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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 517 out of 10,317

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VAERS ID: 1938387 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-11-20
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Off label use, Overdose
SMQs:, Drug abuse and dependence (broad), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211220764

Write-up: RECEIVED 2.5ML OF THE JANSSEN COVID-19 VACCINE; OFF LABEL USE; This spontaneous report received from a health care professional concerned a 31 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1822809, and expiry: 07-MAR-2022) 2.5 ml, administered on 20-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 20-NOV-2021, the patient experienced received 2.5ml of the janssen covid-19 vaccine. On 20-NOV-2021, the patient experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the received 2.5ml of the janssen covid-19 vaccine and off label use was not reported. This report was non-serious.


VAERS ID: 1938670 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eating disorder, Hunger, Immunisation, Influenza like illness, Lethargy, Migraine, Pain, Tinnitus, Vaccination site pain
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DIAZEPAM; LISDEXAMFETAMINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: ADHD; Autism; Blood pressure high; Depression; Generalized anxiety disorder; Penicillin allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101627977

Write-up: dose_number=3; Extreme soreness at injection site; Extreme lethargy approximately 24 hour later; Severe migraine; Noticeable tinnitus; Hunger without ability to actually eat food without feeling sick; Hunger without ability to actually eat food without feeling sick; Overall body aches and soreness; feeling like I have the Flu; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 31 year-old male patient received bnt162b2 (BNT162B2), administered in arm left, administration date 19Nov2021 14:00 (Batch/Lot number: unknown) at the age of 31 years as dose 3 (booster), single for covid-19 immunisation. Relevant medical history included: "Autism" (unspecified if ongoing); "ADHD" (unspecified if ongoing); "GAD" (unspecified if ongoing); "Major Depression type" (unspecified if ongoing); "high blood pressure" (unspecified if ongoing); "known_allergies Penicillin" (unspecified if ongoing). Concomitant medication(s) included: DIAZEPAM; LISDEXAMFETAMINE. Vaccination history included: Bnt162b2 (Dose Number: 2, Batch/Lot No: ER8731, Location of injection: Arm Left, Vaccine Administration Time: 02:00 PM), administration date: 29Apr2021, when the patient was 31 years old, for Covid-19 immunization; Bnt162b2 (Dose Number: 1, Batch/Lot No: EW0185, Location of injection: Arm Left, Vaccine Administration Time: 02:00 PM), administration date: 07Apr2021, when the patient was 31 years old, for Covid-19 immunization. The following information was reported: VACCINATION SITE PAIN (non-serious) with onset 20Nov2021 10:00, outcome "recovering", described as "Extreme soreness at injection site"; LETHARGY (non-serious) with onset 20Nov2021 10:00, outcome "recovered", described as "Extreme lethargy approximately 24 hour later"; MIGRAINE (non-serious) with onset 20Nov2021 10:00, outcome "recovered", described as "Severe migraine"; TINNITUS (non-serious) with onset 20Nov2021 10:00, outcome "recovered", described as "Noticeable tinnitus"; HUNGER (non-serious), EATING DISORDER (non-serious) all with onset 20Nov2021 10:00, outcome "recovered" and all described as "Hunger without ability to actually eat food without feeling sick"; PAIN (non-serious) with onset 20Nov2021 10:00, outcome "recovered", described as "Overall body aches and soreness"; INFLUENZA LIKE ILLNESS (non-serious) with onset 20Nov2021 10:00, outcome "recovered", described as "feeling like I have the Flu"; IMMUNISATION (non-serious), outcome "unknown", described as "dose_number=3". Therapeutic measures were not taken as a result of vaccination site pain, lethargy, migraine, tinnitus, hunger, eating disorder, pain, influenza like illness. Additional Information: Facility where the most recent COVID-19 vaccine was administered was at Pharmacy or Drug Store. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Hospitalization was not Prolonged. Prior to vaccination the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 1938694 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Chills, Immunisation, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101640288

Write-up: Chills; Fever; sore arm; generalized bone pain; Booster; This is a spontaneous report received from a contactable reporter(s) (Other HCP). The reporter is the patient. A patient (no qualifiers provided) received bnt162b2 (BNT162B2), administered in arm left, administration date 20Nov2021 (Lot number: FG3527) as dose 3 (booster), single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: IMMUNISATION (non-serious) with onset 20Nov2021, outcome "unknown", described as "Booster"; CHILLS (non-serious) with onset 21Nov2021, outcome "recovering", described as "Chills"; PYREXIA (non-serious) with onset 21Nov2021, outcome "recovering", described as "Fever"; PAIN IN EXTREMITY (non-serious) with onset 21Nov2021, outcome "recovering", described as "sore arm"; BONE PAIN (non-serious) with onset 21Nov2021, outcome "recovering", described as "generalized bone pain". Therapeutic measures were taken as a result of chills, pyrexia, pain in extremity, bone pain. Additional information: Treatment was given as Theraflu and Tylenol. Upon follow-up on 23Nov2021: This is a follow-up spontaneous report received in response to the mail trail sent regarding the confirmation of below mentioned query. The response included Thanks for reporting to safety. There were two queries about the report are the patient withheld (myself), RN provided on the reporter email. But as per reporter email address, it seems that not consistent with initials CPD. Please help us to provide correct name of patient. And then start of AE Sunday Nov21 was provided the in reporter email. This adverse event start date, which was not always equal to the awareness date. The awareness date was reporter as 21Nov2021 for the adverse events. It was reported as Pfizer US Drug safety unit recently received the attached report submitted by reporter via withheld. This awareness date where reporter became aware of the occurrence of the reported events. If reporter were the patient in the case, the awareness date would be that reporter became aware were experiencing the reported events. This awareness date represents that Pfizer receipt date of the report and reflects the earliest date that any Pfizer colleague learned of the adverse event. It was reported that do not consent further FU. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1938774 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood pressure measurement, Chest pain, Headache, Hypertension, Hypoaesthesia, Immunisation, Pain, Tinnitus, Ulcer, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal ulceration (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), 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: LISINOPRIL; MULTIVITAMINS [VITAMINS NOS]; NYQUIL; TYLENOL; MAGNESIUM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Fibromyalgia; Heart murmur; Hypertension; Penicillin allergy; Rheumatoid arthritis; Syndrome Sjogren''s; Ulcer
Allergies:
Diagnostic Lab Data: Test Name: Blood pressure; Result Unstructured Data: Test Result:180/110 to 140/90
CDC Split Type: USPFIZER INC202101705069

Write-up: This is a spontaneous report received from contactable reporter(s) (Consumer or other non-HCP). The reporter is the patient. A 70-year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 20Nov2021 17:00 (Lot number: 33030BD) at the age of 70 years as dose 3 (booster), single for covid-19 immunization. Patients'' medical history included rheumatoid arthritis, fibromyalgia, shrogen''s syndrome, hypertension, heart murmur, ulcer, known allergies: Penicillin from an unknown date and unknown if ongoing. Concomitant medication(s) included: lisinopril; multivitamins, Nyquil, Tylenol, magnesium. past drug history included: morphine, reaction(s) include known allergies: morphine, Demerol, reaction(s): known allergies: Demerol, tramadol, reaction(s): known allergies: tramadol, stadol, reaction(s): known allergies: stadol. Patient previously received Bnt162b2 (COVID 19, Pfizer, lot number=EW0167, location=Left arm), on 21Mar2021, at 12:00 am, when the patient was 74 years old, as DOSE 1 SINGLE, for COVID-19 immunization and Bnt162b2 (COVID 19 immunization, Pfizer, lot number=EW0167, location=Left arm) as DOSE 2, SINGLE, on 29Apr2021 at 12:00 am, when the patient was 70 years old, for Covid-19 immunization. On 20Nov2021patient experienced dose number: 3, On 20Nov2021 12:00 Persistent hypertension even with Lisinopril. Was taking 15mg OD (had weaned down over past year from 30mg BID) Had to go back to 30mg BID. Still ranging from 180/110 to 140/90, PVC''s chest pain, left arm numbness with tinnitus, left arm numbness with tinnitus, headache, Aggravated ulcer with abdominal pain, vomiting, Multiple joints and muscles painful, Aggravated ulcer with abdominal pain. Patient underwent lab tests and procedures which include blood pressure measurement 180/110 to 140/90 on an unspecified date. Therapeutic measures were not taken as a result of hypertension, chest pain, hypoesthesia, tinnitus, headache, abdominal pain, vomiting, pain. The outcome of events was not recovered. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1938872 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-11-20
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Off label use, Overdose
SMQs:, Drug abuse and dependence (broad), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211219926

Write-up: RECEIVED 2.5 ML OF VACCINE; OFF LABEL USE; This spontaneous report received from a health care professional concerned a 63 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1822809, and expiry: 07-MAR-2022) dose was not reported, administered on 20-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 20-NOV-2021, the patient experienced received 2.5 ml of vaccine. On 20-NOV-2021, the patient experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the received 2.5 ml of vaccine and off label use was not reported. This report was non-serious. This case, from the same reporter is linked to 20211219871, 20211220129, 20211220916, 20211220152, 20211219681, 20211219953, 20211220145, 20211220155, 20211165041, 20211200723, 20211200752, 20211200769, 20211201046, 20211201228, 20211201963, 20211202199, 20211202193, 20211202161, 20211201963, 20211201450, 20211201443, 20211201392, 20211201351, 20211201304, 20211201286, 20211201179, 20211220697 and 20211220928.


VAERS ID: 1938876 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-11-20
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Off label use, Overdose
SMQs:, Drug abuse and dependence (broad), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211220619

Write-up: RECEIVED 2.5 ML OF THE VACCINE; OFF LABEL USE; This spontaneous report received from a health care professional concerned a 51 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1822809, expiry: 07-MAR-2022) 2.5 ml, administered on 20-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 20-NOV-2021, the patient experienced received 2.5 ml of the vaccine. On 20-NOV-2021, the patient experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the received 2.5 ml of the vaccine and off label use was not reported. This report was non-serious. This case, from the same reporter is linked to 20211220146, 20211219681, 20211219953, 20211220152, 20211220152, 20211200723, 20211200752, 20211200769, 20211201046, 20211201228, 20211201963, 20211202193, 20211202207, 20211202246, 20211202250, 20211202371, 20211165041, 20211200675, 20211200717, 20211200723, 20211201082, 20211200994, 20211201168, 20211201179, 20211201286, 20211219871, 20211220527, 20211220697 and 20211220928.


VAERS ID: 1938897 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Contusion, Eye contusion, Eye swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: AMBIEN.
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: bruising on abdomen; bump above left eyebrow; left eye was completely black and swollen shut, closed over like angioedema; left eye was completely black and swollen shut, closed over like angioedema; This spontaneous case was reported by a pharmacist and describes the occurrence of EYE CONTUSION (left eye was completely black and swollen shut, closed over like angioedema), SWELLING FACE (bump above left eyebrow), CONTUSION (bruising on abdomen) and EYE SWELLING (left eye was completely black and swollen shut, closed over like angioedema) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Co-suspect product included non-company product DIPHTHERIA VACCINE TOXOID, PERTUSSIS VACCINE ACELLULAR, TETANUS VACCINE TOXOID (TDAP) for an unknown indication. No medical history was provided by the reporter. Concomitant products included ZOLPIDEM TARTRATE (AMBIEN) for an unknown indication. On 19-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form and dose of DIPHTHERIA VACCINE TOXOID, PERTUSSIS VACCINE ACELLULAR, TETANUS VACCINE TOXOID (TDAP) (unknown route) 1 dosage form. On 20-Nov-2021, the patient experienced EYE CONTUSION (left eye was completely black and swollen shut, closed over like angioedema) and EYE SWELLING (left eye was completely black and swollen shut, closed over like angioedema). On 20-Nov-2021 at 2:00 AM, the patient experienced SWELLING FACE (bump above left eyebrow). On an unknown date, the patient experienced CONTUSION (bruising on abdomen). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) for Adverse event, at an unspecified dose and frequency. At the time of the report, EYE CONTUSION (left eye was completely black and swollen shut, closed over like angioedema), SWELLING FACE (bump above left eyebrow), CONTUSION (bruising on abdomen) and EYE SWELLING (left eye was completely black and swollen shut, closed over like angioedema) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient saw PCP doctor who ruled out angioedema. Gets monoclonal antibodies and suspects clotting or bleeding issue for bruising of abdomen. Patient was instructed to do cold compress and Tylenol. Patient was told this is impact injury.


VAERS ID: 1939385 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1939435 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1939524 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Contusion, Disorientation, Disturbance in attention, Pain of skin
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: The next morning patient experienced chest pain and noticed bruising on left knee and left arm. She had pain on her scalp and reports feeling disoriented and had difficulty concentrating for 2 days. The pain resolved after 3 days, the bruising slowly resolved after a week


VAERS ID: 1939545 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1939555 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1939572 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1939769 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1939832 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Blood test normal, Computerised tomogram head normal, Feeling abnormal, Headache, Hemiparesis, Hypoaesthesia, Magnetic resonance imaging head normal, Muscular weakness, Nausea, Ultrasound Doppler normal, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Centrum silver for women, Vitamin C, Vitamin D3, Fibercon, Iron
Current Illness: None
Preexisting Conditions: Scoliosis, spinal stenosis, arthritis in neck
Allergies: None
Diagnostic Lab Data: My primary care provider instructed me to go the the ER to be evaluated (so imaging could be done). I entered the Hospital emergency room on November 29, 2021. The following tests were run: multiple blood tests, CT scan of my head, MRI of my head and upon outpatient followup, I had an ultrasound of my carotid artery. All these tests were to rule out a TIA/stroke. The testing did not reveal a TIA or stroke. I have now been referred to a neurologist, but I won''t be able to get an appointment until March 2022.
CDC Split Type:

Write-up: After the Pfizer Covid-19 booster shot (administered November 19, 2021), I experienced a severe headache in the left rear of my head (including behind the ear), an increasing unbalanced/foggy feeling and vision impairment. These symptoms began November 20, 2021 and are increasing in severity, and new symptoms are occurring. On November 25, 2021, my headache was so severe that I became nauseated and had to lie down to try to alleviate the pain. I am currently experiencing the following increasing symptoms: headache, vision issues, imbalance, feeling like I''m "in a fog" and weakness/numbness in my left arm and leg.


VAERS ID: 1939836 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the agency, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1940035 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-07
Onset:2021-11-20
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anticoagulant therapy, Limb discomfort, Peripheral swelling, Pulmonary thrombosis, Thrombosis, Vena cava filter insertion
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clots in left leg from ankle to groin and smaller clots in both lungs. Intravenous filter installed before heart and placed on permanent blood thinners. Only symptoms related were some slight discomfort and swelling in the left leg.


VAERS ID: 1940096 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol HFA, Azelastine NS, celecoxib, finasteride, omeprazole, eliquis, gabapentin, potassium citrate,
Current Illness:
Preexisting Conditions: Diabetes (managed by lifestyle), prostate, esophageal, hx blood clots
Allergies: None
Diagnostic Lab Data: None yet, but advised pt to follow-up with primary care provider
CDC Split Type:

Write-up: Pt had arm pain since injection, pt states pain isn''t as constant but still has significant pain with any pressure on the arm - ie if he bumps it, also can''t sleep on that arm. Advised pt to follow-up with his primary care provider.


VAERS ID: 1940117 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: Widespread Hives, no oral Swelling or Shortness of breath


VAERS ID: 1940240 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN Z11DZIA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Headache, Influenza like illness, Limb discomfort, Myalgia, Platelet count increased, Respiratory tract irritation, Sinus congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: I had a lab test for yearly checkup shortly after booster and platelets were high
CDC Split Type:

Write-up: Various thru 3 weeks: flu like, headache, muscle pain, lung irritation, head congestion, . Recently slight pressure in calf and thigh, shortness of breath, pressure (slight) in calf and thigh tiredness


VAERS ID: 1940303 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-12
Onset:2021-11-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glutathione and vitamin C
Current Illness: None
Preexisting Conditions: history of allergy to gluten and corn.
Allergies: Corn and gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Significant angioedema over facial area. No chest pain, SOB, wheezing. Treated with prednisone (20mg) for 3-5 days.


VAERS ID: 1940697 (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: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was 12 years old and given Pfizer 5 to 11Year old vaccine.


VAERS ID: 1940723 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-19
Onset:2021-11-20
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Blood glucose increased, COVID-19, Condition aggravated, Coronary artery disease, Glycosylated haemoglobin increased, Impaired work ability, Pyrexia, Type 2 diabetes mellitus
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Other ischaemic heart disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Atorvastatin, Fenofibrate, Insulin Glargine, Insulin Lispro, Creon, LIsinopril, Metoprolol Succinate XL, Fish Oil, Sildenafil, Spironolactone, Metformin
Current Illness:
Preexisting Conditions: h/o DM2 on insulin (A1C 11.8% 05/2021; A1C 6.0 10/2018), CAD/STEMI s/p PCI, gallstone pancreatitis, HTN, HLD, gout,
Allergies: PCN class
Diagnostic Lab Data:
CDC Split Type:

Write-up: ADMISSION DATE: 11/20/2021 DISCHARGE DATE: 11/25/2021 SERVICE: Internal Medicine ATTENDING PHYSICIAN: PRINCIPAL ADMISSION DIAGNOSIS: AHRF due to COVID-19 infection DISCHARGE DIAGNOSES: Active Hospital Problems Diagnosis ? (Principal) ACUTE HYPOXEMIC RESPIRATORY FAILURE ? DM 2 ? CORONAVIRUS COVID-19 DISEASE ? CAD, PRESENCE OF STENT Resolved Hospital Problems No resolved problems to display. ISSUES TO BE ADDRESSED AT FOLLOW UP: 1) COVID infection - 50 y/o M patient was admitted pn 11/20/21 due to COVID infection causing AHRF, and required 3 days on HFNC supplemental oxygen support. On HD4 patient was weaned off HFNC and did well on RA, with oxygen saturation 95-97% on day of discharge. Patient did not develop a cough or other bothersome symptoms. Please ensure complete resolution of symptoms and any follow up support patient requires. Per current CDC guidelines, patient should self-isolate for a total of 20 days from the last time was febrile, which was on admission to the hospital on 11/20/21. Thus, patient should self-isolate through 12/12/21. Patient instructed to wear a mask when outside of house and keep 6 feet of distance between himself and other individuals. A work note was provided stating patient should remain off work through 12/13/21. If patient is still not feeling fully recovered as that date approaches they are encouraged to contact their PCP for an extension of the time off from work. 2) Insulin dependent diabetes management - patient presented with blood glucose in the 300-400 range. Last A1C 11.8%, up from 6.0 in 2018. Patient''s insulin regimen was adjusted for improved glycemic control. By discharge blood glucose levels were in the 100-200 range. Please follow up on new diabetes regimen and titrate medications as needed. Referral to Diabetes Care Manager placed.


VAERS ID: 1941621 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Loss of personal independence in daily activities, Mobility decreased
SMQs:, Dementia (broad), Parkinson-like events (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: Multi vitamin, omega 3, collagen, vitamin D, calcium
Current Illness: None
Preexisting Conditions: None
Allergies: Shellfish
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Three weeks following the vaccine I continue to have shoulder pain, limited range of motion, and my level of physical activity has been hindered by the pain.


VAERS ID: 1941870 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Discomfort, Hyperhidrosis, Immunisation, Renal disorder, Renal pain
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211120; Test Name: temperature; Result Unstructured Data: Test Result:no temperature
CDC Split Type: USPFIZER INC202101647128

Write-up: left kidney was hurting her; she woke up sweating; intermittent back and forth throbbing discomfort from her kidneys; Pfizer booster shot; discomforting; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A female patient received bnt162b2 (BNT162B2), administration date 20Nov2021 12:30 (Batch/Lot number: unknown) as dose number unknown (booster), single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Johnson and johnson vaccine, administration date: 02Apr2021, for COVID-19 immunization, reaction(s): "fatigued", "had a sore arm for a day or two". The following information was reported: IMMUNISATION (non-serious) with onset 20Nov2021, outcome "unknown", described as "Pfizer booster shot"; RENAL DISORDER (non-serious) with onset 21Nov2021, outcome "unknown", described as "intermittent back and forth throbbing discomfort from her kidneys"; HYPERHIDROSIS (non-serious) with onset 21Nov2021 01:00, outcome "unknown", described as "she woke up sweating"; DISCOMFORT (non-serious) with onset 2021, outcome "not recovered", described as "discomforting"; RENAL PAIN (non-serious) with onset 22Nov2021, outcome "not recovered", described as "left kidney was hurting her". Relevant laboratory tests and procedures are available in the appropriate section. Additional information: The caller stated that she got the Pfizer booster shot on Saturday morning. The caller received her Johnson and Johnson vaccine on 02Apr2021. She had no problems besides that it laid her up for the day. She was fatigued and had a sore arm for a day or two. The caller really truly thought the booster dose would have the same effects. The caller explained that she did her research and she chose the Pfizer shot over the Moderna because with the Pfizer shot, she didn''t see any adverse reactions other than chills, fever. She got the booster right around 12:30 in the afternoon on Saturday. On 1:00 am Sunday, she woke up sweating and experiencing all the things you could imagine. She took her temperature and oddly enough, she had no temperature. She thought okay, this was a side effect, this was to be expected and not a concern. She became concerned when she woke up the next morning and her left kidney was hurting her and it''s still hurting her. She didn''t even know that was her kidney, but her sister was a nurse, and told her that was her kidney. The pain the caller was talking about was very unique. It felt like somebody was squeezing the inside and then releases it, which stops the pain for a second, and then it did it again. The caller clarified it''s like a throbbing pain that started with the left kidney and shifted over to the right kidney yesterday which kind of limited the pain to her left kidney. It''s either that, or the pain in the right kidney superseded the pain in her left kidney. Today, the pain in her right kidney subsided and she was having pain in her left kidney again. It''s intermittent, back and forth, throbbing discomfort from her kidneys. It felt like a back injury but its not. The caller mentioned that she was retired private investigator and she sold her firm and moved back to the area. Her health insurance did not kick in until next month and she was concerned about what''s going on with her health and she wanted to know if Pfizer would allow her to seek a medical professional. The caller didn''t know someone from CDC contacts them but she had someone from the CDC contact her. There also was a blog she jumped on yesterday and reported what she experienced to see if anyone else experienced the same thing and a journalist from privacy contacted her. She was very pro-vaccination obviously and wanted to do the right thing, so she wanted to know if Pfizer would tell what was going on before she got in contact with the journalist. The caller asked the call handler, as a nurse, should she be concerned about that. It''s definitely discomforting and not going away. The caller asked the call handler if she could be a liaison to convey that she wanted Pfizer to make an arrangement with a healthcare professional from Pfizer that she could go see. The caller asks if she talked to somebody in Medical Information, would they be assisting scheduling an appointment. She did not want to complete a report. She did not want to talk about product safety. She wanted to know if she did take the time out of work to talk to someone, would it be a beneficial conversation or would they talk about side effects like fatigue, which she already knows all of that. She wanted to know if anything had happened to the kidney after receiving the Pfizer vaccine. The caller stated that she did not have any health insurance and she would assume since it''s Pfizer''s vaccine and a presumed side effect from the vaccine, Pfizer could have a medical professional look at her and assess her to test her kidneys. She stated that if Pfizer did not want to do that which it seemed that was the case, there were other routes she could take. She would think Pfizer would want to figure out side effects for women in their 50''s. The caller requested to a follow-up call. She declined to transfer from Medical Information, she did not want an explanation of side effects like fatigue or fever. It did not seem medical information could answer questions related to kidneys that benefits her. She declined to complete a report stating she did not appreciate Pfizer and it seems Pfizer did not care at all. She might reach back out to the journalist who contacted her because she felt this was not going anywhere and might be this needed to be brought to light in the public. She stated that its unfortunate. She was a very big proponent of vaccinations and she wanted to work with Pfizer but all Pfizer wanted was to take her information for statistical purposes, which she understood. She used to work for the privacy, but she would feel since it is Pfizer''s vaccine they would provide a medical provider. She did not have health insurance and was very upset. She hoped that her information was clearly conveyed and someone could call her back in a higher position. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 1941913 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation, Pruritus, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101683842

Write-up: Hives/rash; Hives/rash; extreme itching, appearing on different locations of the body.; booster; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 62 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 20Nov2021 14:15 (Batch/Lot number: unknown) at the age of 62 years as dose 3 (booster), single for covid-19 immunisation; influenza vaccine (FLU VACCINE VII), administered in arm right, administration date 20Nov2021 (Batch/Lot number: unknown) as dose 3, single. Relevant medical history included: "known allergies: Sulfa drugs" (unspecified if ongoing). There were no concomitant medications. Vaccination history included: Bnt162b2 (Dose Number: 1, unknown lot number, 04:30 PM, administered on the left arm), administration date: 18Apr2021, when the patient was 61 years old, for Covid-19 immunization; Bnt162b2 (Dose Number: 2, unknown lot number, 04:30 PM, administered on the left arm), administration date: 09May2021, when the patient was 61 years old, for Covid-19 immunization. The following information was reported: IMMUNISATION (non-serious) with onset 20Nov2021 14:15, outcome "unknown", described as "booster"; URTICARIA (non-serious), RASH (non-serious) all with onset 27Nov2021, outcome "unknown" and all described as "Hives/rash"; PRURITUS (non-serious) with onset 27Nov2021, outcome "unknown", described as "extreme itching, appearing on different locations of the body.". Therapeutic measures were taken as a result of urticaria, rash, pruritus. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 1942138 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Pharmacy       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: Unknown
Current Illness: No known health conditions
Preexisting Conditions: No known health conditions
Allergies: No known allergies on file.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: The patient was brought in for their second dose in the COVID 19 dosing series. It was noted by one of my technicians that their vaccination record card listed that the patient received the 5-11 preparation. The vaccine administration record form was double checked and confirmed that the dosing information written on the form was for the 5-11 preparation. The parent was informed of the error. Based on the CDC Administration Errors Revaccination Guidance document (from 12/01/2021), the recommendation not to revaccinate was made. There were no adverse reactions reported from the dose on 11/20/2021. The patient received the age appropriate second dose today.


VAERS ID: 1942400 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-12
Onset:2021-11-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chest discomfort, Chills, Contusion, Dehydration, Dyspnoea, Fatigue, Headache, Hypoaesthesia, Hypophagia, Impaired work ability, Loss of consciousness, Myalgia, Nausea, Oxygen saturation decreased, Pain, Peripheral swelling, Presyncope, Sinus congestion, Skin discolouration, Sleep disorder, Urticaria, Vasculitis
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Arthritis (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo Loestrin Fe (birth control) B12 supplement Elderberry supplement
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8 days post injection (November20th) I started having hives on the back of my neck and shoulders. It worsened overnight and I went to urgent care the following evening. They gave me an injection of Benadryl only as they were afraid a steroid shot would interfere with the vaccine. My symptoms continued to worsen over the next 24 hours--the pain was so bad I couldn''t sleep and hives were covering my entire body. On the morning of November 23rd, I was feeling extremely weak, nauseous and in a lot of pain. My hives were also starting to turn purple. I went back to urgent care and they said I needed an ambulance. I was taken to emergency room and was treated with IV steriods, Zofran, Benadryl and fluids as I was dehydrated. Once my vitals stabilized and the pain was under control, I was discharged. The doctor told me to follow up with a dermatologist the following week if I still had hives as he suspected I could have vasculitis. He cleared me to travel to be with family for the holiday as long as someone else drove me and as long as we mapped out hospitals along the way. He said he''d prefer that I have "eyes on me" all the time versus staying alone. He also prescribed Prednisone, Zyrtec, and Rx strength Prevacid. My cousin drove us to another city that night. Once the meds started to wear off, the pain came back and I only slept about 2-3 hours. I felt extremely weak that morning, with uncontrollable chills, lots of pain and I almost passed out. Once the Prednisone kicked in, I was able to tolerate the car ride with ice packs for the pain. I also have lots of bruising on my legs, along with hives. I''m miserable again that night, covered in hives, and only sleep about 3 hours. November 25: I was in extreme pain in the morning and almost passed out 2 times (vision went black). I was extremely weak and was also having joint and muscle pain. My sinuses were also completely blocked and my chest feels tighter as the day goes on. I could barely eat and if I didn''t keep my feet elevated (due to swelling) they''d go numb. My stepsister (a nurse practitioner) suggests I monitor my O2 sats due to my chest feeling tight. 2 days later I end up back in the ER b/c my O2 sats dropped to 87. I am prescribed more antihistamines and I start using an inhaler. A month after the booster shot I am still dealing with hives, extreme fatigue/weakness, shortness of breath and headaches. I missed 2 weeks of work and it has been extremely difficult to do my job, which is very physical.


VAERS ID: 1942647 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-09
Onset:2021-11-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 - / UN

Administered by: Other       Purchased by: ?
Symptoms: Demyelination, Magnetic resonance imaging head abnormal, Neurological symptom
SMQs:, Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI cetirizine
Current Illness: None
Preexisting Conditions: obesity seasonal allergies
Allergies: cephalexin penicillins
Diagnostic Lab Data: MRI of the brain
CDC Split Type:

Write-up: Patient presented 12/4/21 with new onset of multiple neurologic complaints; concerning for MS. Symptoms had started about 2 weeks before presentation. That was about 11 days post vaccination. Previously healthy patient with no prior neurologic complaints. MRI on 12/11/21 consistent with demyelinating disease


VAERS ID: 1943434 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-11-20
   Days after vaccination:262
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Angiogram pulmonary abnormal, Atelectasis, Brain natriuretic peptide normal, COVID-19, Chest X-ray abnormal, Chills, Cough, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Fibrin D dimer increased, Hypotension, Lung opacity, Pleural effusion, Procalcitonin, SARS-CoV-2 test positive, Sinus arrhythmia, Sinus rhythm, Troponin, Urinary tract infection, Ventricular extrasystoles, Wheezing, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (2.5 MG/3ML) 0.083% INHAL Nebu Soln inhale 3 mL using breathing machine every 4 hours as needed for FOR SHORTNESS OF BREATH. Unknown Unknown time Med Note (Wed Nov 10, 2021 2:17 AM) Start date 11/9/21 (qyt, day supply unava
Current Illness: Hypertension ? Hypothyroidism ? Patient denies medical proble
Preexisting Conditions: Hypertension ? Hypothyroidism ? Patient denies medical proble
Allergies: none
Diagnostic Lab Data: This a 89y.o. male is well known to me and we recently received a message from the facility that was coming into the ER and that he was increasingly SOB. His history of HTN, hypothyroidism, CAD, NSTEMI is a concern and his BP and nutritional status is a concern. Per chart review, he was hospitalized from 11/9/21-11/12/21 for AKI and UTI. He was discharged home with home care. He has been on 4 L home O2 since a hospitalization in October. He has family members that recently tested positive for COVID. He states that he has felt SOB ever since his hospitalization in October, so he is unsure when his current symptoms started. He admits to a nonproductive cough, wheezing, and SOB. He states that he has chills currently and has rigors on exam but has not had fever or chills previously. He denies diarrhea to me but told the ED that he has had nonbloody diarrhea. He denies HA, abdominal pain, N/V, or chest pain. He states that he has been fully vaccinated "ever since they first came out with the vaccine." ER notes reviewed and his BP has been low and is again with BP 86/54, HR 112, SpO2 92-95% on 6 L nasal canula. His COVID-19 swab was positive and his CXR showed small pleural effusions with passive atelectasis and superimposed airspace opacities in the right lower lung. His EKG showed sinus rhythm with sinus arrhythmia and PVCs and his troponin was 0.04, 0.04. His BNP was 83. His d-dimer was $g 10,000. His WBC was 13.1 but his procalcitonin was 0.05. His chest CTA was negative for a PE but showed scattered groundglass opacities in both lungs concerning for an acute infectious/inflammatory process and moderate pleural effusions with passive atelectasis. ID was consulted and he was given 325 mg ASA, 6 mg Decadron, and Albuterol.
CDC Split Type:

Write-up: This a 89y.o. male is well known to me and we recently received a message from the facility that was coming into the ER and that he was increasingly SOB. His history of HTN, hypothyroidism, CAD, NSTEMI is a concern and his BP and nutritional status is a concern. Per chart review, he was hospitalized from 11/9/21-11/12/21 for AKI and UTI. He was discharged home with home care. He has been on 4 L home O2 since a hospitalization in October. He has family members that recently tested positive for COVID. He states that he has felt SOB ever since his hospitalization in October, so he is unsure when his current symptoms started. He admits to a nonproductive cough, wheezing, and SOB. He states that he has chills currently and has rigors on exam but has not had fever or chills previously. He denies diarrhea to me but told the ED that he has had nonbloody diarrhea. He denies HA, abdominal pain, N/V, or chest pain. He states that he has been fully vaccinated "ever since they first came out with the vaccine." ER notes reviewed and his BP has been low and is again with BP 86/54, HR 112, SpO2 92-95% on 6 L nasal canula. His COVID-19 swab was positive and his CXR showed small pleural effusions with passive atelectasis and superimposed airspace opacities in the right lower lung. His EKG showed sinus rhythm with sinus arrhythmia and PVCs and his troponin was 0.04, 0.04. His BNP was 83. His d-dimer was $g 10,000. His WBC was 13.1 but his procalcitonin was 0.05. His chest CTA was negative for a PE but showed scattered groundglass opacities in both lungs concerning for an acute infectious/inflammatory process and moderate pleural effusions with passive atelectasis. ID was consulted and he was given 325 mg ASA, 6 mg Decadron, and Albuterol.


VAERS ID: 1943478 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FR2593 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test, Dizziness, Dyspnoea, Electrocardiogram, Pain, Urine analysis
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (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: Celebrex, Plaquenil, Omeprazole, CBD supplement, Tylenol, Fluoxetine
Current Illness: None
Preexisting Conditions: Difficulty taking deep breaths. Soreness in rib cage.
Allergies: None
Diagnostic Lab Data: Went to ER. Blood and urine tests were normal. EKG and blood O2 levels were normal. Symptoms subsided after a few hours.
CDC Split Type:

Write-up: Severe joint pain in back and hips. Shortness of breath, dizziness. Pain and soreness when trying to take a deep breath.


VAERS ID: 1943509 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1943525 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-27
Onset:2021-11-20
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Adult failure to thrive, Asthenia, Blood chloride increased, Blood creatinine increased, Blood lactic acid, Blood potassium decreased, Blood sodium normal, Blood urea increased, COVID-19, Carbon dioxide increased, Cardiac failure, Chest X-ray abnormal, Condition aggravated, Decreased appetite, Dehydration, Dementia, Echocardiogram abnormal, Ejection fraction normal, Fall, Gait disturbance, Haemoglobin decreased, Hyperchloraemia, Hypernatraemia, Hypertension, Hypokalaemia, Hypophagia, Hypoxia, Left ventricular dysfunction, Lung opacity, Platelet count normal, Pleural effusion, Pneumonia, Polyuria, Procalcitonin, Productive cough, SARS-CoV-2 test positive, Skin laceration, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG PO Tab take 325 mg by mouth every 12 hours. 11/24/2021 Unknown time aspirin (ECOTRIN) 81 MG PO Tablet Delayed Response take 81 mg by mouth once daily. 11/24/2021 Unknown time Med Note ( Wed Nov 24, 202
Current Illness: A-fib ? Congestive heart failure, unspecified ? GERD (gastroesophageal reflux disease) ? Hypertension ? Hypothyroidism ? Pneumonia ? Rheumatoid arthritis
Preexisting Conditions: A-fib ? Congestive heart failure, unspecified ? GERD (gastroesophageal reflux disease) ? Hypertension ? Hypothyroidism ? Pneumonia ? Rheumatoid arthritis
Allergies: Propoxyphene N-Apap Hives ? Codeine Dizziness Pt cannot take regular codeine which makes her dizziness and fatigue. But can take synthetic codeine ? Hydromorphone Mental status changes Profound hypotension
Diagnostic Lab Data: Patient is a 95y.o. female who presented to the emergency department at Hospital - given concerns for SPO2 readings in the mid-80''s by home health care nurse, although upon EMS arrival, she was noted to have SPO2 of 94%. She is not on home oxygen therapy. Her past medical history includes Alzheimer''s dementia, history of paroxysmal atrial fibrillation not currently on anticoagulation given recurrent falls, hypothyroidism, history of falls thought to be multifactorial in etiology - secondary to gait impairment/ weakness/ medication induced/ dehydration and hypertension, and heart failure with preserved ejection fraction with 2-D echocardiogram in November 2021 notable for an ejection fraction of 60% with a grade II left ventricular diastolic dysfunction. Of note, patient was noted to have suffered an unwitnessed fall, and was found on the floor next to her bed at home for an unknown amount of time which prompted further evaluation at Hospital in October 2021 where she required sutures for the head laceration. The patient''s son and DURABLE POWER OF ATTORNEY, was contacted for further information. He states that patient lives at home with 24/7 home health care. Per patient''s home health nurse, it was noted that she was having a "wet" cough which started on 11/7/21. To son''s knowledge, it was not relayed to him that patient was experiencing fevers or diarrhea. Patient has been vaccinated against COVID-19, having received Pfizer vaccines in March 2021 �2. Patient was seen and evaluated by internal medicine. Patient was continued on empiric IV antibiotics. Her overall condition gradually improved. She was cautiously diuresed. She was eventually discharged with continuing oral antibiotics. It was felt the patient should be discharged to a subacute rehabilitation facility with family opted to take her home with home health care instead.
CDC Split Type:

Write-up: Patient is a 95y.o. female it was a history of CHF, advanced dementia, A. Fib not on any anticoagulation, recent community-acquired pneumonia who was brought into the emergency room by EMS for complaints of generalized weakness, decreased appetite and failure to thrive and hypoxia. On examination patient does have advanced dementia, very poor historian patient is alert did not answer any questions limited history available secondary to her status per EMS note at the facility patient wasn''t eating and drinking for the past 1 week and noted to have oxygen saturation of 81% place the patient on oxygen and brought her to the emergency room for evaluation and management. ED course sodium-164 hypernatremia, potassium hypokalemic-2.6, hyperchloremic-114, CO2-38, elevated BUN/creatinine creatinine view and 30, creatinine 0.78, pro calcitonin plasma-0.06, lactic acid-1.7, WBC-11.0, hemoglobin-11.3, platelet-330, covid-positive, patient fully vaccinated with the 2 doses of Vaccine in March.chest x-ray-no improvement from previous improving bilateral patchy airspace opacities, probably small pleural effusion, Past Medical History:


VAERS ID: 1943581 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Vitreous floaters
SMQs:, Retinal disorders (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: Anastrozole Metformin farxiga Atorvastatin Calcium Losartan-HCTZ Verapamil Levimir
Current Illness: None
Preexisting Conditions: Hystoplasmosis in right eye Breast Cancer - 7 years ago Type 2 Diabetes
Allergies: ACE-Inhibitors
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Large black floaters in my eyes


VAERS ID: 1943582 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-05
Onset:2021-11-20
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest pain, Cough, Dyspnoea, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Nausea, Painful respiration, Productive cough, Pyrexia, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol-ipratropium (COMBIVENT) 18-103 MCG/ACT INHAL Aerosol inhale 1 Puff into the lungs as needed. Past Week Unknown time Med Note Fri Nov 26, 2021 10:36 PM) Apple Cider Vinegar 188 MG PO Cap take 1 Capsule by mouth once daily.
Current Illness: Asthma ? Diabetes mellitus ? Gout ? Hypertension
Preexisting Conditions: Asthma ? Diabetes mellitus ? Gout ? Hypertension
Allergies: none
Diagnostic Lab Data: On admission he was requiring 4L NC but required increasing amounts of FiO2 up to maximum HFNC with NRB. He received remdesivir, tocilizumab and a decadron course of 20mg x5 days followed by decadron 10mg course. He had improvement in his breathing and required less oxygen to the point where he was weaned to 3L NC and reported to feel stable for discharge on oxygen. He currently has oxygen at home from his previous hospitalization. He is being discharged on his home medications and is instructed to monitor his sugars and pulse oximetry levels carefully to maintain $g90% Spo2. He is also instructed to report his AM glucose values to his PCP and follow up with them in 3 days. Total time for discharge was in excess of 38 minutes. Contains abnormal data Covid-19, Flu, RSV by NAA Status: Final result Visible to patient: No (inaccessible in chart) Next appt: None Specimen Information: Nasopharyngeal; Swab 0 Result Notes Ref Range & Units Influenza A Not Detected Not Detected Influenza B Not Detected Not Detected RSV Not Detected Not Detected SARS-CoV-2 (COVID-19) by NAA, Micro Not Detected Detected Abnormal Narrative Methodology: Nucleic Acid Amplification(NAA)/Polymerase Chain Reaction(PCR) Specimen Collected: 11/26/21 7:09 PM
CDC Split Type:

Write-up: This is a 44y.o. male with a past medical history of asthma, gout, morbid obesity and obstructive sleep apnea presenting to the emergency department today with increased shortness of breath and chest pain. Patient states that he was positive for Covid about one week ago. Patient is vaccinated for Covid. Patient is known door saying that over the past 2 days he has been increasingly short of breath. Patient states that he is on oxygen at home but has been increasing his requirements and is currently requiring 4 L with oxygen saturation in the low 90s. Patient also is endorsing chest pain. Chest pain is diffuse and worse with deep inspiration. Patient states that he also has been coughing which is productive of a foam-like substance. Patient endorses fever earlier today for which she feels improved after taking Tylenol. Patient also admits to an episode of nausea earlier which resolved on its own and did not have any vomiting. Patient denies chills, current nausea, vomiting, abdominal pain, lower extremity edema, and changes in bowel or urinary habits.


VAERS ID: 1943601 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-25
Onset:2021-11-20
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Asthenia, Bacterial test, Blood albumin decreased, Blood ketone body, COVID-19, Chest X-ray abnormal, Cough, Decreased appetite, Dizziness, Fatigue, Fibrin D dimer increased, Haemoglobin decreased, Impaired driving ability, Lung opacity, SARS-CoV-2 test positive, Urine analysis abnormal
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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? No
Previous Vaccinations:
Other Medications: aspirin 325 MG PO Tab take 325 mg by mouth once daily. 11/25/2021 Unknown time carVEDilol (COREG) 6.25 MG PO Tab take 6.25 mg by mouth twice daily. 11/25/2021 Unknown time Cholecalciferol (vitamin D) 25 MCG (1000 UT) PO Tab take 1,000 Units
Current Illness: Carotid stenosis R; followed by cardiologist ? Chronic pancreatitis (CMS/HCC) 10/28/2017 ? Coronary artery disease ? GERD (gastroesophageal reflux disease) ? High cholesterol ? HTN (hypertension) ? Hx of CABG x3, 2008 ? Nerve pain ? Spinal stenosis
Preexisting Conditions: Carotid stenosis R; followed by cardiologist ? Chronic pancreatitis (CMS/HCC) 10/28/2017 ? Coronary artery disease ? GERD (gastroesophageal reflux disease) ? High cholesterol ? HTN (hypertension) ? Hx of CABG x3, 2008 ? Nerve pain ? Spinal stenosis
Allergies: Sulfa Antibiotics
Diagnostic Lab Data: Requested to see patient for wanting to leave AMA.
CDC Split Type:

Write-up: This is a 77y.o. male with a PMHx of CABG on ASA, HTN on Coreg who presents to the ED for generalized weakness. He states that for the last 20 days his felt intermittent fatigue that has not resolved. He also endorses nonproductive cough that worsens when he lays down, lack of taste/smell or appetite, and dizziness when standing up from a seated position. He denies syncopal episodes with exertion or while having bowel movements. At times his dizziness has forced him to crawl from room to room, and also prompted him to call EMS as he was unable to drive himself to the ED. He lives in a condo with another individual who he suspects gave him COVID prior to symptom onset. He otherwise denies any other interactions with individuals who may have been sick. He endorses compliance with his home medications. He denies tobacco, alcohol, or recreational drug use. He is vaccinated against COVID, and has received his booster. In the ED: BP 93/55, HR 79, RR 19, SPO2 96%, T 97.5F. labs remarkable for HAGMA, Hgb 13.4, D-dimer 835, Albumin 2.7, BHB 1.12, UA shows +LE, +Bacteria. CXR suggests ground glass opacities in RUL concerning for acute process. COVID test positive. Patient is admitted to internal medicine with consult to infectious disease.


VAERS ID: 1943667 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       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: Vyvanse
Current Illness:
Preexisting Conditions:
Allergies: Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was 12.5 years old at the time of vaccination. Was administered the pediatric formulation/dose, despite not being age-eligible for this vaccine. Per CDC guidance, patient received 2nd dose 21 days later, using the adult formulation and dose.


VAERS ID: 1943754 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest pain, Dyspnoea, Fatigue, Feeling cold, Gaze palsy, Loss of consciousness, Nasopharyngitis, Seizure like phenomena, Syncope, Tension
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sore throat
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: No one asked for nothing. The doctor said she fainted ?out of impression?
CDC Split Type:

Write-up: She fainted right after a few seconds of getting the shot, and her body started to move like having seizures. Her eyes were half open but rolled up and her body was hard and tense. The doctor started yelling for help and oxygen while my child was unconscious . After a couple nurses came in and a few minutes passed, she woke up saying that she was very cold and she was feeling tired and weak. After this, she spent 14 days with a very bad rhinopharyngitis, I had to take her to the ER because of her complaining about not being able to breathe fine, chest pain and weakness.


VAERS ID: 1943783 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-16
Onset:2021-11-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased
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: sertalin 50mf, valium 5mg
Current Illness: arthritis
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient unable to move right arm above shoulder line and move backward


VAERS ID: 1943788 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1943795 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-10
Onset:2021-11-20
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1943810 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation, No adverse event, Wrong technique in product usage process
SMQs:, Medication errors (narrow)

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

Write-up: Patient received a dose of Pfizer COVID-19 vaccine pediatric formulation (5-11 years) that may have been reconstituted with a single-use vial of 0.9% NS entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single-use only (to take out 1.3mL then discard). Each time the vial was used, it was swabbed with alcohol and a new syringe was used to enter the vial to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9% NS vial disposed of at the end of each day. The patient did not experience any adverse reaction. At recommendation and due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1943949 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1944083 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the agency, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1944680 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Bronchial hyperreactivity, Bronchiolitis, Chest X-ray normal, Computerised tomogram abnormal, Computerised tomogram thorax, Dyspnoea, Dyspnoea exertional, Electrocardiogram normal, Full blood count normal, Human chorionic gonadotropin normal, Lung opacity, Metabolic function test, Pneumonitis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prescriptions: Apidra, Adderall XR, OTC: Multi-vitamin Gummy, Dietary: None, Herbal: None
Current Illness: None.
Preexisting Conditions: Type 1 Diabetes.
Allergies: Medication Allergies: Halothane, Victoza, Humalog, Novalog, Levemir
Diagnostic Lab Data: 12/9/2021 - All tests (some were 12/10/2021 at ~ 3AM) ECG - Normal sinus rhythm beta - hCG Qualitative Serum - Negative CBC with Auto-Differential - All results within normal ranges Chem 7 - All results within normal ranges Chest X-Ray - No radiographic evidence for acute cardiopulmonary disease on this single view of the chest. Chest CT - No evidence for acute pulmonary embolism from main to the segmental pulmonary arteries. However, the bilateral subsegmental pulmonary arteries are obscured by streak artifact and not well opacified by IV contrast. Multiple tiny foci of air within the main pulmonary artery likely from recent injection. Mild bilateral lower lobe mosaic attenuation of the lungs with minimal ground-glass pulmonary opacities, reflect sequela of small reactive airway disease/bronchiolitis or mild lung inflammation.
CDC Split Type:

Write-up: In the first 5 days after the injection, I had regular bouts of shortness of breath. Usually, after exertion (stairs) or in the evenings. This past week (12/7/2021), I called my PCP - and notified the office that my shortness of breath was still continuing. On 12/9/2021, I was advised by the office to be seen by a medical professional ASAP and they strongly recommended I visit an urgent care. That evening, around 7:30PM, I went to the Urgent Care and was treated by a doctor who recommended that I get straight to an Emergency Room to properly rule out blood clots in my lungs. I drove from the Urgent Care to the Hospital Emergency Room. Thankfully, Doctor called ahead. I arrived at the ER and was immediately given an EKG, blood draws, and a chest X-Ray. I then waited a few hours for my Chest CT. Dr. confirmed that my EKG, blood tests, chest X-Ray, and Chest CT were all clear. In discussing my medical options, he suggested an oral steroid, which would aggravate my diabetes. I ended up on Flovent, which I am currently continuing until my follow up with my pcp.


VAERS ID: 1945103 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Heart rate decreased, Muscular weakness, Myalgia, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Baby and Me 2 - Prenatal Vitamins Fish oil Vitamin D-3
Current Illness:
Preexisting Conditions: Lichen Sclerosis
Allergies: Bananas and eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: I woke up in the night from a slow heart rate and tingling in my left hand (same side the shot was given). After a short while my heart went back to feeling normal, but my hand has not been the same since. It has been 23 days since my first shot. The feeling in my left hand is much less then before, as is that arms strength. This really stood out to me when I was touching a hot pan and it took a few seconds for my body to react. I then tested the reaction of my right hand, which reacted immediately. I also had the normal reactions of headache, and muscle aches for two days after the shot.


VAERS ID: 1946712 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Electrocardiogram, Myocarditis, Ultrasound scan, X-ray
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG (11/22/2021) (11/23/2021) (12/10/2021) Ultrasound (11/22/2022) XRay (11/22/2021)
CDC Split Type:

Write-up: Myocarditis, chest pain, shortness of breath. Chest pain starting 15 hours after vaccination. Diagnosis 2 days later in hospital.


VAERS ID: 1947092 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Diarrhoea, Eating disorder, Headache, Immunisation, Insomnia, Myalgia, Pyrexia, Retching, Tremor, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: RAMIPRIL; AMLODIPINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101640493

Write-up: Shaking; Vomiting/puking; Diarrhea; Joint pain; Fever; Chills; Muscle pain; Headache; I can''t eat; Gagging; I haven''t been able to sleep; Booster; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 61 year-old female patient received bnt162b2 (BNT162B2), administered in arm left, administration date 20Nov2021 13:00 (Lot number: FH8030) at the age of 61 years as dose 3 (booster), single for covid-19 immunisation. Relevant medical history included: "High Blood Pressure" (unspecified if ongoing). Concomitant medication(s) included: RAMIPRIL taken for hypertension; AMLODIPINE taken for hypertension. Vaccination history included: Bnt162b2 (Dose 1, Single (The first two, patient got at the health department)), for COVID-19 immunization; Bnt162b2 (Dose 2, Single (The first two, patient got at the health department)), for COVID-19 immunization. The following information was reported: IMMUNISATION (non-serious) with onset 20Nov2021 13:00, outcome "unknown", described as "Booster"; TREMOR (non-serious) with onset 22Nov2021 01:00, outcome "unknown", described as "Shaking"; VOMITING (non-serious) with onset 22Nov2021 01:00, outcome "unknown", described as "Vomiting/puking"; DIARRHOEA (non-serious) with onset 22Nov2021 01:00, outcome "unknown", described as "Diarrhea"; ARTHRALGIA (non-serious) with onset 22Nov2021 01:00, outcome "unknown", described as "Joint pain"; PYREXIA (non-serious) with onset 22Nov2021 01:00, outcome "unknown", described as "Fever"; CHILLS (non-serious) with onset 22Nov2021 01:00, outcome "unknown", described as "Chills"; MYALGIA (non-serious) with onset 22Nov2021 01:00, outcome "unknown", described as "Muscle pain"; HEADACHE (non-serious) with onset 22Nov2021 01:00, outcome "unknown", described as "Headache"; INSOMNIA (non-serious) with onset 21Nov2021 09:30, outcome "unknown", described as "I haven''t been able to sleep"; RETCHING (non-serious) with onset 22Nov2021, outcome "unknown", described as "Gagging"; EATING DISORDER (non-serious) with onset 22Nov2021 01:00, outcome "unknown", described as "I can''t eat". Additional information: Patient had no prior vaccination (4 Weeks). On 21Nov2021, since morning at 9:30 hours, patient had not been able to sleep. On 22Nov2021, at 01:00 hour (morning), patient was shaking so bad and mean puking, it was happening, and stated that this was supposed to be good for her. So, patient mean it just doesn''t make any sense. Patient mean, that she can''t eat, had diarrhea, vomiting, joint pain, fever, chills, muscle pain and headache. On 22Nov2021, patient opened the refrigerator to get even a drink and she just started gagging. Patient stated that this is how the government is helping us. Patient stated that she had to call and tell somebody that this booster shot, this was cruel and inhumane. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1947690 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1947723 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1947820 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 vaccine pediatric formulation (5-11 years) that may have been reconstituted with a single-use vial of 0.9% NS entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single-use only (to take out 1.3mL then discard). Each time the vial was used, it was swabbed with alcohol and a new syringe was used to enter the vial to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9% NS vial disposed of at the end of each day. The patient did not experience any adverse reaction. At recommendation and due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1947854 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-06
Onset:2021-11-20
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Extra dose administered, Illness, Impaired driving ability, Impaired work ability, Pain, Pruritus, Pyrexia, Sleep disorder, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None, but got sick from the booster itself and had a 100 degree fever that night, was sick that weekend and missed a half day of work that Tuesday due to lingering symptoms.
Preexisting Conditions: Seborheic dermatitis on face/behind ears, controlled with hydrocortisone cream.
Allergies: None
Diagnostic Lab Data: Unable to do allergy testing due to renewed symptoms, will attempt when reaction has stabilized.
CDC Split Type:

Write-up: Hives like symptoms began with severe itching and swelling beginning on the back of neck and shoulders, then spread to include legs, hands and feet. Did not respond to external creams much, so after two weeks I scheduled an allergist appt. Tried to go off any antihistamines for 2-3 days before the appt, and both times on the third day it became unbearable and pt (myself) took an antihistamine. I tried zyrtec first, it only helped a little. Then tried bernadryl. Benadryl was 6 hour version, name brand. Itching and swelling became so bad the day I saw the allergist (Premier Allergist member, FNP) that it began to affect my hands and feet, and private parts. Any friction such as washing of hands and wiping myself clean caused immediate swelling and redness, and deep painful itching that did not improve with scratching or creams (benadryl or cortisone). It caused problems with sleep, driving (due to the hands and feet), and sanitation (hard to wash hands or face, shower). Benadryl helped significantly but wore off after about 6-7 hours, so I needed to take it 3 times a day and for bed to avoid active swelling/itching. Allergist prescribed prednisone for 5 days that Wednesday, and it had no effect so I took benadryl again Saturday evening and into the weekend. Met with allergist to followup on 12/14/21 and told her I was unable to get off the anti histamines long enough to do allergy testing. She suggested continuation of the benadryl then allergy testing once the reaction has improved. I did try switching detergents etc to make sure that wasn''t the issue, and it seemed to have no effect. Allergist stated she has had several patients with the same response after the Moderna booster, and to report it for the sake of documentation for the manufacturer.


VAERS ID: 1948015 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1948032 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1948164 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1948193 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1948241 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-02
Onset:2021-11-20
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lacrimation increased, Muscle twitching, Musculoskeletal stiffness
SMQs:, Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Lacrimal disorders (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid 19
Other Medications: Valsartan 80 mg /1 daily Atorvastatin 80 mg /1 daily Amlodipine 2.5 mg / 1 daily Metoprolol Tartrate 25 mg /2 daily Aspirin 81 mg /1 daily
Current Illness: None
Preexisting Conditions: Low back pain
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Stiffness in right side of face along with twitching and tearing in the right eye. This is similar to the Bel?s Palsy case I had in April 2021 after receiving the J & J Covid vaccine on 03/06/2021. However, the present symptoms are at a lesser scale.


VAERS ID: 1950413 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-08
Onset:2021-11-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoacusis, Inflammation, Middle ear effusion, Nasopharyngitis, Tinnitus
SMQs:, Hearing impairment (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: Severe brain fog and fatigue lasting nearly 2 weeks, Johnson & Johnson COVID vaccine, March 29, 2021, 35 years
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: On the 29th, the doctor thought my ears looked "affected" but that has been the only test so far.
CDC Split Type:

Write-up: About a week after getting my Pfizer booster (I was previously vaccinated with Johnson & Johnson on May 29, 2021), I caught a cold, but had very unusual symptoms. It started with tinnitus in my left ear, and eventually my ear became so inflamed and filled with fluid, I could not hear out of my left ear for several days. Since it coincided with the Thanksgiving holiday, I wasn''t able to get in to see a doctor until the following Monday (29th of November). The doctor checked my ears, and prescribed Amoxicilin and steroids, but they did not seem to improve the ear symptoms. The tissue surrounding my eustachian tubes still feels very inflamed, and I am still getting popping/crackling sounds, even though my cold symptoms have been resolved for weeks now. I plan to follow up with my doctor, but had not yet been able to do so.


VAERS ID: 1951182 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Dizziness, Peripheral swelling, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient reports an upset stomach and refers to dizziness, then faints. He is placed on a stretcher and emergency medical personnel evaluate the patient. Lower extremities are raised. Vital and dextro are monitored. Patient was evaluated by Dr. The family is directed to notify that the patient has a history of vasovagal whenever they are punctured, they must be placed on a stretcher to be punctured.


VAERS ID: 1951283 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951285 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951298 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951347 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951356 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine (PEDS) pediatric formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9% NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9% NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951383 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951385 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint range of motion decreased, Shoulder injury related to vaccine administration
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient reported on 12/12/2021 to a review on Google that she experienced SIRVA from the vaccine given by us on 11/20/2021 "limited range of motion and pain of shoulder" "inhibited to use in activities"


VAERS ID: 1951396 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951508 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951541 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951567 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951670 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951680 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951690 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951701 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951713 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation, No adverse event, Wrong technique in product usage process
SMQs:, Medication errors (narrow)

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951725 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951751 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation, No adverse event, Wrong technique in product usage process
SMQs:, Medication errors (narrow)

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

Write-up: Patient received a dose of Pfizer COVID-19Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL , 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951762 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1951809 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-04
Onset:2021-11-20
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia, Aphonia, Dry skin, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated she has an itchy and dry scalp and is now losing her hair. She''s also losing her voice. Her PCP referred her to a dermatologist but she has not yet been seen.


VAERS ID: 1951935 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache, Lymphadenopathy, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness, rash, headache, nausea, swollen under arm


VAERS ID: 1951952 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Product storage error, Underdose
SMQs:, Medication errors (narrow)

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1952131 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Joint range of motion decreased, Needle issue, Pain, Pain in extremity, Syringe issue, Underdose
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, rosuvastatin, famotidine, amitriptyline, omeprazole, vitamin d
Current Illness:
Preexisting Conditions: high blood pressure, high cholesterol, persistent cough, acid reflux
Allergies: morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is describing difficulty with range of motion of left arm and experiences pain that radiates when lifting There is also sensitivity/pain at the site of injection Patient was given booster dose on 11/20/21, but there was a needle/syringe malfunction where the full dose was not administered - most of the vaccine had spilled from the syringe during administration. Patient was then given another dose to ensure that she had gotten the entire recommended dosage for the booster. After receiving the doses patient described above reactions.


VAERS ID: 1952148 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Public       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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No severe allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 13 year old patient incorrectly received Pfizer 5-11 year old formulation on 11/20/2021 for his first dose. Guardian was counseled and patient received Pfizer 12+ formulation for his second dose on 12/11/2021.


VAERS ID: 1952167 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: 14 year old patient incorrectly received Pfizer 5-11 year old formulation on 11/20/2021 for her first dose. Guardian was counseled and patient received Pfizer 12+ formulation for her second dose on 12/11/2021.


VAERS ID: 1952678 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-08
Onset:2021-11-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Erythema, Feeling hot, Inflammation, Mechanical urticaria, Pruritus, Rash, Rash erythematous, Rash papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D 1000 IU daily; Vitamin C 500 mg chewable occasionally (about 5 days per week)
Current Illness: none
Preexisting Conditions: -Ocular Migraines Note: no longer chronic but had an episode of chronic idiopathic urticaria from 11/18/2012 through year of 2013 only. (before 11/20/2021, had not had one hive since then).
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sat 11/20/21: Developed 1 large hive/wheal below the right buttock around 9 pm. was gone upon awakening next day. Sunday 11/21/21: at night (around8-9pm)- felt itchy & had minimal small hives scattered on mostly my back, neck, & occipital area of head itchy- took Zyrtec 10mg with improvement. Monday 11/22/21: woke up without symptoms. developed same symptoms, as previous night, around 8pm, slightly worse than 11/21/21. Again took zyrtec 10mg. Tues 11/23: woke up 8am with slight improvement in symptoms. Throughout the day had small hives & tiny bumps appearing, disappearing, and re-appearing on random places (i.e. forehead, stomach, arms, back, legs, knees, elbows) - also appeared to have scratch like marks and some linear type wheals. got worse in evening 6pm. improved w/ Benadryl then worse 2 hrs later. also felt burning, warm, reddened ears and behind ears. Wed 11/24: woke up 8am and again felt same feeling behind ears & had 1 or 2 tiny hive-like bumps outside each eye. Took Zyrtec 10 mg & famotidine 20 mg with improvement in symptoms. Thurs 11/25: symptoms improved. had intermittent red marks on varied locations of body, occasionally itchy, and upon scratching got worse and more inflamed and left red slightly raised scratch marks lasting <2 hours. symptoms improved slightly with Zyrtec 10 mg & famotidine 20 mg . Fri 11/26: again had intermittent red marks on varied locations of body, occasionally itchy, and upon scratching got worse and left red scratch marks lasting <2 hours. symptoms improved with Xyzal 5 mg & famotidine 20 mg . Between 11/27 to present: have continued to have intermittent red marks on varied locations of body (arms, legs, palms, top of feet, back, stomach), itchy, and upon scratching gets worse, feels warm & burning. red scratch marks vary in size, are slightly raised, and last <2 hours at a time. diagnosed w/ dermatographia 12/2/21 by an allergist. taking Xyzal 5 mg every night & famotidine 20 mg every afternoon with slight improvement in symptoms each day. symptoms are always worse at night.


VAERS ID: 1952964 (history)  
Form: Version 2.0  
Age: 0.33  
Sex: Male  
Location: Hawaii  
Vaccinated:1972-06-03
Onset:2021-11-20
   Days after vaccination:18067
Submitted: 0000-00-00
Entered: 2021-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Deep vein thrombosis, Pleuritic pain
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Ibuprofen Synthroid
Current Illness: None
Preexisting Conditions: Hypothyroid
Allergies: None
Diagnostic Lab Data: None, I am a medical provider. and Self diagnosis. Again I am not pursuing medical testing or care.
CDC Split Type:

Write-up: I developed left sided pleuritic chest pain without reason, as this seemed to resolve, a DVT to right leg developed. As this resolved, a spontaneous left chest pleuritic chest pain developed 12/13/21, and is still active. I do not wish to seek medical help. I am taking large doses of ibuprofen for pain. Concern for PE, is a concern. I received the J and J vaccine. I have no significant medical problems and was relatively active immediately prior to this starting in November. As such sedentary activity was not a precursor when symptoms started.


VAERS ID: 1954828 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1954968 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 RA / IM

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

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

Write-up: PATIENT REPORTED THAT SHE IS STILL HAVING A SORE ARM/JOINT/SHOULDER PAIN 1 MONTH AFTER SHE RECEIVED HER VACCINE. THE PHARMACIST GAVE HER A BOTTLE OF APAP AND NAPROXEN.


VAERS ID: 1955016 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-20
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Full blood count, Mechanical urticaria, Metabolic function test, Rash, Urticaria, Vitamin D
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: Alive multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Pollen lactose intolerance
Diagnostic Lab Data: CBC count Comprehensive Metabolic Panel Vit D level test Performed on 11/29/21
CDC Split Type:

Write-up: Experiencing full body urticaria hives and rashes . They are spontaneous and worse at night . Dermatographia noted .


VAERS ID: 1955111 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-10
Onset:2021-11-20
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Rash, Rash erythematous, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cough/cold
Preexisting Conditions: Anxiety Depression Celiac Disease
Allergies: Celiac disease Lactose Intolerant
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives all over body approx 9 days after receiving COVID 19 booster. Started on scalp and chest. Then knees, ankles, elbows, forearms. Knees were extremely swollen and hot to touch. No welts on face but red hot rash on face. Took Prednisone 5 day pack which helped some, though hives breaking through in between doses. Started taking 4 Zyrtec, 2 Allegra, 2 Benadryl plus steroid cream for 2 weeks (at advice of allergist) with some but not complete relief. Now on week 4 of hives. Still taking 4 Zyrtec/day. Still hives breaking through on hands, face, chest, butt, ankles.


VAERS ID: 1955177 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation, No adverse event, Wrong technique in product usage process
SMQs:, Medication errors (narrow)

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1955179 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-11-20
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19 BREAKTHROUGH CASE - HOSPITALIZATION


VAERS ID: 1955411 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Unknown  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1955433 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1955446 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hormone level abnormal, Hot flush, Hyperhidrosis, Irritability, Menopause, Pain, Premature menopause
SMQs:, Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Fertility disorders (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi - v, vitamin c, biotin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: My doctor has the ones from the Spring of 2021.
CDC Split Type:

Write-up: I received my vaccine #1 03/27/21 and then the 2nd does 4/24/21 and my periods become irregular and more frequent in btw both doses and thereafter for a couple months. I got two sets of labs for these and they looked like I was going perimenapause but then they just balanced out over the summer with no problem. In Nov on the 19th of 2021 I went for my booster shot and the next day my body began to have Hot flashes, into sweats, into chills, aches etc and for the last 4 weeks to date this has not let up. My mood is more irritable and eventually I went to my doctor who thinks I could be perimenopause again. I am on progesterone for the next week until I receive my period and then I''m going to get labs that he has ordered. I am also seeing a specialist. this is not a coincidence that the vaccine created an irregularity with my hormones and then the booster has basically triggered me into early menopause. I am in the process of seeing doctors


VAERS ID: 1955548 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Product storage error, Underdose
SMQs:, Medication errors (narrow)

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1958148 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-01
Onset:2021-11-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blindness transient, Blood pressure measurement, Mitral valve incompetence, Presyncope, Thrombosis, Transient ischaemic attack
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal 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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Blood pressure; Result Unstructured Data: 170/100
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: She had TIA on the right; she felt like she was going to black out on and off; It made her temporarily go blind.; mitral valve regurgitation; she had a blood clot that traveled to the back of her right eye; This spontaneous case was reported by a consumer and describes the occurrence of TRANSIENT ISCHAEMIC ATTACK (She had TIA on the right), THROMBOSIS (she had a blood clot that traveled to the back of her right eye), BLINDNESS TRANSIENT (It made her temporarily go blind.) and MITRAL VALVE INCOMPETENCE (mitral valve regurgitation) in a 47-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. In November 2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Nov-2021, the patient experienced THROMBOSIS (she had a blood clot that traveled to the back of her right eye) (seriousness criterion medically significant). On an unknown date, the patient experienced TRANSIENT ISCHAEMIC ATTACK (She had TIA on the right) (seriousness criteria hospitalization and medically significant), PRESYNCOPE (she felt like she was going to black out on and off), BLINDNESS TRANSIENT (It made her temporarily go blind.) (seriousness criterion medically significant) and MITRAL VALVE INCOMPETENCE (mitral valve regurgitation) (seriousness criterion medically significant). The patient was hospitalized for 3 days due to TRANSIENT ISCHAEMIC ATTACK. The patient was treated with ATORVASTATIN CALCIUM (LIPITOR) at a dose of 1 dosage form and ASPIRIN [ACETYLSALICYLIC ACID] for Adverse event, at a dose of 1 dosage form. At the time of the report, TRANSIENT ISCHAEMIC ATTACK (She had TIA on the right), THROMBOSIS (she had a blood clot that traveled to the back of her right eye), BLINDNESS TRANSIENT (It made her temporarily go blind.) and MITRAL VALVE INCOMPETENCE (mitral valve regurgitation) outcome was unknown and PRESYNCOPE (she felt like she was going to black out on and off) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood pressure measurement: 170/100 (High) 170/100. Concomitant medications were not reported. Treatment medication included Beta-blocker. About 48 hours after the booster dose, the patient felt like she was going to black out on and off. Then it went away. On 20 Nov 2021, the patient had a blood clot that traveled to the back of the right eye and made the patient temporarily go blind. The patient had TIA on the right side of her face and hospitalised for 3 days. the patient got treatment her for the TIA and placed on protocol for stroke: Lipitor; although cholesterol, sugar, and blood pressure were good. One hour after the stroke hit, the blood pressure was 170/100. The patient had a mitral valve regurgitation and having beta blocker every day. the patient was on aspirin every day. the patient had a heart monitor on and will wear it for one more week. Company comment This case concerns a 47-year-old, female patient with no medical history reported, who experienced the serious unexpected events of thrombosis, transient ischaemic attack, blindness transient, mitral valve incompetence and a non-serious event presyncope. The patient had the booster dose of mRNA-1273 on an unknown date around the first week of November. The patient experienced the event presyncope 48 hours after the third dose of mRNA-1273. The events blindness transient, thrombosis, transient ischaemic attack, mitral valve incompetence occurred on an unknown date after the third dose of mRNA-1273. The benefit-risk relationship of mRNA-1273 is not affected by this report. This case was linked to MOD-2021-406250 (Link).; Sender''s Comments: This case concerns a 47-year-old, female patient with no medical history reported, who experienced the serious unexpected events of thrombosis, transient ischaemic attack, blindness transient, mitral valve incompetence and a non-serious event presyncope. The patient had the booster dose of mRNA-1273 on an unknown date around the first week of November. The patient experienced the event presyncope 48 hours after the third dose of mRNA-1273. The events blindness transient, thrombosis, transient ischaemic attack, mitral valve incompetence occurred on an unknown date after the third dose of mRNA-1273. The benefit-risk relationship of mRNA-1273 is not affected by this report.


VAERS ID: 1958670 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Unknown  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Product storage error, Underdose
SMQs:, Medication errors (narrow)

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1958697 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Product storage error, Underdose
SMQs:, Medication errors (narrow)

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


VAERS ID: 1958714 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Unknown  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Product storage error, Underdose
SMQs:, Medication errors (narrow)

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

Write-up: Patient received a dose of Pfizer COVID-19 Vaccine Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.


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