her dad who was standing next to her. Upon initial evaluation the patient started having convulsive activity affecting her head, face and shoulders. The patient was lowered to the floor to a safe setting. The convulsions lasted approximately 5-10 seconds. Once convulsions were over the patient was alert and responsive. Her vital signs were HR:92, SPO2:96%; BP:113/78. Paramedics were called immediately and arrived approximately at 9:10. The patient was laying on the floor and paramedics started a complete evaluation; placing the patient onto the heart monitor, and ran another set of vital signs and a point of care blood glucose. Vital signs, monitor reading, and blood glucose were unremarkable. The patient has NKA; No past medical history and is on no current medications. Upon evaluation when the patient was helped from laying to sitting by paramedics she started to feel faint once again. The patient was taken to the hospital for further evaluation.


VAERS ID: 1450576 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient temporarily passed out and looked pale. He was supplied with water and felt better after 15 minutes of sitting.


VAERS ID: 1450581 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Patient came in 7/06/21 to get a Pfizer Covid-19 vaccine. He explained that even though he had a J&J vaccine in March, he would like to get the Pfizer too.


VAERS ID: 1450582 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Nausea, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT EXPERIENCED NAUSEA APX 5 MINUTES AFTER HIS VACCINATOIN. HE VOMITED. HE COMPLAINED OF COLD CHILLS AND A TINGLING IN HIS ARM. WE OBSERVED HIM FOR APX 30 MINUTES AND HE WENT HOME WITHOUT MEDICAL INTERVENTION.


VAERS ID: 1450605 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-06-08
Onset:2021-07-06
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mixed series inadvertently administered.


VAERS ID: 1450654 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia oral, Pharyngeal hypoaesthesia, Pharyngeal paraesthesia, Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: epi pen
Current Illness: cardiomyopathy, pulmonary sarcoidosis, OSA, obesity
Preexisting Conditions: cardiomyopathy, pulmonary sarcoidosis, OSA, obesity
Allergies: PCN, shellfish, sulfa, bee venom, iodine, erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving pfizer vaccine (about 10 minutes) pt complained of numbness, tingling with fullness in her throat. She was given epi-0mg in left deltoid area. Paramedics were called in. Pt continued to complain of her tongue tingling and swelling and benadryl 50 mg administered IM. Paramedics arrived and started IV and transported her to ER. Pulse ox was 87% on room air, HR 98 and BP 157/77.


VAERS ID: 1450687 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-26
Onset:2021-07-06
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010B21A / 1 LA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Somnolence, Temperature intolerance, Therapeutic response unexpected
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: multi vitamins
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the 1st vaccine I did not have any hot flashes for a 2 week period. This is highly unusual as I''m going through menopause. After the second vaccine on April 26, 2021 I have had zero hot flashes. Zero hot flashes - since taking the second shot while I''m in the middle of menopause and have been dealing with this for 2 years. Body is sensitive to cold I do not have the stamina I had prior to the shot. I find that I''m sleeping more than usual.


VAERS ID: 1450688 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injury associated with device
SMQs:, Medication errors (broad)

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

Write-up: intern providing immunization inadvertently got a needle stick while trying to activate the safety device


VAERS ID: 1450707 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-01
Onset:2021-07-06
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prevacid, propranolol, metformin, pravastatin, nortriptylin, Super B, aspirin, multi-vitamin, fish oil, vit E, vit D3, calcium, zinc, magnesium, imitrex as needed
Current Illness: none
Preexisting Conditions:
Allergies: Lovastatin, penicillin, latex sensitive, erythromycin
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: It appears that I am now allergic to pistachios. I have never had a problem before, even just a few months ago I was eating them. But now I have rash on my face and neck that itches. It began within a couple of hours of eating the pistachios.


VAERS ID: 1450722 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

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

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

Write-up: While using Vanish point needle and syringe, needle retracted while giving injection. Pt was unable to receive full dose of 2nd covid vaccine. per doctor, additional vaccine was given for full immunization.


VAERS ID: 1450723 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / IM

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

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

Write-up: Patient was accidentally given a 3rd dose of the COVID vaccine. She initially denied history of getting the COVID vaccine and then after being given the dose she realized that she had already gotten 2 doses of the pfizer vaccine back in February. No adverse events noted after standard post-injection monitoring.


VAERS ID: 1450724 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Combivent, Diazepam, Norco, lisinopril/HCTZ, Ventolin, Viagra
Current Illness: none
Preexisting Conditions: hypertension, polyarthritis, Gerd, Chronic pain, Dysthymic Disorder, basal cell carcinoma
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: vial was reconstituted incorrectly. Only .8mL was mixed with the powder


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