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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 509 out of 10,317

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VAERS ID: 1888344 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: I gave patient his pediatric dose around 5pm and when he was sitting in the waiting area, around 5:20pm, my technician ran over to me and told me she had an emergency and the patient is passing out. I went and assessed the situation to see if he was having a reaction or fainting and noticed he was having syncope. I raised his legs and ran to grab cold backs for his wrists, neck, and face, we gave him something to drink while I directed another technician to call 911. We stayed with the patient, he was reactive and doing okay until paramedics arrived and then we let them take over the rest.


VAERS ID: 1888347 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

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

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

Write-up: On Saturday, November 20, 2021 client received her Pfizer Covid-19 vaccine booster (LOT #: FF8841) at 1:33 PM in her left deltoid. During assessment questions, client stated she had no know allergies and takes no medications. Client to be observed for 15 minutes after vaccination. At approximately 1:46 PM, while in Observation Area, client stated to EMT she was experiencing "tingliness or tickleness" in her left palmar surface for less than 5 minutes only with no pain or any other symptoms. Client denied SOB. Client was brought to sit in anti-gravity chair, offered water and vitals started. Lead RN offered 50 mg oral solution Benadryl and EMS to which the patient denied. At 1:45 PM: BP 124/88, HR 69, O2 sat 98%, RR 20, skin warm and dry. At 1:52 PM, client states she was a bit anxious to get the vaccine. EMT educated client to seek medical treatment if symptoms persist and signs and symptoms of adverse reactions. At 1:57 PM, client stated the tickleness sensation was "better" and "less." No further interventions needed. At 1:58 PM, client left vaccination site with a steady gait and her husband drove her home.


VAERS ID: 1888350 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 LA / IM

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

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

Write-up: Patient passed-out after vaccinated.


VAERS ID: 1888351 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site bruising, Injection site discomfort, Injection site erythema, Injection site oedema, Injection site swelling, Injection site warmth, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Upon assessment the deltoid region (approx size of an orange in diameter) is with edema, erythema, and is feverish to touch. There is a small dime size bruise in the center of the erythema and Veteran reports slight left upper extremity discomfort with ROM. Cool compress applied, PRN medication management as ordered


VAERS ID: 1888353 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

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

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

Write-up: Patient immediately felt nauseous, clammy, faint, lightheaded, hot. Symptoms lasted for about 15 minutes. EMT came to access patient and she was able to call her husband and he came to pick her up from the store


VAERS ID: 1888354 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Nervousness, Pain, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none provided
Current Illness: what appears to be impetigo present on nose near nostril
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: About 5 minutes post vaccine patient began complaining of feeling shaky and a little light headed. Breathing, color, and mentation appeared fine. Patient given water and crackers (had not had breakfast) and told to lie down with feet up if he became more lightheaded. Patient was observed for 20 minutes, during which time he developed chills and became sleepy. He also had what appeared to be impetigo on nose near left nostril, which the father was advised to seek medical care since it would likely require an oral antibiotic. Patient appeared stable and was allowed to leave and again father was advised to seek additional care if symptoms worsened and also for evaluation for likely impetigo. Spoke to father at 12:16 pm, they had gone home since patient was tired and wanted to lie down. AT home he developed additional chills, body aches and was given tylenol. The father was calling urgent care to get an appt for son to be evaluated.


VAERS ID: 1888355 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL 0007 / 1 LA / IM

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

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

Write-up: Child had 2 fainting episodes and 2 vomiting episodes about 15 minutes apart, EMS arrived at around 12:45p.m , took vitals and transported child to the hospital.


VAERS ID: 1888356 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 06SF21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry skin, Eye oedema, Eye swelling, Pyrexia, Scan with contrast, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clopidogrel, Iron, Aspirin, Atorvastatin, Losartan,
Current Illness: Anemia, Hypertension
Preexisting Conditions: Chronic pain, Stent
Allergies: Allergic to Penicillin, Codeine
Diagnostic Lab Data: Contrast Dye given at another facility approx 3 hours before vaccine.
CDC Split Type:

Write-up: Edema to right orbital socket, swelling above right eye. Fever, warm to touch. Dry skin.


VAERS ID: 1888359 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Electrocardiogram normal, Exposure during pregnancy, Fibrin D dimer normal, Haemoptysis, Troponin normal, Urine analysis normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, cetirizine, prenatal vitamin, 81mg aspirin, calcium and vit d, nexium
Current Illness: None
Preexisting Conditions: None
Allergies: Nickel, bluegrass, ragweed
Diagnostic Lab Data: All on 11/20/21 Troponin, ddimer (neg) Cxray, EKG (normal) Urine for protein (normal)
CDC Split Type:

Write-up: 18 weeks pregnant, due date 4/22/22. Intermittent left sided chest pain for about 10 min. Stabbing/burning. Then had blood tinged sputum and spit up a dime sized clot.


VAERS ID: 1888364 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: fainted


VAERS ID: 1888367 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nasal congestion, Odynophagia, Throat irritation
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: omeprazole, Larin, ondansetron, fludrocortisone, metoprolol, ketoconazole, sucralfate
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: about 4:30pm pt noticed nose felt like it was closing a bit, throat was a little scratchy and it felt sore to swallow and slight dizziness. onset of symptoms were about 1/2 hour after vaccination. patient did not want to take diphenhydramine as it makes her heart race, so we offered her cetirazine 10mg which she took around 5:30pm. Patient and companion decided to go to car to wait, but I asked her to call back by 6pm or I would call her before we closed. Patient reported during that time period that her symptoms were improving and then again at 6pm that she was feeling better. I instructed her to call 911 if symptoms deteriorated again in the evening or it felt like she was having more trouble breathing later on.


VAERS ID: 1888368 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

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

Write-up: After a child received the Pfizer pediatric vaccine, they became pale, light headed, and weak. The pharmacist had them lie on the floor and applied a cold compress. Another child who also received the same vaccine saw what occurred to their sibling and became nauseous and vomited. After 30 minutes of the pharmacist observing them, both children felt better and left with their family.


VAERS ID: 1888369 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Headache fatigue muscle pain


VAERS ID: 1888371 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt is on Depake and Lamictal for Psych conditions but did not take her medication today according to her.
Current Illness: non known
Preexisting Conditions: psych hx
Allergies: PCN,Sulfa
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Pt experienced nausea and vomiting after the vaccine but she also did not eat all day and did not sleep well the night before per her statements


VAERS ID: 1888373 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / SYR

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

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

Write-up: Patient (12 y.o.) was given a pediatric dosage of Pfizer by mistake instead of the recommended adult dosage. No other adverse reactions to report


VAERS ID: 1888376 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 1 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308458 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Immediately after administration of both vaccines, patient developed a local rash at the injection site.


VAERS ID: 1888377 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Extra dose administered
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Medication errors (narrow)

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

Write-up: Pt reported feeling SOB during post vaccination waiting period. Pt declined epi pen and believed it was her asthma flaring up, and wanted to use her inhaler instead. Pt felt fine after 5 minutes, then left. She came back after 10 minutes again complaining of tightness in the chest. Pt still declined epi-pen but agreed to benadryl. Pt did not report any AE with first two doses of moderna.


VAERS ID: 1888378 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / IM

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

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

Write-up: Patient received a booster dose of the Pfizer vaccine when she is outside the approved age group (18+). No symptoms or adverse events are observed currently.


VAERS ID: 1888381 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt stated he passed out from a flu vaccine in the mid 90''s
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 10 minutes after receiving vaccine patient fainted. patient was doing better but then appeared to possibly have a seizure and faint again about 15 minutes after initial event.


VAERS ID: 1888383 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Work       Purchased by: ?
Symptoms: Headache, Lymphadenopathy, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Moderna covid dose 2
Other Medications: Me Meformin, synthroid
Current Illness: No
Preexisting Conditions:
Allergies: Naproxen
Diagnostic Lab Data:
CDC Split Type:

Write-up: 102.1 fever, body aches, head aches, swollen lymph nodes, arm pain


VAERS ID: 1888389 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: Pt. stated he felt dizzy. Pt placed in recumbent position, observed, vitals taken. Pt. returned home to with mom.


VAERS ID: 1888397 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK51274 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness, Panic attack
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), 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? 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: i administered pfizer 5-11 vaccine to patient - he was very brave and sat still , did nit cry. he was getting it because he has 2 younger brothers . At that point he was fine. a few minutes later his mother was holding him saying that his legs felt limp. i layed him back on a chair , applied a cold water bottle to his wrist and forehead , asked if his tongue felt funny - it did not - and kept taking to him while also having front store manager call 911 . a few minutes later patient said h that he was ok and I asked if he wanted some water -which he did. I explained to him that the firefighters would be coming to check his breathing . they observed him and put him on a stretcher. I called his mother at 6:45 pm to check on him. she stated that they thought that he had a panic attack, and the he would see his pedi md on Monday. Mother also stated that patient was back to normal and was eating and playing all afternoon.


VAERS ID: 1888408 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Nausea, Neck pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine 225mg/daily Buproprion 300mg/daily
Current Illness: None
Preexisting Conditions: Obesity, migranes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up with very sore arm & neck. Once getting up was nauseated and had stomach pains. Headaches fluctuate throughout the day. Fever of 101.3 taken at 8:35pm same day.


VAERS ID: 1888421 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Nortriptyline 50mg qd
Current Illness:
Preexisting Conditions: GERED, High cholesterol, migraines
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fever, left arm pain


VAERS ID: 1888423 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

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

Write-up: The medical assistant at the site was vaccinating patients. The clinic was held by HR support at High School at 1. Rocket. The clinician had drawn up 3 vaccinations for those waiting. 2 Moderna boosters and 1 Pfizer booster. All boosters were labelled with the color coded sticker for that vaccine and had the name of the vaccine on each sticker and had the designated card for each patient in the tray. The MA took the next patients tray with her vaccine card and Modrena booster. When the MA called the patient, she stated she wanted another person to go ahead of her because she had an appointment and was in a rush. This patient wanted the Pfizer booster and the MA did not replace the previous patients tray and grab the correct one. As a result, the MA went through vaccine verification and vaccine history and administered the vaccine without realizing she has the wrong vaccine. Once realized, the MA apologized to the patient, the clinician explained the boosters can be interchangeable but of course the patient was a little upset. The patients card was corrected. Management notified of incident, safety officers and LNO''s notified of incident. No adverse events noted post vaccine.


VAERS ID: 1888427 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-27
Onset:2021-11-20
   Days after vaccination:297
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Hypopnoea, Induration, Mouth swelling, SARS-CoV-2 test positive, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Respiratory failure (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Dementia
Allergies: NKA
Diagnostic Lab Data: COVID+
CDC Split Type:

Write-up: CHIEF COMPLAINT: pt comes from with staff reporting swelling to left side of neck starting last night, becoming worse. area under chin is swollen and firm. area under tongue is swollen. breathing is shallow. HISTORY OF PRESENT ILLNESS: 85-year-old woman with past medical history of COVID-19, atrial fibrillation, constipation, diarrhea, GERD, major depressive disorder, peripheral vascular disease, muscle weakness, generalized anxiety disorder, vitamin D deficiency, hyperlipidemia, diverticulitis of small and large intestine without perforation or abscess, cervical disc degeneration, and dementia presents from rehabilitation and nursing Center for submandibular swelling. Per EMS patient began having left submandibular swelling 1 week ago. This has progressed to the entire submandibular region. Patient herself provides no history. Unknown modifying factors or associated symptoms. Symptom duration reported by EMS from nursing home as 1 week.


VAERS ID: 1888434 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 RA / IM

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

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

Write-up: Pt received Moderna booster 1 day before 18th birthday. No adverse events noted. Pt was understanding when issue was brought back to her attention.


VAERS ID: 1888436 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. P100359454 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Feeling abnormal, Loss of consciousness, Mydriasis, Posture abnormal, Respiratory rate increased
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), Dementia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Client was given the flu shot first and then their Pfizer shot. About 10 seconds after the Pfizer shot he started to feel "weird" and breathing faster. His eyes got bigger (dilated) and he put his head back. We''re pretty sure he passed out at that point. The pharmacist that administered the shot called for assistance. By the time the assistance came within 15 seconds he was coming around more alert. The emergency kit was grabbed. At that point the administering Pharmacist started to go through a breathing method to calm the client. He started to calm and breath in a normal pattern. The client was alert at this point and responding to questions correctly. The client and father waited close by for observation for 30 minutes. The client was alert, breathing well and feeling much better when they left.


VAERS ID: 1888447 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

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

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

Write-up: Same day of injection: left arm and leg pain followed by left neck pain Following day: left supraclavicular lymphadenopathy incidentally noted


VAERS ID: 1888449 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 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:
CDC Split Type:

Write-up: PATIENT 17 YEARS OLD, RECEIVED MODERNA


VAERS ID: 1888456 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known from patient host profile
Current Illness: COVID-19 Dementia (type unkown)
Preexisting Conditions: Not known
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received booster dose shortly upon arrival to pharmacy. No other accompanying family members. Completed paper work independently. After review by pharmacist, no contraindications were noted and vaccine was administered. Patient appeared lucid at time of vaccination. No adverse drug events noted during 15 minute observation period. Pharmacist was later informed by family member (daughter) that patient had dementia but acted out independently. Daughter stated patient had conracted COVID-19 on 10/18/21 and received monoclonal antibodies as part of treatment course. Hosptal personnel instructed daughter that patient shoiuld not receive further vaccine for 90 days after administration of. Patient did not indicate that information on the Vaccine Administration Record and Informed Consent at the Pharmacy and his action were not known by the daughter until after the event had occurred. No observable adverse reactions noted approximately 11 hours after the event.


VAERS ID: 1888459 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / -

Administered by: School       Purchased by: ?
Symptoms: Eye 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? 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: Swollen lump under the eye.


VAERS ID: 1888460 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Unknown  
Location: Oregon  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Electrocardiogram
SMQs:, Anaphylactic reaction (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: Hospitalization after TDaP as a child. Specifics unknown.
Other Medications: Descovy
Current Illness: Unknown.
Preexisting Conditions: Anxiety, depression.
Allergies: cephalexin - anaphylaxis, TDaP leds to hospitalization as a child.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: 1545 - Patient reported hx of hospitalization after TDaP as a child during screening. Consulted w/ NP and PA on site. Given 1st Pfizer dose (lot #EW0217) to RD. Asked to wait 30 minutes for observation. 1600 - Patient reported 5/10 mid-sternal "chest heaviness". No other symptoms. HR feels regular and in 60s. BP 134/83 and HR 65 on over-the-counter BP monitor on-site. No cardiac history. History of anxiety w/ and w/o panic attacks, but patient reports this is well-controlled and today''s symptoms are not consistent with this history. Patient does not want ambulance called, but staff explained that our medical obligation is to call 911 for life-threatening symptoms such as chest pain/tightness/pressure/heaviness. 1605 - Provider on-site called 911. 1615 - Ambulance arrived. HR with SR 60, BP 133/84, and SpO2 99% on their monitor, but EKG print-out has "concerning areas" that warrant evaluation by a hospital given its unclear if they were pre-existing or new and further evaluation is outside ambulance scope. Patient declined transport to a hospital, however, due to financial concerns after having lost his medical insurance when he turned 26 last month. Patient said "I''d rather die than face those medical bills" and "I truly don''t care if I die". 1625 - Ambulance and on-site vaccine staff all repeated hospital transfer recommendation. Patient declined again. Ambulance left. 1635 - Given resources for, Marketplace, and several Portland-area low-income, sliding scale medical offices. Additionally recommended messaging his PCP to discuss whether 2nd Pfizer dose is advised, because messaging can still occur at no cost without health insurance. 1645 - Patient escorted to car by staff for continued observation. No change to 5/10 "chest heaviness". Otherwise stable. Patient left in vehicle.


VAERS ID: 1888463 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: At approximately 3:11 PM on 11/20/2021, male child arrives to vaccine site with his father. Child''s father requests initial pediatric Pfizer dose to be administered to child. Nurse attempted to begin administering dose and poked with needle in left upper arm. Needle was inserted approximately 3 cm, then child withdrew arm and moved away from nurse. Child was difficult to console, and none of vaccine dose was administered to the child. Pfizer pediatric dose was not given to child for safety reasons. This dose and syringe was wasted, per COSD Policy guidelines.


VAERS ID: 1888464 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site warmth, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, Vimpat, Klonopin, Levothyroxine, magnesium, vit b6
Current Illness: None
Preexisting Conditions: Epilepsy Hypothyroidism
Allergies: Soy, MSG, depakote
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on arm, large red circle around injection site, 6? in diameter, hot to the touch, very sore


VAERS ID: 1888465 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-13
Onset:2021-11-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Injection site irritation, Injection site pruritus, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Coarctation of the descending aorta; abnormal formation of heart valves
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Wide spread hives on back and neck; radiates heat; itch/irritation at site


VAERS ID: 1888472 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1 IBUPROFEN, 1 TYLENOL
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE KNOWN
Diagnostic Lab Data: NOT YET
CDC Split Type:

Write-up: HUGE LUMP IN UNDERARM LYMPH NODES AND BACK.


VAERS ID: 1888488 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Myalgia, Pyrexia, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Microgestin fe 1.5 Albuterol inhaler as needed Nebulizer treatments, albuterol .3 ml as needed
Current Illness:
Preexisting Conditions: Asthma, anaphylactic reactions to medicine/food listed above
Allergies: Iv benadryl Chile peppers
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever of 102. 5 at 4:07 am 11/21/2021 increased from 101.7 at around 8:30 pm 11/20/2021 Muscle aches Chest congestion and strained breathing due to excess mucus


VAERS ID: 1888499 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Diarrhoea, Dizziness, Headache, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: The first dose of Pfizer-BioNTech (I reported this as well), caused me to have extreme diarrhea for several hours. Age: 37. Vacc
Other Medications: Norethindrone 0.35mg, Bupropion 150mg, Caltrate, Viviscal
Current Illness: None
Preexisting Conditions: None
Allergies: Tramadol, Vicodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 10 minutes of getting the shot, I felt very dizzy, like I could feel the earth moving under my feet. Pain in my arm began around 8 pm that same day as well. Upon waking around 6 am the following day, I felt feverish, chills and a pounding headache that no amount of ibuprofen would help. At 8 am I took my temp, it was 100.3. Around 6 pm the headache wasn''t as bad, however, that''s when the diarrhea began. For 2 hours, it was constant. I had taken my temp several times throughout the day, it stayed steady at 100.3 until shortly before I went to bed at 10 pm, it was at 100. My entire body ached all the way down to my toes. I woke up at 5:45 am, on 11/21/2021, all symptoms have subsided and temp was back at normal: 98.


VAERS ID: 1888501 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Eye swelling, Lymphadenopathy, Peripheral swelling, Swelling face, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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: LISINOPRIL-HCTZ 10-12.5 MG ATORVASTATIN 20 MG METFORMIN ER 500 MG GASTRC-TB
Current Illness:
Preexisting Conditions: Celiac disease High blood pressure High Cholesterol Pre-Diabetes
Allergies: Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lymph node swelling mainly in left arm but spreading to right arm with a few hours. Started with redness and hives then spread out across underside of both arms. Day 2 included waking up with swollen hands and face. Mainly effecting left eye.


VAERS ID: 1888502 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Body temperature increased, Chills, Headache, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, RaloxifineHCL, Omeprazole, Lisinopril , Calcium OTC
Current Illness: Had a cold
Preexisting Conditions: Hypertension, high cholesterol, hypothyroidism, ostseoporesis,
Allergies: Codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Slight chills, slight headache, temperature 100.6, intense body aches all over. Took 2 Advil and 1 extra strength Tylenol at the same time. Symptoms were gone by noon on 11/20/2021. Did not seek medical treatment.


VAERS ID: 1888504 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Induration, Mobility decreased, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Harding of the left breast. Immobility of left arm. My entire Left side of my body from my head to my toes is stiff


VAERS ID: 1888580 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF5109 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Productive cough, Rales
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Salbutamol Zenhale Zopiclone Montelukast
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: I am educated enough to treat myself and know when it?s an emergency.
CDC Split Type:

Write-up: My chest became tight. I took my Salbutamol (2 puffs with my chamber). Chest became tighter and repeated my Salbutamol. Woke up twice during the night needing my rescue inhaler again. Coughing up mucous now which I never do. Chest is extremely tight and crackly. My Salbutamol is only working for approx 4 hrs max and cannot inhale as well as I could prior. I am at 250L/min with my Peak Flow meter whereas the last 3 months I have improved from 250 up to 450. I?ve been between 400-450 for approx 3 months and have no had a setback until yesterday.


VAERS ID: 1888582 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea exertional, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Fatigue, Feeling abnormal, Fibrin D dimer normal, Myalgia, Palpitations, Pericarditis, Troponin normal, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cetirizine 10mg QDPRN allergy symptoms, Albuterol 90mcg/actuation MDI 2 puffs PRN shortness of breath, Omeprazole 20mg daily
Current Illness: None
Preexisting Conditions: Mild intermittent asthma, Eczema
Allergies: Iodine
Diagnostic Lab Data: 11/21/2021: ECG with diffuse ST segment elevations indicative of pericarditis. Troponin negative, D-Dimer negative, WBC 5.8. Temp 37.4C; HR 99, BP 130/83, SpO2 100% on room air.
CDC Split Type:

Write-up: Approximately four hours after receiving the vaccination patient developed fatigue, "fogginess". Symptoms continued until this afternoon when patient developed palpitations, dyspnea with exertion, and myalgias with right anterior chest pain. Presented to this emergency department at that time.


VAERS ID: 1888585 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Condition aggravated, Cough, Crying, Diarrhoea, Electrocardiogram, Erythema, Headache, Injection site pain, Menstrual disorder, Myalgia, Pain, Polymenorrhoea, Pyrexia, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations: 1st COVID vaccine
Other Medications: None
Current Illness: Had cough from previous vaccine and didn''t feel well and was just starting to improve when 2nd dose was given.
Preexisting Conditions: Hx of hypothyroidism, anxiety, depression, ptsd, eating disorder, liver mass
Allergies: Bactrim and adhesive
Diagnostic Lab Data: EKG, physical exam 11/21/21 at Urgent care Steroid injection 11/21/21
CDC Split Type:

Write-up: 5.5 cm x 4.5 cm warm, very tender, edematous and erythematous area on left deltoid. Pt having body aches - bad enough shes been in tears, site is very painful, chest pain/heaviness/tightness (had EKG done), cough, chills/fever, HA, diarrhea, abnormal period - has had vag bleeding when period just ended 6 days ago.


VAERS ID: 1888596 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Middle of friday morning, had horrible chills, and uncontrollable shaking, stopped with tylenol; on sat morning arms began itching and hives had started and on my legs; started steroid cream and benadryl; by sunday morning the rash and hive
Current Illness: none
Preexisting Conditions: fibromyalgia, lung scarring from chronic bronchitis growing up, disc bulges throughout spine, depression
Allergies: Macrobid, Diflucan
Diagnostic Lab Data:
CDC Split Type:

Write-up: hives and rashes on body, to ER, prescribed oral steroids and steroid ointment; only 2 day since symptoms started, may take time to go away


VAERS ID: 1888623 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeling of body temperature change, Headache, Laboratory test normal, Pain, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: I woke up throwing up all day headache body pain ticks and tremors this was yesterday i was hot and cold cold and hot i still have little ticks and tremors here and there


VAERS ID: 1888631 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21H / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Body temperature increased, Headache, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1/28/2021; 71; Moderna; injection; Fever of 100.2; Chills; Muscle aches; Headache
Other Medications: Lisinopril
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Soreness of injection site Temperature of 100 degrees Muscle aches Slight headache


VAERS ID: 1888637 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: Junel birth control, multivitamin, B12
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sleepiness and fatigue the following day, 28 hours after administration Sore arm at site of injection


VAERS ID: 1888650 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-01
Onset:2021-11-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Deafness unilateral, Diplacusis, SARS-CoV-2 test negative
SMQs:, Hearing impairment (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: The first round of Moderna vaccines caused anosmia (loss of taste) after the second dose.
Other Medications: lisinopril - 25mg daily
Current Illness: Persistent cough lasting 3 or 4 months, tested for covid, negative for that and pneumonia.
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Went home felt fine, took a nap, woke up with significant hearing loss in one ear, about 18 hours after injection loss is near total, loud metallic sounding echo when people talk.


VAERS ID: 1888652 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Axillary mass, Dizziness, Headache, Injection site erythema, Injection site warmth, Oedema peripheral, Pain, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular 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: Gardasil
Other Medications: Synthroid 175mcg
Current Illness: No
Preexisting Conditions: Hypothyroidism/hashimotos
Allergies: Tree nuts, kiwi, seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: Achiness, fever, headache, swollen lump in left armpit, selling, red and hot to the touch at injection site, dizziness


VAERS ID: 1888670 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH . / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Injection site pain, Muscle spasms, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer shot 2 was difficult also
Other Medications: pilocarpine buspirone celecoxib
Current Illness:
Preexisting Conditions: arthritis sicca syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely sore arm at the injection site Muscle cramping fever headache


VAERS ID: 1888671 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 60mg qd, levothyroxine 75mg qd. Multivitamin, calcium 600mg qd, Fish oil supplement qd
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe chills and muscle ache lasting 15 hours


VAERS ID: 1888673 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

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

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

Write-up: Swelling under right eye developed on 2nd day 11/21/2021


VAERS ID: 1888679 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Fatigue, Headache, Hypertension, Hypoaesthesia, Injection site pain, Injection site swelling, Nausea, Pallor, Supraventricular tachycardia, Tachycardia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Dehydration (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: Latanoprost Brimonidine
Current Illness: None
Preexisting Conditions: None
Allergies: Metal Latex
Diagnostic Lab Data: Symptoms observed by medic 11/20/21, 3:46pm. Manual blood pressure170/92, heart rate 130s, spo2 90s.
CDC Split Type:

Write-up: SVT, hypertension, pallor, Tachycardia, numbness, nausea, headache, and weakness for 20 minutes, occurring 6 minutes after injection. Symptoms reoccurred at 530 pm and 7pm lasting 10 minutes. Soreness and swelling at injection site 11/21/21. Tachycardia, numbness and fatigue 11/21/21.


VAERS ID: 1888681 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Influenza, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

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

Write-up: I got the usual flu symptoms the day after, i.e., chills, body aches. Today, two days after I have a rash on my chest and under my arms.


VAERS ID: 1888683 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1888696 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Dose 2
Other Medications: Duloxetine Valacyclovir Vitamin D3 Lisinopril HCTZ Pantoprazole Buspar
Current Illness: Treated with Prednisone for inflammation of bronchial tubes
Preexisting Conditions: Asthma
Allergies: NKDA Pork, Peaches, Grasses, Trees
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received my shot around 11:00am and by 4:30pm I had fever, chills, body aches and the lymph node under my left arm was swollen to the size of 2 golf balls


VAERS ID: 1888709 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / SYR

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

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

Write-up: Injection Site Pain Tiredness Headache Muscle Pain Chills Joint Pain Nausea Feeling Unwell Swollen Lymph Nodes Decreased Appetite Fatigue


VAERS ID: 1888711 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-17
Onset:2021-11-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Site: Bruising at Injection Site-Severe, Site: Itching at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: swelling and pain at injection site-Severe, Additional Details: pain and swelling at the injection siteweakness


VAERS ID: 1888713 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-16
Onset:2021-11-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Chills, Decreased appetite, Eye pain, Fatigue, Headache, Heart rate increased, Nasal congestion, Nausea, Pain, Pyrexia, Sinusitis, Taste disorder
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: The patient received the Moderna booster shot after about 10 months of his Pfizer double vaccination. The patient had many of the previously reported adverse effects (fever, fatigue, headache, weakness, body ache, chills) beginning the night of the vaccination and lasted for about 24 hours. This was followed by a weird stomach pain over the pancreas and gall bladder region, loss of appetite, and bad taste in the mouth for 1.5 days (separate adverse effect filed through the VAERS system). This pain is still present but very mild. The patient felt good for about a day and then on day 2-3 after vaccination, suddenly started having a strong left-sided headache in the middle of the night. The pain was surrounding the left eye region initially. Mild Nausea was also present. Never had a history of similar pain. This appears to be like sinusitis-related pain. Nasal congestion was present but minimal. Heart rate was also elevated for a day. However, the sinusitis has not resolved and appears to be gradually worsening. The patient never leaves the house or has had any close contact with any external person other than the pharmacist who provided the vaccine shot. The patient was double-masked (N95 + surgical mask) during the vaccination. Thoroughly applied alcohol sanitizer many times after leaving the store and hand washed and took a shower after reaching the home. The patient works from home and his spouse does not work. The patient''s son is in virtual school and the spouse also similar precautions and has no close contact with non-household members. Hence, the incidence most likely appears to be triggered by the vaccine booster, which I thought was important to report.


VAERS ID: 1888733 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-01
Onset:2021-11-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary mass, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (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: Covid arm
Other Medications: Levothyroxine, Micardis, Metoprol, Metformin, Xarelto, Dulcolace, Gabapentin, Benadryl, Vitamin C, Vitamin D, Senna, D-Mannose
Current Illness: UTI, Shingles,
Preexisting Conditions: Atrial Fibrillation, Hypothyroidism, Hypertension, pre-diabetes, Asthma
Allergies: Cipro, Ceclor, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen knot in arm pit receiving vaccination. Fever of 101.9


VAERS ID: 1888736 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Vital signs measurement
SMQs:

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

Write-up: My temperature goes to 38.5 degree.


VAERS ID: 1888738 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Vision blurred, Visual impairment
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Visual Changes/Disturbances-Mild, Additional Details: After patient went home, pharmacist contacted family and confirmed that the patient was doing fine and was no longer experiencing dizziness, blurred vision, and excessive sweating.


VAERS ID: 1888739 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic shock
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

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: Multivitamin
Current Illness:
Preexisting Conditions: Bradycardia
Allergies: Cats and pineapple
Diagnostic Lab Data: Epinephrine injection and medrol dose pack and Benadryl
CDC Split Type:

Write-up: Anaphylactic shock


VAERS ID: 1888746 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Chills, shaking, sweat, fever, tired, head ache


VAERS ID: 1888757 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 RA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1888759 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient has pas history of fainting during a blood draw years ago.


VAERS ID: 1888762 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (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: J&J covid felt flu like and headache for 48 hrs
Other Medications: Yaz,Tylenol, Advil PM
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node in arm pit Soar in arm pit Soar muscles


VAERS ID: 1888763 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Mild fatigue first 2 doses of Moderna
Other Medications: Sertraline, amitriptyline, losartin
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe fatigue, nausea, vomiting. Note: this was the booster 8 months after original 2 dose regimen. Only mild fatigue during first 2 doses. Much worse fatigue with booster and nausea and vomiting were not present during first 2 doses.


VAERS ID: 1888766 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 RA / SYR

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

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

Write-up: body aches fever chills headache 15 hours


VAERS ID: 1888767 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Memory impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out for about a minute four minutes after receiving the vaccine as she sat outside on a chair waiting for 15 minutes to elapse. Called 911. Before they came patient was awake and responding. Said she could not remember anything.. Left for home with dad who brought her in for vaccine.


VAERS ID: 1888769 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Lip haemorrhage, Oral contusion, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: pt was seated on the chair after receiving his shot after 2 minutes he fainted-and fell off his chair he was conscious on the floor. he suffered a scraped forehead and a bruised lip we treated those sites he was bleeding from both but not a lot aqnd we stopped the bleed. Target personnel came to the scene and reported it he did not want to go to the er he left with his sister and family after 30mins and said he felt fine he said he had done this before a few years ago after receiving a shot


VAERS ID: 1888777 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Injection site pain
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: first two injections of moderna vaccine - very tired for about 3 days after injection. Injection site tenderness for about 3 da
Other Medications: Meloxicam 15 mg 1 tablet daily Levothyroxine 75 mcg 1 tablet daily Simvastatin 10 mg 1 tablet nightly Vit. D3 2000 IU 1 capsule daily Glucosamine Chondroitin (glucosamine hyd. 1,500 mg, chondroitin sulfate 1,200 mg) 2 capsules daily Comple
Current Illness: none
Preexisting Conditions: hypothyroid high cholesterol chronic pain lower back, neck, hips
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: tenderness at injection site - 3 days, less each day very tired - through day 3 after injection brain fog - thus far, through day 3 after injection


VAERS ID: 1888779 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Pain
SMQs:

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

Write-up: body aches


VAERS ID: 1888789 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Aneurysm Autoimmune
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain Shortness of breath/ tightening of airway


VAERS ID: 1888794 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Burning sensation, Dizziness, Dysstasia, Hypoaesthesia, Migraine, Muscle spasms, Pain in extremity, Uterine spasm, Vaginal haemorrhage
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I woke up the following morning covered in blood. I am not on my period my period is not due for another 7 days. Vaginal bleeding confined for over the day until now it?s been 2 days of heavy bleeding. My legs are hurting almost feel like they are on fire. Cramping and numbness at times. My stomach and uterus are also cramping to the point I can?t stand straight. Dizziness and a terrible migraine


VAERS ID: 1888801 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Dysmenorrhoea, Injection site erythema, Injection site pruritus, Injection site swelling, Menstruation irregular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Irregular and heavy bleeding after second COVID vaccine dose
Other Medications: Progestin only mini pill (contraception, daily pill) Synthroid 137 mcg
Current Illness: N/a
Preexisting Conditions: Hashimoto?s thyroiditis
Allergies: Sulfa drugs, azithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Irregular menstrual bleeding. Period-like bleeding beginning on day 19 of cycle (2 days post booster administration) despite no history of breakthrough bleeding on current contraception. Had same issue after second Pfizer dose in April, which led to heavy bleeding and labor-like cramps. I also currently have redness, itchiness, and swelling at the injection site, which began yesterday, two days after I received the injection.


VAERS ID: 1888802 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1888812 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-14
Onset:2021-11-20
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Fully vaccinated employee tested positive for covid-19


VAERS ID: 1888818 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: cough and congestion Tested negative for covid
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: IV Benadryl
CDC Split Type:

Write-up: Rashes to bilateral upper arms and chest. Redness to both cheeks


VAERS ID: 1888830 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Lymphadenopathy, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (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: Miralax, dicyclomine, enbrel, methotrexate, losartan, vitamin c, vitamin d, turmeric, fish oil, garlic, zinc
Current Illness: NA
Preexisting Conditions: Rheumatoid arthritis, IBS, hypertension
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes under left arm, injection site pain, under arm pain, fatigue, headache, slight chills,.


VAERS ID: 1888843 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Rhinorrhoea
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to Amoxicillin
Diagnostic Lab Data: Nonce yet.
CDC Split Type:

Write-up: Within 1-2 hours after receiving the 1st dosage of Pfizer vaccine my child had a runny nose. It has now been 24hrs and he still has a non-stop runny nose and fever.


VAERS ID: 1888845 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: HPV in 2017
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid vaccine given at 1440 and symptoms of feeling like "going to pass out" stated by patient at 1450. Skin color pale and skin temperature warm. Lowered patient to the floor on yoga mat and elevated legs to chair. Blood pressure taken 90/42. Pink color to face and patient began talking and stated that she was feeling much better lying down. After a 5-10 minutes blood pressure taken and was 120/78. Assisted patient to sitting position and blood pressure taken again at 135/86. After 5-10 minutes blood pressure taken at 126/84. Assisted patient to standing and she waited until she felt steady on her feet. Walked patient to car and she stated that she was feeling steady . Instructed patient and mother to have second dose of Pfizer at her physician office where vaccine can be given while she is lying down. Patient and mother verbalized understanding.


VAERS ID: 1888849 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast swelling, Diarrhoea, Dizziness, Nausea, Pain, Peripheral swelling, Tenderness, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline, yaz, Nurtec, Zyrtec, Lexapro, Wellbutrin, benedryl
Current Illness: Sinus infection
Preexisting Conditions: Migraines, allergies, endometriosis
Allergies: Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Significant swelling under arm in armpit area and into the distal of the right breast with pain/tenderness; severe nausea and dizziness, some vomiting and diarrhea


VAERS ID: 1888852 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939908 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Condition aggravated, Fatigue, Headache, Myalgia, Nausea, Somnolence, Thirst
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament 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: Fatigue; Chills; Muscle ache 72 03/15/21 Moderna, Lot 036A21A
Other Medications: Atorvastatin 20mg; Amlodipine Besylate 10mg
Current Illness:
Preexisting Conditions: Hypertension
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle & joint aches; short-lived very mild headache; mild chills; fatigue; thirst; strong sleepiness, very mild nausea;


VAERS ID: 1888873 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Pain, Supraclavicular fossa pain
SMQs:, Retroperitoneal fibrosis (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:
Allergies: Ceclor
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Sharp pain in the right supraclavicular area radiating to the back (suprascapular) area. Seems to be temporarily controlled with a combination of acetaminophen and ibuprofen but resumes after the medication wears off.


VAERS ID: 1888892 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN ALARIO CENTER / 1 RA / SC

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Pain in extremity, Pyrexia, Tinnitus
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (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: Flu vaccine two separate times
Other Medications: LavoThyroxine Sertraline Xanax Vitamin D Folic acid
Current Illness:
Preexisting Conditions: Hashimoto''s Idiopathic optic neuritis
Allergies: Iodine Gluten Menthol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme Tinnitus, nausea, headache and fever over 100 for extended period of time currently at 14 hours. Also mild arm pain and extreme fatigue.


VAERS ID: 1888914 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Fatigue, Headache, Heart rate decreased, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart rate slowed and arrhythmic, numbness in the chest area followed by headache and fatigued.


VAERS ID: 1888934 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Pain in extremity, Product administered at inappropriate site
SMQs:, Drug abuse and dependence (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: PATIENT MOVED WHILE PROVIDING IMMUNIZATION RESULTING IN VACCINE GIVEN HIGHER UP IN DELTOID THAN RECOMMENDED. PATIENT REPORTED HER ARM FEELING SORE IMMEDIATELY AFTER. NO OTHER ADVERSE EFFECTS REPORTED. RECOMMENDED OTC PAIN RELIEF AND SYMPTOMS SHOULD SELF RESOLVE IN A COUPLE OF DAYS. DISCUSSED SIRVA ALTHOUGH UNLIKELY TO OCCUR.


VAERS ID: 1888951 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 RA / SYR

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1888966 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Mom called to report a rash about 48 hours post vaccination with Pfizer COVID vaccine. Reported that patient received the IMZ in left deltoid at about 6pm Thursday 11/18/21. At about 10pm Saturday 11/20/21 patient showed her a rash on her RIGHT arm and RIGHT leg. Described as red dots in a line from shoulder to elbow and hip to knee. Overnight a few more had appeared in each area. Each compromised of 10-12 "dots". Mom denies any report of itching, burning, erythema, involvement of the chest, jaw, lips or tongue or difficulty breathing. Recommended monitoring, diphenhydramine for worsening localized reaction and inform doctor in morning


VAERS ID: 1888975 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: no allergies on file
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient received 2nd Pfizer vaccination 11/20/21 and called pharmacy 11/21/21 to complain of adverse reaction("itching from head to toe"). Patient informed me that the reaction also happened after the 1st dose on 10/26/21 and the itching has never stopped. She did not report the adverse reaction until 11/21/21. I asked if she was having difficulty breathing and she she no. I recommended benadryl every 6 hours and she said she has been taking benadryl since the 1st vaccination. I told her to call her primary care physician.


VAERS ID: 1888986 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 5 LA / IM

Administered by: Private       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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: AMPICILLIN, TETRACYLINE
Diagnostic Lab Data: Patient was monitored for 20 min. following administration of vaccine. No side effects were observed.
CDC Split Type:

Write-up: No adverse reaction observed. Patient signed off on consent forms for Pfizer booster. She did not have her vaccination card, so opened her profile. 2 doses of Pfizer visible from Jan and Feb 2021. Showed patient her profile and she confirmed that it was her. MA also verbally confirmed that she was about to administer a Pfizer booster, to which the patient verbally consented. Patient in reality has 3 profiles, apparent only after the event when charting. (Charting in EHR had to be done after as this was an outdoor vaccination event). Patient had received 3 Pfizer and 1 Moderna vaccine prior to 11/20/2021.


VAERS ID: 1888987 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1888997 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Asthenia, Chills, Feeling cold, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega-3 supplements, Multivitamins, Milk Thistle supplements.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Slightly gluten intolerant.
Diagnostic Lab Data: None yet.
CDC Split Type:

Write-up: I received my second shot of the BioNTech, Pfizer COVID-19 vaccine on November 19th, 2021. Initially, did not have any symptoms other than soreness in the area where the injection was administered and I felt fine. But that night I woke up with a burning fever (102.2), my whole body was aching to the point where even the pores in my skin were hurting; despite the high fever, I felt terribly cold and shivery. I took one Tylenol and tried to go back to bed. By 10-11 am the next morning, my temperature had gone down to 101 but I still felt incredibly weak and cold, could barely mange to lift the frying pan or pour water out of the jug. I took another Tylenol around noon on November 20 with food. Couldn''t taste the food either so it was hard to eat. Took more Tylenol at 6-8 hour intervals and by Sunday afternoon (today), my temperature returned to normal. Still feeling horribly weak and achey.


VAERS ID: 1888998 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Heart rate increased, Hyperhidrosis, Throat irritation
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Seasonal allergies
Allergies: Unknown- listed as yes on immunization statement
Diagnostic Lab Data: Patient taken to hospital for observation and antihistamine.
CDC Split Type:

Write-up: About 10 minutes after administration, patient said he had a scratchy throat. It was not that way prior to administration. No difficulty breathing. I gave him water and asked him to sit for an additional 15 minutes. I explained that typical allergic reactions occur within 15-30 minutes. Patient then said his heart started raising and he did not feel good. He also started sweating and got chills. At that time he agreed to have EMS called.


VAERS ID: 1889001 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: similar, but less severe reaction to flue vaccine a couple of years ago
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe swelling around vaccine injection, severe pain


VAERS ID: 1889013 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-01
Onset:2021-11-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site nodule, Menstruation irregular, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Fertility 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: Anthrax
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm swelling and ?knot? at injection site. Period began 7 days earlier than usual.


VAERS ID: 1889019 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Hypertension, Malaise
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Armour thyroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood pressure has gotten much higher then normal. 150/101 and normally it runs 117/75. I haven''t felt well since I got my booster.


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