National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/17/2021 release of VAERS data:

Found 711,579 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 5 out of 7,116

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104   next


VAERS ID: 1696549 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac flutter, Hyperventilation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypersensitivity (broad)

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

Write-up: Patient had vaccine at 830am. She stated that she has a history of atrial fibrillation to the vaccine nurse. The patient was asked to stay for 30 minutes for monitoring as a result. The nurse put a cardiac and automatic B/P on the patient due to her afib. Vitals were stable. At about 8:50am, the patient stated she felt her heart flutter. She was moved to a recliner and legs elevated. at 8:55am, her vitals were: 164/94 HR 83 P02 99% & Resp 14, 9:02am BP 150/100 HR 80,P02 99 Resp 18. 9:09am BP 173/93, HR 90, p02 100 & Resp 26 Decision made to call rapid response RN. Patient started to breath very deeply and clutch her chest. Nurse arrived . Patient stated that her throat was getting tight Assessed patient. Benadryl 25mg IV given @ 9:12am. Adult medical emergency called overhead. All team members arrived. Patient started on 2L O2 via nasal cannula. Patient transferred to Wheelchair and transferred to ED at approx 9:18am .Patient awake and alert at all times. Patient discharged from ED 9/14/2021


VAERS ID: 1696575 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

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

Write-up: Pt was given Pzifer for 2nd vaccine instead of Moderna


VAERS ID: 1696580 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Hypoaesthesia, Nausea, Tremor, Visual impairment
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (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: unknown
CDC Split Type:

Write-up: pt received 1st dose moderna and experienced nausea, vision changes. He became hot, sweaty and shaky. Pt was administered first aid and 911 was called. Pt reported numbness in arms, hands and legs. Emergency staff arrived and ambulance and took patient to local er


VAERS ID: 1696583 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-09-14
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 LA / IM

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

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

Write-up: Patient had a positive COVID test on 9/14/2021


VAERS ID: 1696587 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-09-14
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

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

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

Write-up: Patient had positive COVID test on 9/14/2021.


VAERS ID: 1696602 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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: unknown
Current Illness: unknown
Preexisting Conditions: low kidney function
Allergies: pcn, codeine
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Immediately after receiving the vaccine, the patient had trouble breathing and chest tightness. We administered an EpiPen and the patient began to feel better within minutes. EMS was called and took the patient to the hospital in stable condition


VAERS ID: 1696614 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: Advised patient to go to urgent care and/or call PCP and follow up.
CDC Split Type:

Write-up: Patient called around 9:30am and stated that when we woke up numbness in arm he received the shot in and tingle (pen and needle feeling) in fingers of the same arm.


VAERS ID: 1696620 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Sept 14, 2021: 32 year old male patient received his first COVID 19 vaccine. Patient stated before the vaccine was administered that he tends to feel lightheaded. After the vaccine was administered the vaccinator asked the patient how he was feeling and the patient stated he was "fine". Patient was given discharge instructions and told to sit in the observation area. It was there that the patient stated "he was feeling hot and sweaty" approx. 10 minutes after receiving the vaccine. Patient then laid himself on the ground for comfort. Patient stated this was a common reaction for him. Vital signs were Within Normal Limits. Patient taken to the Emergency Room based off hospital protocol.


VAERS ID: 1696631 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-24
Onset:2021-09-14
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private       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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization (non-ICU)


VAERS ID: 1696644 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-12
Onset:2021-09-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Peripheral coldness
SMQs:, Peripheral neuropathy (broad)

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

Write-up: Patient began to describe a cold feeling throughout her lower left extremities and a burning/hot sensation throughout left arm 10 minutes after injection. I assessed the injection was located in correct area of upper arm muscle. I had the patient wait an additional 10 minutes for monitoring.


VAERS ID: 1696681 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206AZ1A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Balance disorder, Chills, Decreased appetite, Dizziness, Head discomfort, Headache
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Arthritis (broad)

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

Write-up: headaches, no appetite, dizziness, loss of balance, head feels heavy, chills, wide spread pain that started in her back , aches behind her hips and knees


VAERS ID: 1696702 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Agitation, Chest pain, Feeling cold
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Cardiomyopathy (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: At approximately 9 am Pt walked up to PHN and stated he was having chest pain pointing to left chest. Assisted to cot and PHN attempted to check BP, Pt refused stating he was cold. PHN explained that would need to call emergency services, called at 9:03 and reported incident. Pt denies Hx of cardiovascular disease or being on any medications. Pt stated he wanted to leave but needed a ride, states he walked to vaccine appt. Advised to wait for ambulance but declines and walked out of waiting area, police officer nearby and went out to talk with Pt, clinical lead also went out to talk with Pt and convinced to come back in and wait for ambulance. Pt refused to sit down and became agitated trying to leave and saw the ambulance and agreed to sit down. Paramedic spoke with Pt and he refused care from them,then ambulated out of clinic on his own volition, with steady gait During time here displays being a poor historian and appeared agitated when trying to offer care.


VAERS ID: 1696725 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Cold sweat, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt waited the 15 min and was feeling fine. No SOB. She left the clinic with her Nephew but after leaving felt like she was starting to get dizzy. She returned to clinic and was pale and clammy. We took her to procedure room and had a provider assess her.


VAERS ID: 1696726 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

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

Write-up: C/O throat tightening, difficulty to breath and swallow 911 called , gave epi IM left thigh, taken to hospital ER


VAERS ID: 1696751 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Pain in extremity
SMQs:, Other ischaemic heart disease (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Was diagnosed with pericarditis a couple years back. No reason tied to diagnosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm first day, woke up second day with heart pain


VAERS ID: 1696763 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Nervousness, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Hypoglycaemia (broad)

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

Write-up: Pt waiting in observation with his mother post #1 Pfizer vaccination, at 9:10am c/o "feeling a lump in throat". No observed SOB or c/o difficulty swallowing. Given Diphenhydramine 50mg at 9:11 am. Hx of anaphylaxis with food only, wheat, nuts. No rash or difficulty breathing, VS 99% room air 110/60 78 12. Pt states feeling nervous due to previous Pt who c/o chest pain post vaccination. Pt observed in clinic until 9:50a and did not have any other symptoms. Advised to contact PCP to report incident. Instructions given to Pt and his mother (by spanish speaking RN) For any further symptoms and implementing 911 if necessary. VSS remained stable, lungs clear, 02 sat 99%. Pt reports he is feeling fine now and ambulated out of clinic with steady gait. States he will rest at home today and his mom will be there.


VAERS ID: 1696779 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Dyskinesia, Eye movement disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Ocular motility disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: Asthma
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Approximately 2 to 3 minutes after the vaccine was given the patient''s body, head, arms, hands, legs and feet begin to bow and draw. Eyes were rolled back and body felt clammy. Two RNs gently began to lower patient to the floor. Approximately 10 to 15 seconds after lowering patient to the floor she sit straight up and ask what happened. Crash crat had been retrieved and vitals checked, patient''s O2 was 99, pulse was 56 and BP was 99/62. Patient was alert, aware of where she was and why. Patient stated she only felt dizzy before the incident and at this time was just shaky. She stated she had not eaten or drank anything all morning prior to the visit and vaccine administration. Patient was given something to drink and was sipping slowly. She stated she felt better. Patient was monitored for approximately 40 minutes. Patient''s brother and stepmother was with her. Advised stepmother to take the patient to a doctor for further evaluation for precaution. Stepmother stated she was informed by family member to take the patient to Hospital ER, she was going to do so. Patient walked out of the building without any assistants or further incident.


VAERS ID: 1696801 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-01
Onset:2021-09-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Klonipin, ambien, effexor, Lamictal, Magnesium, potassium gluconate, biotin, vitamin c, vitamin d, black cohosh
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Ceclor, percocet, Darvocet, morphine, eggplant, mango
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen feet and ankles


VAERS ID: 1696823 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 RA / IM

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

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

Write-up: Patient stated that he felt like his lips were swelling about 10 minutes after encounter. After 30 minutes there were no changes or reactions at the site. Patient wanted to go home, take a Benadryl and be observed by a family member/friend and would update us if necessary and follow up with medical provider if needed.


VAERS ID: 1696841 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Pain in extremity, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: This morning (my vaccine was yesterday), I woke up feeling groggy. I attended a class in from 8:00am-9:00am, then went home since I felt bad. I took my temperature around 10:00am and it was 98, then 45 minutes later it was 99.8. I took some Ibuprofen and my fever reduced after a few hours, now I''m just left with a sore arm and a headache. I more or less feel fine now as of 3:00pm but I''m just very tired since I was feverish for a few hours straight. (I didn''t think these were adverse reactions but I was recommended to report the symptoms)


VAERS ID: 1696867 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

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

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

Write-up: hives. pt has tried benadryl with no improvement


VAERS ID: 1696869 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: 2 or 3 minutes after getting the vaccine, the patient passed out for about 40 seconds. the pharmacist called him couple times then he waked up and started to talk. He was ok after that.


VAERS ID: 1696871 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-05
Onset:2021-09-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, zyrtec
Current Illness:
Preexisting Conditions:
Allergies: Nuts, seeds, banana, squash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red tender circle at injection site appeared 9 days after vaccination.


VAERS ID: 1696887 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

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

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

Write-up: Patient presents for her second COVID-19 vaccination, she did not have her vaccine card with her at the time of her second dose and she did not remember what vaccine she received for her first dose. It was written on a sticky note that she was due for Pfizer dose today 09-14-2021. Medication removed from fridge, mixed per directions, and administered per standing orders. Writer did not check system prior to administration of vaccine. Patient monitored for 15 minutes after administration with no adverse reaction and was released back to work. After patient was released, I went to put vaccine in system it was figured out that she was administered Moderna on 08-17-2021 and Pfizer was administered today 09-14-2021. Pt notified at this time.


VAERS ID: 1696897 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Inappropriate schedule of product administration
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow)

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

Write-up: Nurse administered COVID Vaccine #2 @ 14 days after dose #1. EDD: 10/18/21


VAERS ID: 1696911 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Agitation, Balance disorder, Sensation of foreign body, Throat irritation
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient refers not taking any medication
Current Illness:
Preexisting Conditions: asthma
Allergies: patient refers not having any allergies to medication
Diagnostic Lab Data: Does not apply
CDC Split Type:

Write-up: Female patient refers feeling agitated and itchy in the throat. Patient refers feeling unsteady and feels a lump in the throat. Vitals are BP 120/80, Sat02 97%. Paramedic and voice personnel talked with the patient, and she was given prep alcohol treated with breathing exercises for 30min. They recommended to calm down and practice breathing exercises. She was referred to primary doctor.


VAERS ID: 1696912 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062K21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Dizziness, headache, muscle ache, joint ache, fever


VAERS ID: 1696914 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hypersensitivity, Nervousness, Swelling face, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (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: Temp 97.5 ?F Heart Rate 116 Resp 20 BP 94/72 SpO2 98 %
CDC Split Type:

Write-up: ED c/o allergic reaction the second Covid vaccine. Patient states she received her second dose of Pfizer Covid vaccine this morning and about 5 minutes later began to feel shaky, then lightheaded and dizzy and felt like she was going to pass out. She notified the nurse who felt the patient had some facial swelling and tightening of the throat and thus she was given an EpiPen. EMS was called and the patient was transported to the emergency room and states she is feeling much better but is not at baseline. Currently the patient denies headache, neck pain, sore throat, throat swelling, lip swelling, chest pain, fevers, chills, cough, shortness of breath, abdominal pain, vomiting, diarrhea, rash or focal neuro deficit


VAERS ID: 1696933 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA 7484 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abnormal sensation in eye, Blood glucose normal, Chest discomfort, Dysphagia
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Corneal 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: SYNTHROID; ZOLOFT; SILVASTA; LASIX; NEURONTIN
Current Illness:
Preexisting Conditions: Anemia, Pseudotumor cerebri, Hypoglycemia, Fibromyalgia, Hypothyroidism
Allergies: Patient reports not having any.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 31 year old female, after the vaccine administration refers to the nurse feeling pressure in the chest and difficulty swallowing and warmth in the eye are. Patient does not present difficulty in breathing, clear lungs not obstructed, intact skin, no edema in the airway visual inspection. Vital signs are taken, BP 120/80, P72, DXT 96MG/ DL, R 16. Consultation with Doctor is made, she indicates to keep patient under observation for 30 minutes. At 30 minutes, vitals are taken. P 70. BP 110/70, R16, Doctor indicates the patient can leave the vaccination center.


VAERS ID: 1696934 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Cardiac flutter, Dizziness, Head discomfort, Joint noise, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Immediate lightheadedness and heart fluttering. Heaviness in head feels like a band around my eyes. Joint popping and soreness in wrists almost immediately. Blurred vision.


VAERS ID: 1696935 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Hypoaesthesia, Nausea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: banana, kiwi fruit, pineapple
Diagnostic Lab Data: Vital signs taken: BP 134/84, HR 55, O2sat 100% Room Air.
CDC Split Type:

Write-up: 9/14/21 Pt received 1st dose of Moderna vaccine at 10:45 AM . After 15 mins of observation, patient started to have Rt arm soreness and nausea. Then patient developed Rt arm numbness and chest pressure. Patient had some crackers and orange juice . Observed patient until 11:55 AM with no symptoms improvement , then RN transported patient to ER for further evaluation.


VAERS ID: 1696942 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Headache, Heart rate increased, Hypertension, Muscle tightness, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Pt said she was experiencing right arm tightness along with palpations, headache ,chest tightness. Pt was experiencing difficulty breathing with a rapid heart rate and high BP. Pt was then administered EPI at 9:20 am in the left lateral thigh. After epi was administered a rapid response was called and ER personnel and preformed a assessment. and was taken to the ER


VAERS ID: 1696957 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Anaphylactic reaction, Dysphagia, Dysphonia, Lip swelling, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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:
Current Illness: N/A
Preexisting Conditions:
Allergies: TREE NUTS, LATEX
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had anaphylaxis reaction to Pfizer ( LOT#: FF2587, EXP date: DEC2022)first dose. Vaccine administered around 0952, approximately 10 minutes later patient began having generalized itchiness. She then waited another 10 minutes to see if it would pass. After 20 minutes of waiting she returned to the front desk and reported difficulty swallowing along with itchiness. HM3 brought the patient to a patient care room and reported it to the provider. Patient voice hoarse, when provider entered room. Patient also felt her upper lip was swollen. EpiPen 0.3mL (Lot #1F090 Exp: DEC2022) was administered at 1031 and held in patients left lateral thigh for 10 seconds. Patient reported a burning sensation when Epipen was given. EMS was called at 1033 arrived at 1037. Patient reporting that her symptoms were improved. Vital signs taken at 1035 BP: 127/78 HR:90. Patient transported to Hospital at 1046.


VAERS ID: 1696959 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-09
Onset:2021-09-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: patient states went to ER but wait was outrageous, went to urgent care this morning but their system was down. Her pcp could not see her until Thursday. I advised to either go back to ER or another urgent care.
CDC Split Type:

Write-up: The night (Thurs) the vaccine was administered pt reports fever and chills. The following 2 days (Friday & Saturday) the patient reports itching. She reports starting benadryl capsules 2 caps every 6-8hours. By Sunday she reports welts and swollen hands, feet, and face.


VAERS ID: 1696985 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / UNK LA / IM

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

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

Write-up: PT RECIVED 2ND DOSE (07/09/21) 2 WEEKS EARLY FROM RECOMMENDED TIME INTERVAL AFTER RECIVING 1ST DOES (07/01/21).


VAERS ID: 1696988 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / UNK OT / IM

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

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

Write-up: Patient was given 1ml injection instead of 0.5ml


VAERS ID: 1696994 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dry mouth, Feeling hot, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: xarelto
Current Illness: n/a
Preexisting Conditions: Atrial flutter, A-fib, Sarcoidosis, morbidly obese
Allergies: strawberries, peanuts, eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6 mins after receiving pfizer vaccine. The Patient experienced light-headedness, a warm flushing sensation around her neck, dry mouth. Vital signs were taken and were within normal limits. Patient was given water to sip on. patient was seated for 30 mins, until she felt better. She stood up slowly and was standing for several minutes before she was permitted to leave.


VAERS ID: 1697014 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Unknown  
Location: Hawaii  
Vaccinated:2021-07-01
Onset:2021-09-14
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / UNK LA / IM

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

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

Write-up: PATIENT RECEIVED FIRST DOSE OF MODERNA COVID VACCINE ON1JUL2021. RECEIVED SECOND DOSE BEFORE RECOMMENDED TIME FRAME ON 09JUL2021.


VAERS ID: 1697165 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Condition aggravated, Dizziness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: 53 year old male with history of HTN and non-adherence with medications, was NPO when he received his Vaccination. Symptoms of dizzyness reported within 30minutes. Blood Pressure remains essentially unchanged but Ginger ale appeared to ameliorate the dizzyness. Attendee was advised to speak to his PCP asap re: his current elevated Blood Pressure. Declined EMS.


VAERS ID: 1697186 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Sjogren''s and hypogammaglobulinemia
Allergies: Cardizem [diltiazem], Benadryl [altaryl], Bentyl, Codeine, Doxycycline, Indocin, Latex, Morphine and related, Peanuts [peanut oil], Peppers, Pumpkin seed, Tolectin [tolmetin sodium], and Tomato
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syncopal episode, generalized malaise, weakness, fatigue, nausea with one episode of vomiting


VAERS ID: 1697189 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-11
Onset:2021-09-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 20 mg 1x Gabapentin 100 mg 3x Tramadol 50 mg 3x as needed Bupropion 75 mg 1x Baclofen 10 mg 2x as needed
Current Illness: None
Preexisting Conditions: Permanent nerve damage (stretched nerve roots) resulting in loss of use of arms.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Red rash, slight swelling, warm to touch No treatment as of yet


VAERS ID: 1697192 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Electrocardiogram, Pain, Somnolence, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: No drug allergies
Diagnostic Lab Data: 9/14 glucose 90 mg/dL and ECG (results pending). Instructions to follow up with a neurologist.
CDC Split Type:

Write-up: Grandmother caught her and laid her down on the floor as it looked like she was about to pass out. She had a whole body shaking episode that lasted ~ 2 minutes. She vomited one time. She does not remember this. After this episode she was groggy for ~15 minutes. Then she was back to baseline which is achy. She was brought to the E.D.


VAERS ID: 1697196 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate irregular
SMQs:, Cardiac arrhythmia terms, nonspecific (narrow)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient called in to the pharmacy the day after receiving her second dose of the COVID vaccine saying that she was experiencing what she believed was an irregular heartbeat starting around noon. She is a nurse and said she believed them to be "PVCs," but did not report any other issues. She was instructed to seek medical attention ASAP.


VAERS ID: 1697197 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-30
Onset:2021-09-14
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Wife reported getting a lung clot after getting vaccinated. Patient was hospitalized for 3 days and all three md from hospital concluded that it was caused by the vaccine.


VAERS ID: 1697214 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Adverse reaction, Allergy to vaccine, Auscultation, Chest discomfort, Chest pain, Feeling abnormal, Feeling hot, Flushing, Pharyngeal hypoaesthesia
SMQs:, Anaphylactic reaction (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Infective pneumonia (broad)

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

Write-up: Situation 2/21/1962 Patient is here for first dose of covid vaccination Background History of hypertension Assessment Pt has completed a 60 minute-minute observation period with the following signs and symptoms of an adverse reaction: other - chest pain/pressure and throat numbness and flushing. Pfizer-BioNTech COVID-19 vaccine #1 in series administered. Action(s) taken: Other - Vital signs, MD evaluation, O2 2lnc Allergy to COVID-19 vaccine documented in Allergies activity: Yes Patient advised to discuss second dose considerations with a clinician 1339: Patient awake, alert, ambulatory, reporting mid chest pressure 8/10, and throat feeling "different," pt fanning herself and feeling hot. Denies SOB, nausea, dizziness, palpitations or any other symptoms. 1340: Pt taken to procedure. Pt is able to speak in full sentences. VS taken BP 174/106 HR 77 SpO2 97% RA RR 20. No angio edema, no rash, no reports of itching, BS clear to auscultation. Denies history of anxiety and states she has never had this pain before. Does report feeling nervous prior to getting vaccinated. Pt reports hx of HTN which she takes lisinopril 1/2 tab daily (she took today''s dose), pt did not know dosage. 1342: BP recheck 172/99 HR 80. 1346: I have called Dr., incident to for the covid vaccine clinic, and given report. Received VO to transport pt to ER via ALS, read back completed. 1350: Pt now reporting pain is traveling to abdomen and is intermittent. Dr. notified. Received VO to administer O2 2lcn and aspirin 325 mg PO x 1 now. Readback completed. 1400: Pt is agreeable to being transported to ER via ambulance. Pt also reported she had taken aspirin this morning, she did not know the dose. Dr. notified and ordered to hold aspirin 325 mg PO x 1, read back completed. Pt placed on O2 2lnc. 1411: Called to request ambulance transportation to Hospital. 1414: Pt denies any chest pain or any other symptoms. BP 157/105 HR 78 SpO2 97% RA Recommendation/Action: 1440: Paramedics have arrived. Report given. While report was being given to paramedics pt stated she started having the chest pain 5 minutes after vaccine was administered and reported it 14 minutes after vaccine administration.


VAERS ID: 1697354 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-09-11
Onset:2021-09-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

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

Write-up: 2 bruises on arm, 1 bruise on foot; referred patient to physician


VAERS ID: 1697355 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD (chronic obstructive pulmonary disease) (CMS/HCC) Essential hypertension Benign prostatic hyperplasia with lower urinary tract symptoms, symptom details unspecified Obesity ED (erectile dysfunction) GERD (gastroesophageal reflux disease) Hx of colonic polyps Glaucoma Cataracts, bilateral Bunion Unspecified hearing loss Kyphosis (acquired) (postural) Pure hypercholesterolemia Abdominal aortic ectasia (CMS/HCC) History of skin cancer in adulthood Gait disorder Actinic keratoses Gastroesophageal reflux disease Closed traumatic compression fracture of thoracic vertebra (CMS/HCC) Constipation Fatty liver Post-traumatic osteoarthritis of left knee Coronary artery disease involving native coronary artery of native heart (Calcified LAD on CT) Primary osteoarthritis of right knee Non-ischemic cardiomyopathy (CMS/HCC) Essential hypertension
Allergies: Bactrim [Sulfamethoxazole W-trimethoprim]Other: Document details in comments Feldene [Piroxicam]Rash/Dermatitis FoodHives/Urticaria, Itching Neosporin [Neomycin-bacitracin-polymyxin]Rash/Dermatitis Sulfa DrugsOther: Document details in comments
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: patient complained of lightheadedness following vaccination. he was given water & crackers & monitored for an additional 10 mins. his disposition improved.


VAERS ID: 1697357 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysphagia, Hypopnoea, Interchange of vaccine products, Respiration abnormal, Respiratory rate increased
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Respiratory failure (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: Anaphylaxis from Moderna Covid 19 first dose
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: Diabetic, High blood pressure, Chronic Kidney Disease.
Allergies: Previous anaphylaxis reaction to Moderna Covid-19 Vaccine. (Cleared today by patient''s PCP to receive Johnson and Johnson vaccine).
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient became unable to swallow, then tripod and purse lip breathing. Patient stated it felt like the Moderna Anaphylaxis reaction she previously had. Respirations became shallow and rapid. Administered Epi 0.3 mg into left anterior lateral quad and called 9-1-1. Patient respirations after administration of Epi was 22 bpm, P 97, SaO2 98% on Room Air, B/P 110/84. Patient taken by ambulance to ED.


VAERS ID: 1697360 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient passed out about 10 seconds after vaccine administered, eyes remained open, his body became limp, and he remained unresponsive to verbal and physical prompts (patient''s wife rubbed patient chest to try to awaken him) for about 3 to 4 minutes. EMTs evaluated patient after he regained consciousness and found his vitals were within normal range. Patient denied suggested visit to hospital and was taken home about 45 minutes later.


VAERS ID: 1697367 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, Hot flush, Hyperhidrosis, Sensory disturbance
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VALTREX.
Current Illness: NONE
Preexisting Conditions: ANXIETY
Allergies: AUGMENTIN AND BACTRIM : HAD TO GO TO HOSPITAL TO GET EPIEN.
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: LIGHTHEADED AND HOT FLASHES. FELT VACCINE GOING THROUHOUT BODY. SWEATING AND DROP IN BLOOD PRESSURE. 3:30pm BP 92/55. 3:40pm BP 113/74. 3:47pm BP 126/80 HR 64. 3:57pm BP 129/80 HR 59. GAVE PATIENT WATER AND GRANOLA. AFTER 30 MINUTES PATIENT FELT NORMAL. CHECKED ON PATIENT 5:37PM AND FEELS NORMAL.


VAERS ID: 1697369 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-24
Onset:2021-09-14
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0810 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Flushing, Vertigo
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (narrow), 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: Candesartan
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dizziness Vertigo Feeling Flush


VAERS ID: 1697371 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Exemestane 25mg, hydrochlorothiazide 12.5mg
Current Illness: None
Preexisting Conditions: HTN
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the Pfizer vaccine for the first and second dose but Moderna for the third. No events have occurred to date.


VAERS ID: 1697385 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Cough, Dyspnoea, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (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: Influenza Vaccine
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies: Influenza vaccine and many other medication allergies
Diagnostic Lab Data: Given 1mg Epinepherin, escorted to Emergency room by first response team 9/14/2021
CDC Split Type:

Write-up: Short of breath, coughing, shaking


VAERS ID: 1697386 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

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

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

Write-up: Gave moderna to 17yr old patient


VAERS ID: 1697392 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, Hot flush, Immediate post-injection reaction, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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: MULTIVITAMIN, SYMBICORT INHALER
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: HORSEHAIR, SHELLFISH
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: LIGHTHEADED, DIZZY, HOT FLASHES IMMEDIATELY AFTER GIVING VACCINE. FELT VACCINE GO THROUGH ENTIRE BODY. DROP IN BLOOD PRESSURE. BP 3:30PM 92/55. 3:40PM BP 113/74. 3:47PM BP 126/80 HR 63. 3:57PM BP 128/88 HR 64. GAVE PATIENT WATER AND GRANOLA. AFTER 30 MINUTES PATIENT FELT NORMAL. FOLLWED UP WITH PATIENT 5:44PM. FELT NORMAL AND ONLY HAD ARM PAIN.


VAERS ID: 1697399 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135B19 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Diarrhoea, Headache, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever chills headache muscle ache joint ache nausea vomiting diarrhea


VAERS ID: 1697400 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Deafness, Dizziness, Hyperhidrosis, Pallor, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unknown vaccine he also had it watching another get an IV
Other Medications: None
Current Illness: None reported.
Preexisting Conditions: None
Allergies: Patient reported no known allergies to medications, foods, or other products
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given Pfizer #1 at 5:20 PM he went into the waiting area with his mother. I was called to the area because he felt faint, he stated he could not see or hear us, he was diaphoretic, he had no breathing problems, no facial edema, no wheezing or stridor, he was pale and clammy. He continued to speak to us and was given water. He then went back into the exam room and rested on the table with legs elevated. He declined EMS. His mother noted he has had this type of reaction before when watching a person get an IV or getting an injection. He was alert and oriented x 4, stated that he felt well and ambulated with steady gait from the clinic with his mother.


VAERS ID: 1697406 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-09-14
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling abnormal, Headache, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 7.5mg daily Spironolactone 50mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vertigo. Woke up in the early morning with room spinning. Headache. Feeling of nausea. Happened several times throughout the day. Have "foggy head" or "brain fog" today. I have no inner ear problem. I believe this is related to the vaccine b/c I have had covid and recovered (Jan 2020) and have struggled with brain fog ever since. It took about 7 months to clear 90%. I also have had a dull headache in the back bottom of my head for the same amount of time. I believe these are related as it has also cleared about 90% in the last 7 months. I chose to get the vaccine to protect against the DeltaVariant and a little over 2 weeks after getting the vaccine, I have the same dull base headache I had for the past 7 months and now I have vertigo. I hope my body is just still processing the vaccine and I do not continue to have this problem.


VAERS ID: 1697567 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Eye movement disorder, Hypoaesthesia, Nervousness, Panic reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Prior to receiving the shot the patient said she was extremely nervous to get shots. Patient initially tolerated the shot well and left smiling and left the office. Told the patient it is recommended to stay near the location for 15 minutes after the shot so we could monitor for any adverse reactions. Shortly thereafter the patient was in line picking up a prescription at the consult window and collapsed. Patient recovered and sat back down in the waiting room. She said she could not feel her hands and appeared panicked. We called a service 88 and called 911. Per other staff reports her eyes rolled to back her head, could not feel her hands but were moving her hands up and down, said she could not talk but was talking coherently. Assistant managers and others directed EMS to the patient and she was taken away in a stretcher.


VAERS ID: 1697568 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Glossodynia, Mouth ulceration, Paraesthesia oral
SMQs:, Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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: Pantoprazole
Current Illness: GERD
Preexisting Conditions:
Allergies: Sulfa antibiotics, pumpkin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported to me on 9/14/21, that 15 minutes after vaccination while walking to her car, that her tongue felt swollen. Once she made it home she took benadryl. She reported that this helped but her tongue remained sore for the next several days and also had a sore on the top of her mouth.


VAERS ID: 1697571 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-26
Onset:2021-09-14
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Allodynia, Tenderness
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
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Allodynia (pain to light touch) on extensor side of both upper extremities (overlying triceps)


VAERS ID: 1697573 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 - / IM

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

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

Write-up: My first does was Moderna. The form I had to sign today said Moderna-2nd dose. My vaccine card says Moderna. Why was I given Pfizer! This is a huge problem and it is not acceptable! I did not choose to have the Pfizer vaccine and it was given to me against my will. I suffer from anxiety and had a panic attack. Now I can not stop thinking about all of the adverse effect I am going to have have.


VAERS ID: 1697577 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling cold, Hyperhidrosis, Oropharyngeal pain, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A. This is patient''s first time at our pharmacy to obtain the COVID-19 vaccine.
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: This is patient''s first Moderna shot. Patient was given the vaccination by our trained technician and was instructed to sit for 15 minutes post administration to make sure patient tolerates the vaccine. Approximately 10 minutes after the shot, patient''s friend came to get our attention to come take a look at his friend. The patient was stated he was dizzy and that he was cold, however there were perspiration on the patient''s forehead. We grabbed water for the patient and a fan to give patient a cool breeze with his feet on a stool to help with elevation. We came to check on patient a few minutes later and he was not feeling dizzy anymore but stated his throat hurts but cannot confirm if he has anaphylaxis. Pharmacist asked patient a series of questions such as what are you feeling? Can you breathe or do you have a hard time breathing? Patient stated he has a hard time breathing but clearly can breathe although with difficulty. It was hard to determine if patient was having a hard time breathing due to panic or his throat closing up and/or both. EMS was called and patient was taken by EMS at approximately 11:56am. No epinephrine was administered as anaphylaxis shock cannot be determined and EMS did not give epi pen either upon arrival. Pharmacist asked his friend if he has a primary care physician to send a copy of this report to and his friend stated he doesn''t think patient has a primary care. Patient was too stressed to be able to answer a lot of questions


VAERS ID: 1697581 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-09-14
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray abnormal, Diaphragmatic disorder, Dyspnoea, Fear, Lung disorder, Lung opacity, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (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: Well at time of vaccination
Preexisting Conditions: COPD, Asthma
Allergies:
Diagnostic Lab Data: Chest xray showed hazy opacifications at both of my lung bases.
CDC Split Type:

Write-up: Approx. 24 hours after receiving 1st Moderna dose I started to have trouble breathing with constriction in the area of my lower lungs/diaphragm. Trouble breathing & constriction continued to worsen over the following 8 hours at which point I called EMS and was taken to the emergency department at a local hospital. Chest x-ray showed some hazy opacifications in both my lower lung lobes. I was given a breathing treatment and an injection of Toradol. After I returned home, trouble breathing, constriction, and mucus accummulating in lower lobes of my lungs continued - for several weeks. I had to use my Albuterol inhaler every 4 hours, take an expectorant and a NSAID - every day - for nearly 4 weeks before I finally started to feel better. This was a real ordeal for me to get through. I have had asthma all my life and COPD for +30 years. Whenever I catch even the simplest of colds, it always hits me in the lungs, mucus accummulates in my lungs very rapidly & sometimes leads to a bacterial infection, I struggle to breathe, and it takes me weeks to recover. I was afraid of getting one of the Mrna vaccines because I worried this might happen - and it did. I am extremely afraid of & cannot get the 2nd Moderna dose because I believe there is a strong possibility I may have an even worse adverse reaction. If I catch this terrible virus, it will kill me. I am praying new, NON-MRNA VACCINES, will be developed soon for people like me. These Mrna vaccines are too dangerous for someone like me with COPD & how my immune system reacts to it.


VAERS ID: 1697582 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HTNx3 medications Thyroid Lasix Pantoprozole Zyrtec Pravastatin Gabapentin
Current Illness: Ear ache
Preexisting Conditions: Cardiac Asthma Graves CHF
Allergies: PCN SULFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3 inx4 in welt Hot to touch Pain


VAERS ID: 1697587 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

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

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

Write-up: 5 minutes after administration, patient reported that they could not see and were very dizzy. Pt. was hunched over on the ground and helped them be seated. Pt. was very dizzy and sweating immensely. 911 was called and pt. appeared to be OK after sitting and talking with them after 10-15 minutes. Pt.was able to walk out of pharmacy on their own with 911 personnel by their side.


VAERS ID: 1697593 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Eye pruritus, Restless legs syndrome, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (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: Flu Vaccine- Edema,Hives Pfizer 1st dose Asthma exasperated
Other Medications: Albuterol inhaler taken the last time on 8/25/21. 10 minutes after 1st Pfizer vaccine. Had asthma issues for 2-3 days following first (thought was a coincidence).
Current Illness: Occasionally GI upset due to chronic gallbladder
Preexisting Conditions: Systemic Lupus (though one remission for the last 4 years) Asthma
Allergies: Flu Vaccine, Shell fish, fish derivatives, Naproxen, doxycycline, Ceftin, Augmenting, IV and oral contrast both types, latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Had first vaccine on 8/25/21 had asthma attack 10 minutes post vaccine ( had significant asthma issues for 2-3days.. At first thought it was a coincidence). Had vaccine today 10-15 minutes later has asthma attack took inhaler still felt a bit tight after. Hives on face and chest, itchy eyes. Five hours after vaccine have restless leg like symptoms


VAERS ID: 1697756 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

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

Write-up: numb in his left arm


VAERS ID: 1697757 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Dysstasia, Fall
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: BP was 107/74
CDC Split Type:

Write-up: Post vaccination, patient was ok but shortly after complained of dizziness and was unable to stand, actually fell on the floor from a sitting position. Did not loose consciousness but was weak for about a minute or two before gradually regaining strength.


VAERS ID: 1697761 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

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

Write-up: DAD CALLED AND REPORTED THAT COUPLE OF HOURS AFTER THE VACCINE, HIS SON STARTED HAVING SEIZURES. AND THEY WENT OT THE ER


VAERS ID: 1697764 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (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: Augmentin and advil sinus
Current Illness: Sinus infection
Preexisting Conditions: Sinus infections
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: My left armpit is swollen and sore all the way up to my breast.


VAERS ID: 1697768 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

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

Write-up: Sudden onset fatigue and fever.


VAERS ID: 1697770 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold, Injection site hypoaesthesia, Injection site paraesthesia, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: pt reported numbness in the left arm at the injection site with little tingling within 1 minute of injection. progressed to whole arm tingling within 5 minutes. within 15 to 20min right hand started tingling, also reported feeling cold. 30 to 45 minutes small leg tremors. called 911. ambulance and emts took pt at about 1 hour after vaccine.


VAERS ID: 1697778 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Swollen tongue, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1745 vaccine administered. 1755 a bystander alerted staff of patient having a reaction. Staff summoned clinical staff to patient. Patient''s BP 148/70 HR 120, O2 saturation 99%. Tongue appeared slightly swollen. RLL slightly wheezy, otherwise clear throughout. Patient was able to communicate with staff and consumed 500 mL water independently. 1805 50 mg Benadryl administered orally. 1810 BP 130/70, HR 90, O2 saturation 99%. Lungs clear to auscultation throughout. At 1820 patient stated she felt better and felt well enough to go home with her daughter who was with patient. Prior to departure patient was educated about when to seek further care and when to utilize emergency services. At time of departure patient had no further questions or concerns.


VAERS ID: 1697779 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-11
Onset:2021-09-14
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, COVID-19, Exposure to SARS-CoV-2, Fatigue, Influenza like illness, Patient isolation, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (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:
CDC Split Type:

Write-up: Individual with positive test result on 9/13/21. Symptoms of congestion, fatigue, loss of taste, and other "flu-like symptoms" since 9/12/21. He has been isolating since 9/10/21, his last contact with his positive roommate. They have separate bedrooms but share a bathroom that they clean between uses. Advised to isolate until 9/22/21. He''s also agreeable to antibody testing after isolation period is over.


VAERS ID: 1697935 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-09-10
Onset:2021-09-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: No known
Diagnostic Lab Data: He has not yet went to a doctor about the ringing.
CDC Split Type:

Write-up: PT told me he was experiencing ringing in both ears consistently all day today. He had not experienced this ringing prior to today.


VAERS ID: 1697939 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Lymphadenopathy, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: L arm pain, L chest pain, L axillary lymphadenopathy- ER visit. minor symptoms.


VAERS ID: 1697943 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / N/A LA / IM

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

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

Write-up: Incorrect vaccine was given for the 2nd dose, instead of Moderna, Pfizer was administered


VAERS ID: 1697944 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-09-03
Onset:2021-09-14
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 - / IM

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

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

Write-up: Gav second dose Pfizer when first dose was moderna


VAERS ID: 1698518 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial paralysis, Lip oedema, Sensory loss
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Acetaminophen, eggs
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Paralysis left side of face, lower lip with edema and loss of sensation starting 4 days post vaccination. Treatment will be 5 day course of prednisone 50 mg daily and OTC Benadryl for anti histamine .


VAERS ID: 1700055 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-13
Onset:2021-09-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: Vemlidy Amitriptiline Nadolol
Current Illness: None
Preexisting Conditions: Hepatitis B Migraine
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Slight fever,chills,malaise,muscle aches


VAERS ID: 1700060 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

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

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

Write-up: After receiving the vaccination patient passed out.


VAERS ID: 1700061 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Unknown vaccine - had multiple vaccines at the same time. Reaction was rash and itching. Date - March 1997
Other Medications: Daily antihistamine
Current Illness: Migraine
Preexisting Conditions: PTSD, Ehlers-Danlos Syndrome-hypermobility
Allergies: Vioxx, vercet, Valium, Wellbutrin, prozac, compozine, benzodiazapines, vitamin D3 supplement, lanolin, wool, lamb, unknown seasonal allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Itching and redness over majority of body. Reported to person who gave injection, and she said to go home and take Benadryl. 50 mg Benadryl taken three times 6 hours apart. Redness is subsiding, still itchy at 8:45am on 09/15/2021


VAERS ID: 1700068 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: The Pfizer COVID-19 vaccine was diluted incorrectly: 0.8mL of diluent was used instead of the 1.8mL that is required. The patient still received a 0.3mL volume dose however that dose was more concentrated due to the incorrect dilution. The patient was made aware of this incident and was not experiencing any adverse side effects from the vaccine when contacted.


VAERS ID: 1700075 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-13
Onset:2021-09-14
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/14 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1700080 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Muscular weakness, Paraesthesia oral
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Reported anaphylactic reaction to Flu vaccine at age 48. Went to ER Epinephrine administered
Other Medications: none Reported
Current Illness: n/a
Preexisting Conditions: Anemia DVT
Allergies: Tetracycline
Diagnostic Lab Data: Unkown
CDC Split Type:

Write-up: 5 minutes after administration employee c/o of generalized weakness especially in legs. Employee placed in semi fowlers position and monitored. Approximately 56 mins after administration employee c/o tingling to lips and tongue, 25mg of Benadryl given im with relief. Employee transported via ambulance to Hospital ER.


VAERS ID: 1700095 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-09-14
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Acute respiratory failure, Anxiety, Asthenia, Azotaemia, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Cough, Dyspnoea, Hyperglycaemia, Hypophagia, Lactic acidosis, Myalgia, Patient isolation, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Sepsis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: melanoma status post excision in 2015
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 72-year-old male with past medical history of melanoma status post excision in 2015 and hypertension presented to the emergency department complaints of shortness of breath. Patient reports that he was usual state of health until approximately 1.5 weeks ago when he started noticing some shortness of breath along with cough. Patient reports that he got fully vaccinated with Moderna against COVID-19 on February 19, 2021. Patient reports that his symptoms were worrisome therefore, couple of days later, he got tested positive for COVID-19. Patient reports that he initially isolated and had only mild cough with congestion however, his symptoms continued to worsen. Tested positive on 9/14/2021 72-year-old male with past medical history of melanoma status post excision in 2015 and hypertension presented to the emergency department complaints of shortness of breath. Patient reports that he was usual state of health until approximately 1.5 weeks ago when he started noticing some shortness of breath along with cough. Patient reports that he got fully vaccinated with Moderna against COVID-19 on February 19, 2021. Patient reports that his symptoms were worrisome therefore, couple of days later, he got tested positive for COVID-19. Patient reports that he initially isolated and had only mild cough with congestion however, his symptoms continued to worsen. Patient has had multiple episodes of pneumonia in the past. He tried to wait as he thought his symptoms would improve. Went to get regeneron 4 days ago. Patient reports that his symptoms continued to worsen and he has had multiple episodes of fevers/chills along with cough and congestion. Also has had muscle aches and weakness. Has had very poor oral intake. He was not improving therefore, his daughter convinced him to come to the emergency department for further evaluation. Upon arrival to the emergency department, patient was found to have acute hypoxemic respiratory failure secondary to sepsis in the setting of COVID 19 pneumonia and possible superimposed bacterial pneumonia, hyperglycemia, uremia, acute renal failure, elevated troponin/type 2 MI, elevated BNP, and lactic acidosis.


VAERS ID: 1700096 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-20
Onset:2021-09-14
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Atelectasis, Blood creatinine increased, Blood urea increased, COVID-19, Chest X-ray abnormal, Condition aggravated, Cough, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Fluid retention, Respiratory tract congestion, SARS-CoV-2 test positive, Serum ferritin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Angiogram Back pain CAD Chronic kidney disease Claudication Diabetes mellitus Hallux valgus,
Allergies: tetanus toxoid
Diagnostic Lab Data:
CDC Split Type:

Write-up: 72-year-old male with past medical history of melanoma status post excision in 2015 and hypertension presented to the emergency department complaints of shortness of breath. Patient reports that he was usual state of health until approximately 1.5 weeks ago when he started noticing some shortness of breath along with cough. Patient reports that he got fully vaccinated with Moderna against COVID-19 on February 19, 2021. Patient reports that his symptoms were worrisome therefore, couple of days later, he got tested positive for COVID-19. Patient reports that he initially isolated and had only mild cough with congestion however, his symptoms continued to worsen. Tested positive on 9/14/2021


VAERS ID: 1700098 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

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

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

Write-up: Approximately 10 minutes post vaccine administration patient experienced a tonic-clonic seizure while seated in the pharmacy waiting area. Seizure lasted approximately 30 seconds (+/-). No past history of seizure. EMS responded. Patient was alert and conversant within 3 minutes. Patient was released by EMS to her mother for transport for further medical evaluation by her doctor.


VAERS ID: 1700113 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: On 01/06/2021- had a reaction the Moderna Covid vaccine. age was 45. Adverse report weas filled out for this. She had itching al
Other Medications: Fiber, Calcium, Synthriod, Dertol LA, Kelnor, Metoprolol, Hydrochlorothiazide, Omeprazole
Current Illness: Sinus infection
Preexisting Conditions: Thyriod, cancer, overactive bladder, HTN, Depression, Mirgraines, fatty liver, Cyst on right kidney, Thyriod removal
Allergies: Cococunt, Moderna COVID vaccine - First shot had a reaction
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started to itch about 5 min after getting vaccine. Patient was premedicated with 25 mg of benadryl because she had a reaction to the first shot. Patient had some red spots on her body. Took another 25 mg of benadrly about 30 mins after the shot. Patient states that she cont to itch all over.


VAERS ID: 1700115 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: EKG on 9/14/21 result was normal
CDC Split Type:

Write-up: Within 10 minutes of receiving vaccines, developed rapid heart rate and chest pressure. Was seen at Urgent Care.


VAERS ID: 1700128 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-09-14
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/15/21 SARS/COV-2, NAAT, POSITIVE
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1700130 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Penicillin , cherries
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever , chills , muscle aches, headache, vomiting


VAERS ID: 1700135 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-01
Onset:2021-09-14
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Moderna 5/4 and 6/1. Positive on 9/14


VAERS ID: 1700152 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-01
Onset:2021-09-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad)

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

Write-up: Tingling in right hand/fingers and extreme back pain


VAERS ID: 1700158 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-05
Onset:2021-09-14
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral normal, Basal ganglia infarction, Computerised tomogram head abnormal, Dysarthria, Facial paresis, Haemoglobin decreased, Hemiparesis, Ischaemic stroke
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Methocarbamol 750 mg TID
Current Illness:
Preexisting Conditions: Tobacco use
Allergies: NKDA
Diagnostic Lab Data: CT Head w/o contrast: Acute or subacute infarct involving left basal ganglia and internal capsule as described, without evidence of hemorrhagic conversion. CT Angiogram head: No intracranial proximal arterial stenosis/occlusion, aneurysm, or arteriovenous malformation. Hemoglobin: 8.7 All tests done on 9/14/2021
CDC Split Type:

Write-up: Patient received COVID vaccine (PFizer) on 7/7/2021 and 8/5/2021 respectively. She presents to hospital on 9/14, which is 41 days after second vaccination, suffering an ischemic stroke with an acute/subacute infarct involving the left basal ganglia and internal capsule without evidence of hemorrhagic conversion. Patient has hx of tobacco abuse. She demonstrates moderate degree of dysarthria, right facial weakness and mild weakness of her right upper and lower extremities. NIHSS of 4.


VAERS ID: 1700163 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-11
Onset:2021-09-14
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization (non-ICU)


VAERS ID: 1700164 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product administration error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Clonidine, Lantus, Lisinopril, Metformin, Regular s/s insulin, Tylenol, Albuterol
Current Illness: None
Preexisting Conditions: Type 2 diabetes, arthritis, mood disorder, obesity, hyperlipidemia, asthma
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt did not have any adverse side affects. The vaccine was administered in error


VAERS ID: 1700167 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-24
Onset:2021-09-14
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization (non-ICU)


VAERS ID: 1700192 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-02-12
Onset:2021-09-14
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Fatigue, Headache, Parosmia, Rash, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (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: SEREVENT, ALBUTEROL, LISINOPRIL, MAGNESIUM OXIDE, TIZANIDINE, KETOTIFEN, GABAPENTIN, MELATONIN, LEVOTHYROXINE, FLONASE, HYDROXYZINE, ASMANEX, DICLOFENAC GEL.
Current Illness: DRY EYES, BILATERAL LEG SWELLING.
Preexisting Conditions: SHOULDER PAIN, HYPOTHYROIDISM, HTN, INSOMNIA, ASTHMA, ALLERGIC RHINITIS, CHRONIC PAIN, HSV2, ALLERIGIC CONJUNCTIVITIS, DEPRESSION, OVERWEIGHT, OSTEOARTHRITIS, NONCOMPLIANCE WITH MEDICATION REGIMEN, POSTMENOPAUSAL STATE, FORMER TOBACCO SMOKER, OSTEOPOROSIS.
Allergies: NKA.
Diagnostic Lab Data: 09/14/21: POSITIVE POC SARS COVID RAPID ANTIGEN (QUICKVUE.)
CDC Split Type:

Write-up: COUGH, SOB, RASH, RUNNY NOSE, CONGESTION, HEADACHE, CHEST CONGESTION, CHANGE IN SMELL, FATIGUE.


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=5&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166