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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)

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VAERS ID: 2029362 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-14
Onset:2021-11-20
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Decreased appetite, Echocardiogram, Electrocardiogram, Haemoptysis, Headache, Pericarditis, Troponin, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Tobacco user (1.5 PA)
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma
Allergies:
Diagnostic Lab Data: Test Name: Trans-thoracic echocardiography; Result Unstructured Data: Test Result:normal examination; Test Date: 20211209; Test Name: cardiology; Result Unstructured Data: Test Result:repolarisation disorder; Comments: normal examination without clear repolarisation disorder on electrocardiography(discrete elevation of the junction point in this young patient). Pain suggestive of pericarditis not relieved since the introduction of an anti-inflammatory dose of Aspirin.; Test Name: electrocardiography; Result Unstructured Data: Test Result:normal; Comments: with early repolarization; Test Name: troponin; Result Unstructured Data: Test Result:Negative; Comments: Patient discharged with Aspirin 1000mg and Colchicine 0.5mg.
CDC Split Type: FRPFIZER INC202101879369

Write-up: Chest pain with radiation to left arm; Vomiting; Appetite lost; Pericarditis; Headache; Haemoptysis; This is a spontaneous report received from a contactable reporter(s) (Physician) from the WEB. Regulatory number: FR-AFSSAPS-CN20213971 (AFSSAPS). An 18-year-old male patient received bnt162b2 (COMIRNATY), intramuscular, administration date 14Sep2021 (Batch/Lot number: unknown) as dose 2, single for covid-19 immunisation. Relevant medical history included: "asthma" (unspecified if ongoing); "active tobacco" (ongoing), notes: 1.5 PA. The patient''s concomitant medications were not reported. Vaccination history included: Covid-19 vaccine (Manufacturer: Unknown), for COVID-19 immunization. The following information was reported: PERICARDITIS (medically significant) with onset 20Nov2021, outcome "not recovered", described as "Pericarditis"; HEADACHE (medically significant) with onset 20Nov2021, outcome "not recovered", described as "Headache"; HAEMOPTYSIS (medically significant) with onset 20Nov2021, outcome "not recovered", described as "Haemoptysis"; CHEST PAIN (non-serious) with onset 21Nov2021, outcome "unknown", described as "Chest pain with radiation to left arm"; VOMITING (non-serious) with onset 21Nov2021, outcome "unknown", described as "Vomiting"; DECREASED APPETITE (non-serious) with onset 21Nov2021, outcome "unknown", described as "Appetite lost". The event "pericarditis" was evaluated at the emergency room visit. The patient underwent the following laboratory tests and procedures: echocardiogram: (unspecified date) normal examination; electrocardiogram: (09Dec2021) repolarisation disorder, notes: normal examination without clear repolarisation disorder on electrocardiography (discrete elevation of the junction point in this young patient). Pain suggestive of pericarditis not relieved since the introduction of an anti-inflammatory dose of Aspirin; (unspecified date) normal, notes: with early repolarization; troponin: (unspecified date) negative, notes: Patient discharged with Aspirin 1000mg and Colchicine 0.5mg. Therapeutic measures were taken as a result of pericarditis. Clinical Course: The patient had an onset of first chest pain about 6 weeks after Dose 2, then worsening at 10 weeks of Dose 2 and consultation at the emergency room / Diagnosis of pericarditis and Headache and haemoptysis in the morning for 1 month. The patient had an irradiating chest pain in left arm with vomiting after each meal, loss of appetite (no diarrhoea/constipation). The patient had a normal electrocardiography with early repolarization and negative troponin. The pain suggestive of pericarditis not relieved since the introduction of an anti-inflammatory dose of Aspirin. Patient discharged with Aspirin 1000mg and Colchicine 0.5mg. Cardiology report 09Dec2021, normal examination without clear repolarisation disorder on electrocardiography (discrete elevation of the junction point in this young patient). Trans-thoracic echocardiography: normal examination. Holter planned for 20Jan2022 and thoracic scanner to be discussed. No signs of infection. FdRCV: active tobacco. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 2029499 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthmatic crisis, Cough, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; COVID-19; Mite allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210413; Test Name: SARS-CoV-2 test; Test Result: Positive
CDC Split Type: FRPFIZER INC202200023143

Write-up: Asthmatic crisis; Cough; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from the WEB. Regulatory number: FR-AFSSAPS-TO20219944 (AFSSAPS). A 14 year-old male patient received bnt162b2 (COMIRNATY), intramuscular, administration date 19Nov2021 (Lot number: Unknown) as dose 1, single for covid-19 immunisation. Relevant medical history included: "Mite allergy" (unspecified if ongoing); "COVID-19" (unspecified if ongoing); "Asthma" (unspecified if ongoing). The patient''s concomitant medications were not reported. The following information was reported: ASTHMATIC CRISIS (medically significant) with onset 20Nov2021, outcome "recovering", described as "Asthmatic crisis"; COUGH (non-serious) with onset 20Nov2021, outcome "recovering", described as "Cough". The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (13Apr2021) positive. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 2029873 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK9413 / 3 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Dyspnoea, Electrocardiogram, Fatigue, Fibrin D dimer, Immunisation, Interchange of vaccine products, Myocardial necrosis marker, Off label use, Pericarditis, SARS-CoV-2 test, Troponin
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NORTRIPTYLINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Gastric spasm
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Chest x-ray; Result Unstructured Data: Test Result:Normal Two and a half hours after start of pain; Test Date: 2021; Test Name: ECG; Result Unstructured Data: Test Result:Normal Two and a half hours after start of pain; Test Date: 2021; Test Name: ECG; Result Unstructured Data: Test Result:Diffuse ST elevation after 20 hours of pain; Comments: and after 20 hours following start of pain, there was diffuse ST elevation, pericarditis diagnosed; Test Date: 2021; Test Name: D-dimer; Result Unstructured Data: Test Result:Normal Two and a half hours after start of pain; Test Date: 2021; Test Name: D-dimer; Result Unstructured Data: Test Result:Unknown results; Test Date: 2021; Test Name: Cardiac Enzymes; Result Unstructured Data: Test Result:Normal Two and a half hours after start of pain; Test Date: 2021; Test Name: Cardiac Enzymes; Result Unstructured Data: Test Result:Unknown results; Test Date: 20211222; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test; Test Date: 2021; Test Name: Blood test for Troponin; Result Unstructured Data: Test Result:Normal
CDC Split Type: GBPFIZER INC202101885811

Write-up: Pericarditis; Off label use; Interchange of vaccine products; Booster; Fatigue/unusual tiredness; Crushing central chest pain; Shortness of breath; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from the Regulatory Authority. Regulatory number: GB-MHRA-WEBCOVID-202112301141559510-RIJQV. Other Case identifier(s): GB-MHRA-ADR 26415499. A 48 year-old male patient received bnt162b2 (COMIRNATY), administration date 20Nov2021 (Lot number: FK9413) as dose 3 (booster), single for covid-19 immunisation. Relevant medical history included: "Gastric spasm" (unspecified if ongoing). Concomitant medication(s) included: INFLUENZA VIRUS taken for immunisation, administration date 08Nov2021; NORTRIPTYLINE taken for abdominal pain upper, start date: 01Sep2004. Patient has not had symptoms associated with COVID-19. Patient had not tested positive for COVID-19 since having the vaccine and not enrolled in clinical trial. Vaccination history included: Covid-19 vaccine astrazeneca (Dose 1), administration date: 18Jan2021, for COVID-19 immunisation; Covid-19 vaccine astrazeneca (Dose 2), administration date: 09Apr2021, for COVID-19 immunisation. The following information was reported: OFF LABEL USE (hospitalization, medically significant) with onset 20Nov2021, outcome "unknown", described as "Off label use"; INTERCHANGE OF VACCINE PRODUCTS (hospitalization, medically significant) with onset 20Nov2021, outcome "unknown", described as "Interchange of vaccine products"; IMMUNISATION (hospitalization, medically significant) with onset 20Nov2021, outcome "unknown", described as "Booster"; PERICARDITIS (hospitalization, medically significant) with onset 22Dec2021, outcome "recovering", described as "Pericarditis"; FATIGUE (hospitalization, medically significant) with onset 2021, outcome "unknown", described as "Fatigue/unusual tiredness"; CHEST PAIN (hospitalization, medically significant) with onset 2021, outcome "unknown", described as "Crushing central chest pain"; DYSPNOEA (hospitalization, medically significant) with onset 2021, outcome "unknown", described as "Shortness of breath". The patient was hospitalized for off label use, interchange of vaccine products, immunisation, pericarditis, fatigue, chest pain, dyspnoea (start date: 2021). The events "pericarditis", "fatigue/unusual tiredness", "crushing central chest pain" and "shortness of breath" were evaluated at the physician office visit. The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (22Dec2021) no - negative covid-19 test; troponin: (2021) normal; chest x-ray: (2021) normal two and a half hours after start of pain; electrocardiogram: (2021) normal two and a half hours after start of pain; (2021) diffuse ST elevation after 20 hours of pain, notes: after 20 hours following start of pain, there was diffuse ST elevation, pericarditis diagnosed; fibrin d dimer: (2021) normal two and a half hours after start of pain; (2021) unknown results; myocardial necrosis marker: (2021) normal two and a half hours after start of pain; (2021) unknown results. Therapeutic measures were taken as a result of pericarditis, fatigue, chest pain, dyspnoea. The treatment was given because of symptoms and details of medication prescribed "Two week course of NSAID, 3 month course of colchicine". Clinical course: It was reported that 32 days post covid vaccination, crushing central chest pain started at rest. No history or signs indicating musculoskeletal (MSK) cause. Two and a half hours after the start of pain ECG, Cardiac Enzymes, D-dimer and chest x-ray all normal. Pain eased following co-codamol and naproxen. Pain increased in severity following pain relief wearing off. 20 hours following start of pain ECG, Cardiac Enzymes, D-dimer repeated, the ECG showed diffuse ST elevation, pericarditis diagnosed - initiated on 2 week course of NSAIDs and 3 month course of colchicine. The report related to possible inflammation of the heart (myocarditis or pericarditis). The symptoms did not lead to a hospital stay. There were "Two visits - the first was 12 hours the second was 6 hours". The diagnosis was made by a medical professional and cardiologist was confirmed as the type of healthcare professional that provided this diagnosis and any specific details of the diagnosis given. Imaging was carried out for chest X-ray and blood tests such as for certain proteins (called troponin) that signal heart muscle damage was taken and troponin was normal. There had not been any other recent or ongoing illness that haven''t already mentioned. No follow-up attempts are possible. No further information is expected.


VAERS ID: 2030242 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-11-11
Onset:2021-11-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004675 / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Lethargy, SARS-CoV-2 test, Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: No - Negative COVID-19 test
CDC Split Type: GBMODERNATX, INC.MOD20224

Write-up: Lethargy; Thrombocytopenia purpura; This case was received via Agency Regulatory Authority (Reference number: GB-MHRA-ADR 26424210) on 02-Jan-2022 and was forwarded to Moderna on 02-Jan-2022. This regulatory authority case was reported by a consumer and describes the occurrence of THROMBOCYTOPENIC PURPURA (Thrombocytopenia purpura) and LETHARGY (Lethargy) in a 53-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3004675) for an unknown indication. No Medical History information was reported. On 11-Nov-2021, the patient received third dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 20-Nov-2021, after starting mRNA-1273 (Moderna CoviD-19 Vaccine), the patient experienced THROMBOCYTOPENIC PURPURA (Thrombocytopenia purpura) (seriousness criteria hospitalization, medically significant and life threatening). On an unknown date, the patient experienced LETHARGY (Lethargy) (seriousness criteria hospitalization, medically significant and life threatening). At the time of the report, THROMBOCYTOPENIC PURPURA (Thrombocytopenia purpura) had not resolved and LETHARGY (Lethargy) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: no - negative covid-19 test (Negative) No - Negative COVID-19 test. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Patient had no relevant medical history and concurrent conditions. Patient has not had symptoms associated with COVID-19 Concomitant product use was not provided. Patient had peticchae and blood blisters in mouth on 20 November 2021. Also had purpura over next 3 days. Patient had spontaneous black eye and lethargy on 25 November 2021. Patient sought medical assistance and platelet count was 2000. Treatment information was not provided. Patient had not tested positive for COVID-19 since having the vaccine. Patient was not enrolled in clinical trial. This report was not related to possible inflammation of the heart (myocarditis or pericarditis). Company comment: This case concerns a 53-year-old male patient with no medical history reported, who experienced the unexpected, serious (life-threatening, hospitalization, and medically significant) events of thrombocytopenic purpura and lethargy. The events occurred approximately 9 days after the booster dose of mRNA-1273. The patient first experienced petechias and blood blisters in mouth 9 days after vaccination, followed by purpura over the next 3 days. Fourteen days after vaccination, the patient experienced lethargy and a bruise in his eye. Diagnostic tests included a platelet count which was reported as 2000. Information regarding clinical evaluation, other diagnostic tests and treatment provided has not been disclosed. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This case concerns a 53-year-old male patient with no medical history reported, who experienced the unexpected, serious (life-threatening, hospitalization, and medically significant) events of thrombocytopenic purpura and lethargy. The events occurred approximately 9 days after the booster dose of mRNA-1273. The patient first experienced petechias and blood blisters in mouth 9 days after vaccination, followed by purpura over the next 3 days. Fourteen days after vaccination, the patient experienced lethargy and a bruise in his eye. Diagnostic tests included a platelet count which was reported as 2000. Information regarding clinical evaluation, other diagnostic tests and treatment provided has not been disclosed. The benefit-risk relationship of mRNA-1273 is not affected by this report.


VAERS ID: 1884305 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin normal, Blood alkaline phosphatase increased, Blood calcium normal, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood lactic acid, Blood magnesium normal, Blood phosphorus increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Brain natriuretic peptide, Carbon dioxide decreased, Chills, Haematocrit normal, Intensive care, Procalcitonin, SARS-CoV-2 test negative, Shock, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Biliary system related investigations, signs and symptoms (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

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, ? days
   Extended hospital stay? No
Previous Vaccinations: Reported "bad reaction" to previous COVID vaccine
Other Medications:
Current Illness:
Preexisting Conditions: CAD, ESRD, Previous extended hospitalization for COVID-19 pneumonia, HTN, Systolic HF
Allergies: NKDA
Diagnostic Lab Data: admission labs: WBC 11.5, hematocrit 42, sodium 144, potassium 4.6, chloride 98, CO2 21, BUN 46, creatinine 4.3, glucose 175, lactate 8.6, calcium 9.4, phosphorus 6.1, magnesium 2.1, AST 61, ALT 38, alk-phos 186, BNP greater than 70 K, albumin 4.1, procalcitonin 0.49, COVID PCR negative;
CDC Split Type:

Write-up: 74-year-old gentleman received COVID19 booster dose today at dialysis appointment, sometime around 1300 hours. Experienced rigors afterwards. Admitted to the emergency department tonight, and subsequently to ICU in shock state requiring vasopressors. Admission to the hospital approximately 12 hours after administration of vaccine.


VAERS ID: 1884848 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dicloxacillin 500mg four times daily (day 7 of 10) Prenatal vitamin
Current Illness: Mastitis (treatment started 11/10)
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash at injection site. Approximately 3 inches in diameter. Warm, swollen, itchy.


VAERS ID: 1884850 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Appendicitis, Condition aggravated, Food allergy
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: anaphylaxis several weeks later (separate source); appendicitis
Other Medications: zyrtec; pepcid; prozac; hydroxyzine; glucosamine and chrondroitin
Current Illness: none
Preexisting Conditions: none
Allergies: latex: rash; amoxicillin: childhood-unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: anaphylaxis; treated with epinephrine, benadryl, steroids. Prior anaphylaxis to foods previously not reacted to after first series of COVID vaccine as well as subsequent appendicitis noted


VAERS ID: 1884858 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer; adverse reaction to first COVID-19 vaccine; symptomatic for a month then cleared by doctor for same shot.
Other Medications: N/A
Current Illness:
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced dizziness and an elevated blood pressure of 155/100. He started experiencing symptoms during the mandatory 15-minute waiting period in the immunization clinic. A provider called for patient management. Manual BP retaken: 148/100. Doctor recommend blood pressure monitoring, severe ER precautions and a follow-up appointment booked.


VAERS ID: 1884860 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-11-19
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884864 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Vasovagal syncope


VAERS ID: 1884865 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-11-19
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884869 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-11-19
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884874 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-18
Onset:2021-11-19
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884877 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-19
Onset:2021-11-19
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond-use-date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended patient receive an additional vaccine.


VAERS ID: 1884881 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-19
Onset:2021-11-19
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884885 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-19
Onset:2021-11-19
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond-use-date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended patient receive an additional vaccine.


VAERS ID: 1884887 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-11-19
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, COVID-19, Nausea, Pain, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: o ALPHA LIPOIC ACID
Current Illness:
Preexisting Conditions: Atrial fibrillation o Benign essential HTN o Diabetes mellitus o Hyperlipidemia o Obesity
Allergies: No known allergies
Diagnostic Lab Data: 11/19/21 SARS-CoV-2 PCR - Detected
CDC Split Type:

Write-up: The patient is a 67-year-old white male who presents to the emergency department with a chief complaint of abdominal pain. He complains of pain in the left upper quadrant that has been present for the last 2 days. The pain was initially intermittent but is now constant. The pain radiates to the back on the left side. Of note, the pain initially started as pain in the left mid back. He denies exacerbating and relieving factors. He admits to nausea and near emesis but no actual vomiting. He denies diarrhea and bloody stools. He denies dysuria and hematuria. He has no history of kidney stones. He denies chest pain and difficulty breathing.


VAERS ID: 1884889 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-19
Onset:2021-11-19
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884890 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-19
Onset:2021-11-19
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF25903 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Headache, Pain
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: D3, CoQ10
Current Illness: No
Preexisting Conditions: Heart disease, stage 4 kidney disease, borderline diabetic
Allergies: No
Diagnostic Lab Data: No.
CDC Split Type:

Write-up: Started getting headaches. It hurts to sit and stand. Headaches have lasted and been continuous. Feels like head is going to explode. Tightness in chest. Went to the doctor.


VAERS ID: 1884893 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-19
Onset:2021-11-19
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884895 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-19
Onset:2021-11-19
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884898 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-11-19
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884902 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-11-19
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884905 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-26
Onset:2021-11-19
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884907 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-31
Onset:2021-11-19
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884908 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 1 LA / IM

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

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

Write-up: passed out


VAERS ID: 1884911 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-24
Onset:2021-11-19
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1884912 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Peanut allergy
Allergies: Peanuts
Diagnostic Lab Data: None in cardiology office
CDC Split Type:

Write-up: Patient received his COVID vaccine yesterday and when he was at school today (11/19/2021) he passed out when he was on his knees and slid under the seat. He was checked by a doctor who then referred him to a Pediatric Cardiologist for evaluation. He was only unconscious for 4 seconds.


VAERS ID: 1884914 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-05
Onset:2021-11-19
   Days after vaccination:318
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray, SARS-CoV-2 test positive
SMQs:, Guillain-Barre 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Type 2 diabetes Hypertension Hx of CVA with lacunar infarcts and previous transient ischemic attacks Neurogenic bladder secondary to diabetes mellitus with chronic indwelling Foley
Allergies: Pineapple
Diagnostic Lab Data: ABBOTT ID NOW COVID-19 positive 11/19 CXR - similar to prior exam June 30,2021
CDC Split Type:

Write-up: Patient presented to ED with c/o weakness, COVID test resulted as positive,


VAERS ID: 1884918 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-19
Onset:2021-11-19
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F / N/A UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Computerised tomogram thorax abnormal, Dyspnoea, Echocardiogram, Pulmonary embolism, Ultrasound Doppler, X-ray
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rosuvastatin
Current Illness: None
Preexisting Conditions: Dislipidemia, chronic back pain, HTN
Allergies: Ciprofloxacin, PCN, Beef prod, pork derived prod
Diagnostic Lab Data: Xray, CT (PE), venous doppler and echocardiogram performed while hospitalized
CDC Split Type:

Write-up: Pt developed shortness of breath. Fount to have PE. Physician feels PE could be result of vaccines since pt has no known risk factors or cause for this incident. Pt started on Xarelto since other meds contraindicated due to pt allergies.


VAERS ID: 1884919 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 RA / IM

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

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

Write-up: Patient got the full dose (0.5mL) but they are not immunocompromised and should have only received 0.25mL. I realized my dose error while patient was still in the store. I notified the patient immediately.


VAERS ID: 1884931 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-13
Onset:2021-11-19
   Days after vaccination:279
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive, Upper respiratory tract infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple Vitamin (MULTIVITAMIN) tablet, pantoprazole (PROTONIX) 40 MG tablet Take 1 tablet by mouth daily. triamcinolone (NASACORT ALLERGY 24HR) 55 MCG/ACT nasal inhaler
Current Illness:
Preexisting Conditions: Arthritis Collapse of left lung 1963 Colon polyp Diverticulosis GERD (gastroesophageal reflux disease) 11/19/21: GERD (gastroesophageal reflux disease) 12/4/2017 History of BPH History of colon polyps HOH (hard of hearing) Seasonal allergies 4/3/2015 Snoring
Allergies: Sulfa antibiotics
Diagnostic Lab Data: 11/19/21 SARS-CoV-2 PCR Detected Abnormal
CDC Split Type:

Write-up: 11/19/21-He is fairly healthy for his age, has chronic allergies with allergic rhinitis, worked a day before his symptom onset in his front yard, raking the leaves with mask on. URI The primary symptoms include nasal congestion and nasal drainage. Primary symptoms do not include fever, headaches, sore throat, cough, wheezing, myalgias or shortness of breath. The current episode started 3 to 5 days ago (4 days). This is a new problem. The problem has not changed since onset. Symptoms associated with the illness include congestion and rhinorrhea. The illness is not associated with chills. Physical Exam 11/19/21 Vitals and nursing note reviewed. Constitutional: General: He is not in acute distress. Appearance: He is well-developed. He is not diaphoretic. HENT: Right Ear: Tympanic membrane and ear canal normal. Decreased hearing noted. Left Ear: Ear canal normal. Ears: Comments: Hearing aid in right ear noted. Nose: Congestion and rhinorrhea present. Right Sinus: No maxillary sinus tenderness or frontal sinus tenderness. Left Sinus: No maxillary sinus tenderness or frontal sinus tenderness. Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: No posterior oropharyngeal erythema. Tonsils: No tonsillar exudate. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. No murmur heard. Pulmonary: Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds. No wheezing. Musculoskeletal: General: No deformity. Normal range of motion. Lymphadenopathy: Cervical: No cervical adenopathy. Neurological: Mental Status: He is alert and oriented to person, place, and time. Coordination: Coordination normal. Psychiatric: Behavior: Behavior normal. 11/19/21-Discussed the lab findings with him, he is referred for Regeneron infusion. Rest, fluids and other supportive care including supplements (Vit C, Vit D, Zn) and OTC med prn for symptom relief discussed, expected course of illness and recovery time discussed. CDC guidelines for self quarantine and timeframe for RTW


VAERS ID: 1884934 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

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

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

Write-up: Pt recieved second dose of pfizer covid vaccine a week early. Initial dose was given on 11/5/21, second dose was given on 11/19/21


VAERS ID: 1884944 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 499ZC / 1 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. U007665 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U7191AB / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: Asthma, hypermetropia, astigmatism, anisometropia, obesity, hyperlipidemia, hx of COVID infection, allergic rhinitis
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Dizziness, headache about 15 mins after vaccine administration. Had pt lay down, gave some apple juice. Pt reported having not eaten yet this morning. Vitals: BP 94/63, P 109, R 20, SPO2 97% RA. Pt assessed by Doctor. Pt started to feel better about 10 mins after lying down and given apple juice.


VAERS ID: 1884957 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D 4000Iu daily Vitamin B complex one tab daily
Current Illness: None
Preexisting Conditions: None
Allergies: Nkda, nkfa
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Red rash on chest/brest area with slight tightness to right breast (same rash after 2nd dose of Moderna in Feb 2021)


VAERS ID: 1884959 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Additional Details: Patient fainted while seated 3-4 minutes after immunization while in the observation area. Pt fell out of seat and landed on the ground, may have hit head on wall during fall, claims to be ok and recovered after several seconds and was monitored for 30 minutes.


VAERS ID: 1884967 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol arthritis, hydrochlorothiazide, Zetia
Current Illness:
Preexisting Conditions: osteoarthritis, sinus
Allergies: food coloring, preservatives, gluten
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Woke up the next morning and all her joints on the right side was hurt. Took Tylenol and it clam it down. Talk to Doctor about it.


VAERS ID: 1884971 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / SYR

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

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

Write-up: my son received his 1st dose of the Pfizer COVID-19 vaccine today at his doctors office. After the shot was administered we were waiting our 15 minutes and the doctor came in to tell us there was an issue that they had administered a shot that was outside of the 12 hour window of dilution. She said there was a patient who should have received theirs in the prior afternoon, and did not show, and they did not discard the dose and instead administered it to my son in an administrative error.


VAERS ID: 1884977 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: made aware after that patient has anxiety to vaccines and goes "blank" after vaccinations, unsure if fully loses consciousness
Other Medications: no
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no
Diagnostic Lab Data: vitals taken by ems
CDC Split Type:

Write-up: patient was feeling anxious prior to administration, decision made to continue with vaccination, right after vaccine patient fainted and was unresponsive, tech immediately made rxm aware and rxm dialed 911, patient was breathing but unconscious, parents trying to wake up child, rxm continued to monitor breathing, ems came and brought patient out to ambulance and at that time patient regained consciousness, parent took child to pediatrician office


VAERS ID: 1884985 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Inflammation, Pain, Peripheral swelling, Somnolence, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Groggy for 48 hours after. On 3rd day very sore, tender and inflamed/swollen under left armpit (same arm where 3rd Pfizer booster shot was administered).


VAERS ID: 1885024 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FRI527 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: cough and fever 3 weeks before vaccination, covid test negative
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash on legs noticed in the morning of 11/19, not seen the night before, vaccine was administered at school vaccine clinic


VAERS ID: 1885060 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02B21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: PATIENT RECIEVED VACCINE THAT EXPERIENCED A TEMPERATURE EXCURSION, VACCINE WAS KEPT IN THE REFRIGERATOR FOR MORE THAN 30 DAYS.


VAERS ID: 1885061 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin 20, losartan 50, celecoxib 200, hydrochlorothiazide 12.5
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: came for his booster vaccine and the 0.25ml dose was administered. After his 15 minute waiting period when the staff was drawing up a dose for a subsequent patient it was discovered that the vial had been kept at room temperature for greater than 12 hours


VAERS ID: 1885068 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Pain
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: First COVID vaccination in March, extreme fatigue lethargy day after shot.
Other Medications: Montelukast, Simvastatin, metamucil fiber
Current Illness:
Preexisting Conditions:
Allergies: Atopic dermatitis, gold and certain chemicals
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chills, body aches, ?smooth? sensation in the mouth.


VAERS ID: 1885124 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Child turned 12 on 11-9-21, this was not noticed by staff, child was given the pediatric dose instead of the adult dose.


VAERS ID: 1885125 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Booter Shot, woke up in the middle of night with fever, chills, and headache.


VAERS ID: 1885133 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Musculoskeletal pain, Pyrexia, Skin burning sensation, Tremor, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Uncontrollable shaking (chattering of jaw), musculoskeletal pain, burning sensation of skin, fever <102 degrees, uncontrollable vomiting.


VAERS ID: 1885149 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Incorrect dose administered, Muscle spasms, Pain, Product preparation issue
SMQs:, Dystonia (broad), Medication errors (narrow)

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

Write-up: Incorrect diluent volume resulting in higher-than-authourized dose. Generalized mild body aches and cramping., prescibed NSAIDS.


VAERS ID: 1885165 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA KEW/JJH/JJH/JJH / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Bladder disorder, Cystitis, Micturition urgency, Muscle strain
SMQs:, Retroperitoneal fibrosis (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Olmesartan 40mg, metonrolol Succer 100mg, HydroCHLOROthiaz 25 mg, Wellbutrin-xl 300 mg Flovent 44 mcg, Albuterol HFa 90 mcg, singular
Current Illness: Seasonal allergy asthma
Preexisting Conditions:
Allergies: Penicillin, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: The morning after having the shot I was up for about an hour. A pain started in my middle back, left side. It continued for about half an hour, getting more painful, like a badly pulled muscle. Within 10 minutes my bladder started to feel the pressure that comes with a bladder infection. Urgency to urinate without anything there. It was painful enough to double me over. It continued for about an hour before I went to the local pharmacy and bought AZO, urinary pain relief medication. It has relieved the painful bladder, the pain in my back is still there two hours later.


VAERS ID: 1885221 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-11-19
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Cough, Diarrhoea, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, hypertension
Allergies:
Diagnostic Lab Data: PCR nasal swab COVID-19.
CDC Split Type:

Write-up: Patient presented with a cough, diarrhea, congestion and abdominal pain. Patient had J&J and tested positive for COVID-19.


VAERS ID: 1885224 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE Reported
Preexisting Conditions: NONE Reported
Allergies: NKA
Diagnostic Lab Data: BP: 72/60 P:68 - 0940 BP: 137/107 - 0950 EMS created reported and did not make available to nursing staff.
CDC Split Type:

Write-up: Vaccine was administered at 9:35. at approximately 9:40 pt. reported " I am dizzy and I see trails", RN had pt. sit down. Pt became diaphoretic was unconscious for less than 30 seconds. Ice pack was applied to back of his neck and bottle of water was offered. Pt reported he felt better. Pt than became diaphoretic and reported feeling "dizzy" Nursing staffed called EMS at 9:42 and EMS arrived on scene at 9:45 EMS observed and evaluated patient. Pt''s father was present and called patient''s mother who declined allowing EMS to take patient to hospital. Patient was escorted to personal vehicle by father and EMS.


VAERS ID: 1885229 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: Pt vomited about 1 minute after being vaccinated. Proceeded to state she was dizzy. Never lost consciousness. States pt. was anxious to get the vaccine. Pt sat quietly for about 10 more minutes after getting cleaned and felt better before leaving facility. Parent was with pt. at time.


VAERS ID: 1885235 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: None
Current Illness: None known
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data: None Yet
CDC Split Type:

Write-up: Elevated heart rate at around 105. Usually my heart rate stays near 70. I also have body ache, low grade fever of around 99.5.


VAERS ID: 1885258 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-10
Onset:2021-11-19
   Days after vaccination:282
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest discomfort, Chills, Cough, Fatigue, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medications on file
Current Illness:
Preexisting Conditions: No past history on file
Allergies: Cephalosporins
Diagnostic Lab Data: 11/19/21 SARS-CoV-2 PCR - detected Abnormal
CDC Split Type:

Write-up: 11/19/21-Patient states 4 days ago developed fatigue, chills and sporadic dry cough. This morning states that her chest felt tight. mucinex and motrin helping with symptoms. Husband recently tested + for covid. Patient took at home covid test and positive. covid vaccinated. 11/19/21 Albuterol HFA inhaler; Referral for EUA Covid antibody treatment


VAERS ID: 1885280 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT CAME IN FOR J& J VACCINE RECEIVED VACCINE AND WENT TO BE SEATED. UPON SITTING THE PT BECAME PALE AND WAS SWEATING. HE BEGAN TO SEE DARK AND FELT FAINT. I EXPLAINED WHAT WAS HAPPENING AND AND HAD THE PATIENT TRY TO STAY AWAKE AND TALKING. HIS BLOOD PRESSURE WAS 180/154 WITH PULSE OF 99. HE FELT NAUSEOUS AND VOMITED. PT STATED THAT HE DID HAVE THIS REACTION OCCUR ONCE BEFORE WHILE DRAWING BLOOD. HE SAT FOR A FEW MORE MINUTES AND BEGAN TO REGAIN COLOR AND TEMPERATURE WARMED BACK UP AND HE STOPPED SWEATING. I TOOK HIS BLOOD PRESURE AGAIN AND IT WAS IN NORMAL RANGE. HE FELT FINE AND THEN LEFT.


VAERS ID: 1885284 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-29
Onset:2021-11-19
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 553580 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion 150mg
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: In the 6 years that I have had the Nexplanon birth control implant I have never had my period or any spotting. 3 weeks exactly from the first dose and I have a period. I can tell it?s the shed lining and not an injury from the tissue coming out.


VAERS ID: 1885287 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: The child was given the vaccine in the right arm. The vaccination was completed at 12:39 pm. A few minutes later after the vaccination, the mom states that the daughter slumped over while waiting in the waiting area. The child may have passed out for a few seconds. The child seems a little dizzy and disoriented after the vaccination while waiting in the waiting area after the vaccination. She was not verbally responding to questions. 911 was called and EMT came to evaluate the child. EMT checked out the child''s vitals and the child''s vital was within normal limits. The child did not go to the hospital and was able to leave on her own from the pharmacy after the EMT evaluated her.


VAERS ID: 1885302 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest discomfort, Muscle tightness
SMQs:, Anaphylactic reaction (broad), Dystonia (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: Pfizer- chest tightness
Other Medications: Loratadin, montelukast, alubterol
Current Illness: asthma, cold or cough
Preexisting Conditions: athsma
Allergies: PCN-chest hurts and nausea
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient described chest tightness about 15 minutes after getting vaccination and back tightness about 25 minutes after getting the vaccination.


VAERS ID: 1885315 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: Headache with dose 1 of Moderna 10/14/2021
Other Medications: Effexor Zyrtec Daily vitamin Prilosec Probiotic
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: Sulfa Minocycline
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever chills body aches joint pain headache nausea 12 hrs after injections. Treating with otc pain relievers/ fever reducers.


VAERS ID: 1885325 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling abnormal, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: unspecified seizure disorder per pt
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: approximately 10 mins after vaccine administration patient was observed by accompanying person to be slumped over, unresponsive to stimulation, given 0.3mg epinephrine IM. Pt became coherent, vitals signs stable, transported to local hospital by ambulance. pt reports episodes of "spacing out" often, accompanying person confirms hx of unspecified seizure disorder.


VAERS ID: 1885332 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Seven minutes post-vaccine patient stated she felt light-headed and dizzy. Vitals within normal limits, then BP and pulse slightly dropped the patient remained under further observation. The patient began to feel a headache and nausea 30 minutes post-vaccination. Benadryl 12.5 mg chewable was given. Due to increased headache and dizziness with no improvement, EMS was called, and the patient was taken for further observation.


VAERS ID: 1885333 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Gave 22 doses out of Moderna Booster vial. Max 20


VAERS ID: 1885340 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Dyspnoea, Electrocardiogram normal, Swollen tongue, Troponin normal
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (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: influenza
Other Medications: Tylenol, Calcium carbonate, pepcid, neurontin, L-Lysine, Melatonin, ultram
Current Illness:
Preexisting Conditions: GERD, Seasonal Allergies, Migraine, Peptic ulcer disease
Allergies: Lansoprazole, milk, peanut, preservative, red food color, wasp venom, codeine, sumatriptan, conjugated estrogens
Diagnostic Lab Data: Given 12.5 mg of benadryl IV. EKG normal. CXR normal. Trop negative x 2. MOnitored for 3 hrs in the ED and had complete resolution of all symptoms and patient was feeling "normal". 11/19/2021
CDC Split Type:

Write-up: 15 minutes after vaccine given patient had feeling of tongue swelling and chest pain with some shortness of breath. Was brought from the clinic in the hospital to the emergency department. Upon arrival in the emergency department the patient had near complete resolution of symptoms. No significant abnormalities seen or found on exam. Given 12.5 mg of benadryl IV. EKG normal. CXR normal. Trop negative x 2. MOnitored for 3 hrs in the ED and had complete resolution of all symptoms and patient was feeling "normal". discharged home.


VAERS ID: 1885341 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / IM

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

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

Write-up: Moderna 0.25 ml administered for a Moderna primary series. The correct dose that should have been administered was 0.5 ml. No direct harm to the patient noted. Patient contacted and asked to return to receive an additional 0.25 ml if he could return same day or 0.5 ml if he will need to return on a different day. per the guidelines. Patient voiced understanding.


VAERS ID: 1885343 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 4L97X / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Immediate post-injection reaction, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE REPORTED
Preexisting Conditions: NONE REPORTED
Allergies: N/A
Diagnostic Lab Data: EMS called, refused by patient''s spouse. Recommended immediate ER visit.
CDC Split Type:

Write-up: pt had extreme chest pain and nausea immediately following vaccination


VAERS ID: 1885352 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2020-12-29
Onset:2021-11-19
   Days after vaccination:325
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Electric shock sensation, Headache, Malaise, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Headache, muscle aches, shocking pains, aching , weakness, overall malaise


VAERS ID: 1885379 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H218 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin, metformin, propranolol, olmesartan, Viagra
Current Illness: none
Preexisting Conditions: Diabetes, hypertension, hyperlipidemia
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccine given too early, 21 days after 1st dose


VAERS ID: 1885425 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

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

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

Write-up: Left axillary lymphadenopathy


VAERS ID: 1885465 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-13
Onset:2021-11-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, pantoprazole, atorvastatin, bystolic, vascepa, vitamin d 1000iu
Current Illness:
Preexisting Conditions: DM2, HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 week after vaccination, pt experienced intense pain and swelling of the left thumb joint which lasted for awhile, and resolved by taking otc NSAID.


VAERS ID: 1885472 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / UNK RA / IM

Administered by: School       Purchased by: ?
Symptoms: Chest discomfort, Feeling abnormal, Feeling cold, Hypoaesthesia, Malaise, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Pt was brought down by the staff c/o general malaise, feeling cold. As pt. sat with me longer she c/o chest discomfort and pain in both her arms and legs. Pt sat with me for 15 min and returned to normal activities. Came down 1 hour later with new c/o chest discomfort worsening and numbness in both hands and fingers and weakness and numbness in her legs. Pt said she feels "awful"


VAERS ID: 1885492 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immunisation, 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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client at COVID vaccine clinic POD to receive booster dose of Pfizer. Client inadvertently given 0.25 ml instead of the full 0.3 ml. Per CDC guidance, client notified of error and full dose immediately administered in opposite arm. Monitored for full time with no sign of reactions.


VAERS ID: 1885505 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / UNK - / IM

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

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

Write-up: While administering Moderna Covid vaccine boosters, the vile was punctured 22 times, and 22 doses were drawn up and administered.


VAERS ID: 1885506 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-11
Onset:2021-11-19
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1885508 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-12
Onset:2021-11-19
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond-use-date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended patient receive an additional vaccine.


VAERS ID: 1885510 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-11-19
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1885511 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysgeusia, Dyspnoea, Nausea, Pain, Paraesthesia, Tremor, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ 25MG DAILY DULOXETINE 30MG DAILY OXYBUTYNIN ER 10MG DAILY
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data: BP, PULSE OX, others unknown contact Healthcare for more info.
CDC Split Type:

Write-up: Patient received booster dose of Moderna vaccine in left arm at around 10:03 am on Friday, 11/19/21. A few minutes after vaccine administration patient complained of "weird metallic taste" in her mouth and was offered a bottle of water. After a few sips of water patient complained of a "tingling sensation" down left arm. Patients BP was checked and was 148/99. patient was then escorted upstairs to see nurse practitioner. I am unsure what tests/laboratory results were completed. As patient was coming down the steps she said she "hurt all over and was nauseated". Patient was helped down the stairs were she said she felt lightheaded and was having trouble breathing. Nurse practitioner listened to patient and said she was starting to wheeze and needed epinephrine. Pharmacist (me) called emergency number and administered 0.3 mg of epinephrine via auto injector. Patient began to shake all over and said she was still struggling to breath. patient was given 25 mg of liquid benadryl. The nurse then brought a solu medrol shot and administered it to patient in hip. Ambulance arrived a few moments later and took patient to Hospital.


VAERS ID: 1885515 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 1st dose: Seizure one day after vaccination
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced Left arm numbness 10-15 minutes after injection into L arm.


VAERS ID: 1885525 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Needle issue, Syringe issue
SMQs:, Medication errors (broad)

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

Write-up: Pt was given booster vaccine by our contractor and needle was not placed properly and when administered the covid vaccine in the syringe spilled out and none was given through the needle.


VAERS ID: 1885528 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Aggression, Alanine aminotransferase normal, Albumin globulin ratio normal, Aspartate aminotransferase increased, Basophil count normal, Basophil percentage, Bilirubin urine, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatine phosphokinase increased, Blood creatinine normal, Blood glucose decreased, Blood lactic acid increased, Blood potassium decreased, Blood sodium normal, Blood urea nitrogen/creatinine ratio, Blood urea normal, Blood urine absent, Body temperature increased, CSF glucose decreased, CSF mononuclear cell count increased, CSF protein increased, CSF red blood cell count, CSF test, CSF volume, Carbon dioxide normal, Chest X-ray normal, Chromaturia, Computerised tomogram head normal, Computerised tomogram spine, Confusional state, Cortisol normal, Culture urine, Differential white blood cell count, Eosinophil count normal, Eosinophil percentage, Full blood count, Globulins decreased, Glomerular filtration rate, Glucose urine absent, Gram stain negative, Haematocrit normal, Haemoglobin normal, International normalised ratio increased, Lumbar puncture, Lymphocyte count, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume normal, Mean platelet volume decreased, Meningitis, Mental status changes, Metabolic encephalopathy, Monocyte count increased, Monocyte percentage increased, Neutrophil count, Neutrophil percentage increased, Nitrite urine absent, Platelet count normal, Protein total decreased, Protein urine absent, Prothrombin time prolonged, Red blood cell count decreased, Red blood cells urine positive, Red cell distribution width normal, Rhabdomyolysis, Seizure, Similar reaction on previous exposure to drug, Specific gravity urine normal, Unresponsive to stimuli, Urinary casts present, Urinary incontinence, Urinary sediment present, Urine abnormality, Urine analysis, Urine ketone body present, Urine leukocyte esterase, Urobilinogen urine, White blood cell count increased, White blood cells urine negative, pH urine normal
SMQs:, Rhabdomyolysis/myopathy (narrow), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (narrow), Hostility/aggression (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Proteinuria (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (narrow), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: Moderna 3/15/21 030A21A
Other Medications: ? pantoprazole (PROTONIX) 40 mg EC tablet, Take 40 mg by mouth 1 (one) time each day before breakfast. Do not crush, chew, or split., Disp: , Rfl: ? pregabalin (LYRICA) 75 mg capsule, Take 75 mg by mouth 2 (two) times a day., Disp: , Rfl
Current Illness: lung melanoma, hypothyroidism and adrenal insufficiency
Preexisting Conditions: lung melanoma, hypothyroidism and adrenal insufficiency
Allergies: Per medical record no known allergies
Diagnostic Lab Data: Procedures performed: 10/10/21 1621 CT C-spine: No acute abnormality, 11/10/21 1222 Chest x-ray: No acute cardiopulmonary process and 11/10/21 1052 CT brain: No acute intracranial process Visit Vitals BP 118/61 Pulse 79 Temp (!) 38.7 �C (101.6 �F) (Oral) Resp (!) 7 Ht 1.727 m (5'' 8") Wt 81.6 kg (180 lb) SpO2 97% BMI 27.37 kg/m� Smoking Status Never Smoker BSA 1.98 m� CBC and differential Collection Time: 11/10/21 10:43 AM Result Value Ref Range Auto WBC 10.7 (H) 4.1 - 10.3 K/mm3 RBC 4.61 4.19 - 6.12 M/mm3 HGB 14.7 13.2 - 17.3 g/dL HCT 43.2 40.0 - 51.0 % MCV 93.8 78.6 - 98.1 fL MCH 31.9 (H) 27.0 - 31.0 pg MCHC 34.0 33.0 - 37.0 g/dL RDW 13.1 11.5 - 14.5 % Platelets 187 130 - 400 K/mm3 MPV 6.2 (L) 7.4 - 10.4 fL Neutrophils Relative 71 % Lymphocytes Relative 16 % Monocytes Relative 12 % Eosinophils Relative 1 % Basophils Relative 1 % Neutrophils Absolute 7.6 (H) 2.0 - 7.0 K/mm3 Lymphocytes Absolute 1.7 0.4 - 3.2 K/mm3 Monocytes Absolute 1.3 0.4 - 1.3 K/mm3 Eosinophils Absolute 0.1 0.0 - 0.4 K/mm3 Basophils Absolute 0.10 0.00 - 0.20 K/mm3 Comprehensive metabolic panel Collection Time: 11/10/21 10:43 AM Result Value Ref Range CO2 23 20 - 32 mEq/L Creatinine 0.98 0.76 - 1.27 mg/dL NA 141 134 - 144 mEq/L K 3.0 (L) 3.5 - 4.9 mEq/L CL 106 97 - 108 mEq/L BUN 19 8 - 27 mg/dL BUN/CREAT RATIO 19 GLU 62 (L) 65 - 99 mg/dL CA 7.6 (L) 8.6 - 10.2 mg/dL AST/SGOT 178 (H) 0 - 40 U/L ALT/SGPT 34 0 - 44 U/L ALK PHOS 43 25 - 160 U/L T.PROTEIN 5.6 (L) 6.0 - 8.5 g/dL ALBUMIN 3.4 (L) 3.6 - 4.8 g/dL T.BILI 0.6 0.0 - 1.2 mg/dL EGFR 79 $g60 mL/min GLOBULIN 2.2 2.0 - 3.9 g/dL A/G RATIO 1.5 1.1 - 2.5 Cortisol, RANDOM Collection Time: 11/10/21 10:43 AM Result Value Ref Range CORTISOL,RANDOM 8.1 2.3 - 19.4 ug/dL Protime-INR Collection Time: 11/10/21 11:37 AM Result Value Ref Range PROTIME 13.9 11.7 - 14.8 SEC INR 1.12 0.84 - 1.18 APTT Collection Time: 11/10/21 11:37 AM Result Value Ref Range PTT 27.1 23.0 - 36.5 SEC Lactic acid, plasma Collection Time: 11/10/21 11:37 AM Result Value Ref Range Lactate 2.2 (HH) 0.5 - 2.0 mmol/L URINALYSIS WITH REFLEX TO CULTURE Collection Time: 11/10/21 1:40 PM Result Value Ref Range Clarity, Urine Cloudy (A) Clear Nitrite, Urine NEGATIVE NEGATIVE Urobilinogen, Urine Negative 0.2, Negative E.U./dL Protein, Urine 100 (A) Negative mg/dL pH, Urine 5.0 5.0 - 8.0 Blood, Urine Large (A) Neg SPEC GRAV 1.021 1.001 - 1.035 Ketones, Urine 5 (A) NEGATIVE, TRACE mg/dL Bilirubin, Urine NEGATIVE NEGATIVE Glucose, Urine NEGATIVE NEGATIVE mg/dL Leukocytes, Urine NEGATIVE NEGATIVE Color, Urine Amber (A) Colorless, Light Yellow, Yellow, Straw WBC, Urine 2 0 - 5 /HPF RBC, Urine 2 (H) 0 /HPF Squamous Epithelial, Urine <1 0 - 5 /HPF Granular Casts, Urine 1 (H) 0 /HPF Hyaline Casts, Urine 4 (H) 0 /LPF Mucus, Urine Rare None Seen, Occasional, Rare, Few, NP /HPF CSF culture and sensitivitiy Tube # 1 Collection Time: 11/10/21 1:40 PM Specimen: Lumbar Puncture; Cerebrospinal Fluid Result Value Ref Range Gram Stain Result No organisms seen Glucose, CSF Tube #2 Collection Time: 11/10/21 1:40 PM Result Value Ref Range Glucose, CSF 48 40 - 70 mg/dL CSF protein Tube #2 Collection Time: 11/10/21 1:40 PM Result Value Ref Range Protein, CSF 65 (H) 15 - 45 mg/dL CSF Cell Count 2nd Count Tube #4 Collection Time: 11/10/21 1:40 PM Result Value Ref Range Tube Number, CSF Tube 4 Volume, CSF 4.0 mL Color, CSF Colorless Colorless Appearance, CSF Clear Clear CSF RBC MANUAL COUNT 1 /mm3 CSF NUC MANUAL COUNT 6 (HH) 0 - 5 /mm3
CDC Split Type:

Write-up: 11/10 patient found at on the floor unresponsive by family, when EMS arrived it appeared as though the patient had a seizure episode, urinated on himself and mental status was altered/combative. Patient treated in ED and admitted for altered mental status due to being confused and 101.6F. Per chart the patient had a similar reaction to the second dose. DISCHARGE DIAGNOSIS: -Acute metabolic encephalopathy, now improved Patient is now at baseline mental state Unclear if this is related to the recent COVID-19 vaccine booster dose Patient was found laying on the floor initially CT brain: Reviewed LP done in the ED - low suspicion for meningitis Initially started on empiric IV Rocephin Stable for discharge home today. Return if symptoms worsen. Follow-up with primary care physician -Rhabdomyolysis, improved CK level trended down with IV fluids


VAERS ID: 1885537 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

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

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

Write-up: Patient received first dose of Moderna on 10/9/21 at age 14. She received her second dose of Moderna on 11/19/21 to complete her series.


VAERS ID: 1885539 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol 25mg BID, ASA 325mg QD, Zyrtec 10mg QD, Prevalite 4.4g QD.
Current Illness: Persistent congestion, mild asthma and chronic rhinitis (years).
Preexisting Conditions: * Persistent congestion, mild asthma and chronic rhinitis (years). * AFIB diagnosed 2020-04. Genetic, first event in 1996. * obese bmi 31.5 chronic forever * IBS secondary to cholecystectomy since 2001 * adhd-i, anxiety, asperger?s
Allergies: Erythromycin causes nausea. (not present) Cedar pollen. (persistent)
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Slight tingling of tongue, lips, at 15 mins. Persisting hours. Mild soreness injection site


VAERS ID: 1885559 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenopia, Deafness, Dizziness, Immediate post-injection reaction, Lethargy, Malaise, Nasal congestion, Nausea, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Patient immediately felt ill after administration of the second dose of Pfizer. Patient felt dizzy, nauseous, had blurry vision and could not hear for a few moments. Patient complained that her nose got congested and that her eyes felt extremely heavy and she felt extremely lethargic. Patient did not lose conscientiousness at any time. We immediately put her to sit next to her father in the waiting area, applied an ice pack to her neck and gave her some water. We continued to talk to her to keep her awake and alert. Father asked that we call the paramedics which we did and in the meantime prior to their arrival we continued to engage the patient in conversation. She had no difficulty breathing at any time. Paramedics came, we informed them of the event and they offered to take the patient in for medical attention. The father and daughter both declined transport via ambulance to the hospital. After about 30 minutes, the patient was better, the symptoms for the most part had subsided and she was able to stand up and walk out with her father.


VAERS ID: 1885573 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Patient recieved first dose of Pfizer vaccine in left arm. Patient fainted immediately after administration. Patient was hot to the touch and sweating. Brought patient water and placed cool compress on back of neck. Seat with patient as he recovered.


VAERS ID: 1885584 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 AR / IM

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

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

Write-up: presented to the vaccination site on 11/19/2021 at 1055 requesting dose 2 of the Pfizer COVID vaccine. The client notified that she received a single dose of Janssen COVID vaccine on 3/10/2021 and dose 1 of Pfizer COVID vaccine on 10/28/2021. Patient reported medical conditions include asthma, reactive airway disease, and GERD. Allergies include amoxicillin, Rocephin, ibuprofen, NSAIDs, shellfish, Septra. Medications include azelastine, flucatisone, Protonix, Pulmicort, Singulair, Spiriva, Symbicort, and frequent use of up to 60mg of Prednisone, last use 1 month ago. Patient showed a medical note from provider recommending the patient receive the full Pfizer series. Patient reported feeling lightheaded with mild dysphagia after receiving the Janssen dose, no side effects to the 1st dose of Pfizer. submitted a medical consult via text message to Vaccine Operations Leads, requesting to proceed with the COVID vaccine Pfizer. Approval to proceed with COVID vaccine Pfizer dose 2 was obtained from medical consult team via text message from RN, Vaccine Operations Lead. Client received COVID vaccine Pfizer LotFF8841 on 11/19/2021. The client did not report any symptoms during the 30 minute observation period. RN educated client on possible adverse reactions and when to seek medical care. The client left the vaccination site at 1205 walking with steady gait.


VAERS ID: 1885608 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM

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

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

Write-up: Patient presented for COVID19 Pfizer booster. Her primary series was with Moderna COVID 19 vaccine over 6 months ago. Approximately 15 minutes post-vaccination, reported lightheadedness. No dizziness, weakness or blurry vision. Provided water and crackers. BP at 11:08 85/53. Recheck 10 minutes later same. Patient transferred to stretcher to lay down. Patient reported not eating prior to coming in, so was given additional water, graham crackers, juice. BP at 11:54 104/63. Reported feeling better but wanted to stay for observation. Additional BP rechecks stable. She felt improved and left with caregiver around 12:50. PCP office notified.


VAERS ID: 1885621 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: The patient jerked downwards from the needle, resulting in a subdermal prick and bending the needle. That needle was null and void. The majority of vaccine ''dispersed'' on the outside of the arm.


VAERS ID: 1885632 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 LA / IM

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

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

Write-up: Patient received full 0.5ml dose, not 0.25ml. Pt is not immunocompromised.


VAERS ID: 1885637 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-17
Onset:2021-11-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F63527 / 3 LA / IM

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

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

Write-up: Pt. states that after receiving the 3rd Booster of Phizer 11/17/2021, started experiencing symptoms 11/19/2021 of swelling under the left armpit area and pain. No noted Primary visit/communications.


VAERS ID: 1885648 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-08
Onset:2021-11-19
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Anion gap increased, Blood bicarbonate decreased, Blood creatinine normal, Blood glucose increased, Blood ketone body, Blood lactic acid increased, Blood pH normal, Blood potassium normal, Blood sodium decreased, COVID-19, Computerised tomogram abdomen normal, Condition aggravated, Diabetes mellitus, Electrocardiogram normal, Haemoglobin normal, Hyperglycaemia, Laboratory test, Oedema peripheral, Platelet count normal, SARS-CoV-2 test positive, Somnolence, White blood cell count normal
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Hypoglycaemia (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Diabetes Mellitus Type 1 Hyperglycemia (HCC) Hepatomegaly Anemia Macrocytic Elevated Liver Enzyme Test Abnormal Laboratory Results Hyponatremia COVID-19 Infection Non-Hospital Anasarca
Allergies: NKA
Diagnostic Lab Data: 11/19/2021 Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: PFizer 6/8/21, 7/1/21, 10/26/21 CHIEF COMPLAINT Hyperglycemia HISTORY OF PRESENT ILLNESS Patient is a 21 y.o. female with medical comorbidities including type 1 diabetes, transaminitis likely due to NASH, and macrocytic anemia who presents with hyperglycemia. She had an outpatient video visit on 11/17 for evaluation of lower extremity edema, abdominal swelling, and worsening type 1 diabetes. See the note of Dr. on 11/17 for a very detailed recent patient history. Essentially, she has had a couple of admissions for DKA along with some issues with severe transaminitis thought to be due to NASH. She has some labs obtained 11/18 following this visit and they showed a glucose over 900 and a sodium of 118. She was then told to come into the emergency department. In the emergency department, vital signs were largely unremarkable. Labs showed a normal hemoglobin, WBC, and platelet count. Sodium was 125, bicarbonate 20, anion gap 22, potassium 4.5. Creatinine was normal. She had a undetectable beta hydroxybutyrate. Initial lactate was quite elevated at 9.1. She was given 2 L of IV fluids in the subsequently improved to 4.4. VBG showed a normal pH of 7.37. CT abdomen and pelvis showed no acute findings. ECG was unremarkable. She incidentally tested positive for COVID with no symptoms. She is vaccinated. She was not given any insulin, but she was admitted to the floor. On arrival to the floor she was lying in bed. She appeared sleepy but would answer questions. She states that she normally takes 33 units of Lantus in the morning and 1:10 carb correction. She denies any cough, chest pain, shortness of breath, or abdominal pain.


VAERS ID: 1885651 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-11-19
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1885654 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-11-19
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Stored beyond use date. Moderna analysis requested. Full vaccine efficacy not shown. Recommended that patient receive an additional vaccine.


VAERS ID: 1885661 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Immunisation, Incorrect dose administered, Incorrect route of product administration, Injury associated with device, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Drug abuse and dependence (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The patient jerked to the right and the needle entered the sub-dermal layer of the patient and caused it to be raised and red. A second needle was utilized the patient got scrapped by the needle tip before it even got close to the arm this was also wasted due to bloodborne pathogen risks and concerns. The 3rd attempt was done fine after the mother had a bear hug the patient with back rub support.


VAERS ID: 1885662 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Incomplete course of vaccination
SMQs:, Medication errors (narrow)

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

Write-up: Child pulled out needle before administration


VAERS ID: 1885668 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Influenza like illness, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec (20mg) Advil (400 mg)
Current Illness: None
Preexisting Conditions: None
Allergies: Eggs, nuts, shellfish, melons
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild to moderate flu-like symptoms five hours after injection; relieved with OTC ibuprofen. Moderate flu-like symptoms new onset 26 hours after vaccine administration, not relieved by ibuprofen. Extreme fatigue, mild chills, mild fever, slight cough.


VAERS ID: 1885672 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyskinesia, Gaze palsy, Malaise, Nausea, Seizure, Unresponsive to stimuli
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none reported
Allergies: nkda
Diagnostic Lab Data: The patient was placed on her left side and attended to by three registered nursing staff members during the event. EMS was called and arrived on the scene promptly. Pt BP at 0850 was 79/50 and she was unable to sit without feeling faint and nauseous. She was transported by EMS to ER
CDC Split Type:

Write-up: Approximately 10 minutes after receiving the vaccine the patient reported to the nurse that she was "not feeling well and I feel like I am going to faint" The nurse seated the patient. The patient began to have seizure-like symptoms to include eyes rolling back in her head, arm and limb jerking, not responding to verbal stimulation. These s/s continued for approximately 45 seconds. After muscle jerking stopped the patient remained unresponsive to verbal stim for approximately one minute.


VAERS ID: 1885682 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Differential white blood cell count, Electrocardiogram normal, Fibrin D dimer, Full blood count, Heart rate increased, Hyperhidrosis, Metabolic function test, Palpitations, Sinus tachycardia, Troponin I
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ED EKG normal, BMP, CBC w/auto diff, D Dimes, Manual Different, tripoli l completed. Dr said findings were normal.
CDC Split Type:

Write-up: Palpitations, Sinus Tachycardia. Woke up in the middle of the night, around 2 am.. I was sweaty, clammy, and my heart was beating really fast. My resting heart rate jumped between 105 and 140 and has stayed high since. I went to the emergency room. EKG and blood work was normal so they sent me home a d recommending I rest. Heart rate is now resting at around 100bpm, so it has gone down a bit.


VAERS ID: 1885700 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-08
Onset:2021-11-19
   Days after vaccination:284
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, COVID-19, Exposure to SARS-CoV-2, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, clonidine, coumadin, hydralazine, levothyroxine, preservision, propranolol, seroquel, levetiracetam, megace, senna s
Current Illness: none
Preexisting Conditions: dementia, asthma, PTSD, anxiety DO, hyperlipidemia, afib, mitral valve prolapse, HTN, OA, epilepsy
Allergies: ampicillin, enalapril, erythromycin
Diagnostic Lab Data: Rapid molecular covid test, positive for covid 11/19/21.
CDC Split Type:

Write-up: tested for covid r/t temp of 102 F and known recent exposure to covid positive individual- tested positive for COVID


VAERS ID: 1885715 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / UNK LA / IM

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

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

Write-up: dose given only one month after 2nd dose of Pfizer vaccine. Given too soon.


VAERS ID: 1885717 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received pediatric 10mcg dose of Pfizer vaccine instead of the 30mcg dose of Pfizer vaccine. Communicated error with patient and her mother and the plan for her 2nd dose of vaccine.


VAERS ID: 1885731 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:2021-11-19
Onset:2021-11-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hyperventilation, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: At 12:05pm pt. c/o dizziness, feeling nauseated , hyperventilating and diaphoretic . Helped pt. to the floor in a supine position with legs elevated, encouraged slow deep breaths. V/S included; BP=142/90, HR=67, O2 sat=99%. Pt. A&O X4. Loosened pt.''s clothing, Applied icepack at the back of her neck, offered RM temp H2O and some animal crackers.( Pt. reported not having eaten for a long time) .At 12:26pm pt. reported feeling better with no dizziness. Pt. was d/c at 1pm in a stable condition, No ambulation problems noted. Pt. did not incur any injuries, trauma or falls while at the clinic.


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