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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 543 out of 10,317

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VAERS ID: 1882669 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

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

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

Write-up: 10 year old female paient was administered an adult dose of Pfizer covid 19 vaccine. No adverse affects present at this time.


VAERS ID: 1882673 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / ID

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

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

Write-up: Patient was fine standing up and walking out of consultation room. Once she exited she said something to her mother about not feeling well, eyes rolled back and she passed out into a chair. Patient immediately came to, and was attended to. She was very pale, but speaking and seeing clearly. She sat for about 15 minutes and was able to leave with mother.


VAERS ID: 1882676 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Potassium 20mg Vitamin B12 Chews (OTC) Altavera Cyanocobalamin Magnesium 400mg (OTC) Multi-Vitamin (OTC)
Current Illness: Stomach virus 3 weeks prior
Preexisting Conditions: Short Gut Bowel Syndrome Hypothyroidism
Allergies: None
Diagnostic Lab Data: Not applicable at this time.
CDC Split Type:

Write-up: Tingling, numbness in the hands, feet, and face. "Pins and needles" feeling.


VAERS ID: 1882679 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Chest pain, Dysarthria, Extra dose administered, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Medication errors (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Continued monitoring BP 137/83 Pulse 79, temp 36.3. Rechecked BP 129/82 Pulse 88
CDC Split Type:

Write-up: Patient came to the clinic after received booster of COVID-19 Pfizer vaccine at 1430, noticed 45minutes to one hour numbness on right side of face, arm and leg, slurred speech noted by her sister. Patient also complained of burning sensation on chest area.


VAERS ID: 1882680 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Non-cardiac chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Chest pain, not the heart, just the chest


VAERS ID: 1882689 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Emt responded.
CDC Split Type:

Write-up: Five minutes after the shot, He lost consciousness without warning and fell from his chair onto the floor.


VAERS ID: 1882894 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DENTAL SURGERY - 11/11/21 ANTIBIOTICS - CEPHALEXIN ACETAMINOPHEN -CODINE; IBUPROFEN
Current Illness: HIGH BLOOD PRESSURE - HYDROCHLOROTHIAZIDE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: TIREDNESS; SORE ARM & NECK, CHILLS AND FEVER, HEADACHE


VAERS ID: 1882898 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-01
Onset:2021-11-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anovulatory cycle, Progesterone
SMQs:, Fertility 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: Femara
Current Illness: Cold 1 week prior
Preexisting Conditions: PCOS
Allergies: None
Diagnostic Lab Data: Took labs for progesterone on 11/17/21 that confirmed I don?t ovulate this month
CDC Split Type:

Write-up: On fertility treatment. Ovulated last two months but did not ovulate this month after second dose of vaccine and my fertility medication did not change at all.


VAERS ID: 1882903 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: Patient was given an undiluted Pfizer pediatric dose today on 11/18/21 around 4:30 PM. We were in between vials, and I asked a technician to draw up more, but they didn''t realize they had to dilute the vaccine before. I called the parent to let them, and I advised them on what to expect (increased flu-like symptoms). I also let them know to call if they had any questions or concerns, but as of yet they had no side effects.


VAERS ID: 1882909 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 3 LA / IM

Administered by: Work       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 listed
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given Pfizer Booster at age 15 years . Attempted to notify father, left message on voicemail. No return phone call at this time.


VAERS ID: 1882916 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-15
Onset:2021-11-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Locating 100mg, HCTZ 25mg, Clonidine .01 mg
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: Sulfa, lincocin and omnicef
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Round red area at site of injection.


VAERS ID: 1882923 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 1 LA / IM

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

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

Write-up: Patient received booster dose instead of a regular dose


VAERS ID: 1883110 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Injection site vesicles, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Blister on the injection site, slight pain and slightly swollen and painful.


VAERS ID: 1883117 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar adverse effects from 2nd Pfizer covid vaccine, however that also included nausea and vomiting.
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma, obesity, smoker
Allergies: Aspirin, sulfa, certain adhesives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, muscle aches, chills started around 6am. Fever started around 4pm (101.8 highest)


VAERS ID: 1883122 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: FAINTED


VAERS ID: 1883125 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Exposure during pregnancy, Hot flush, Joint range of motion decreased, Pain in extremity, Tinnitus, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: 28 weeks pregnant Arm so sore I cannot move, along with chills causing shaking uncontrollably and hot flashes. Hearing ringing or whispering around 10pm


VAERS ID: 1883132 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Diplopia, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, magnesium, D3, zinc, zyrtec, ibuprofen
Current Illness:
Preexisting Conditions: OA, shoulder injury, peripheral neuropathy from foot drop, other arthritis including back, meralgia parenthetical, Hashimotos, Sleep Apnea
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blurry vision, double vision


VAERS ID: 1958430 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A unknown.
Current Illness: N/A. None.
Preexisting Conditions: -
Allergies: N/A None per mom.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 min after Vaccine administration, Pt. needed to.go to. Restroom. In Restroom she passed out for coulple seconds and then came out to mom.When hugging mom she again fainted. for seconds. Mom Laid her down. Rpn was by the childs side and child was awake and was.dizzy.wanted to just lie on floor. 911 were called. and Pt was OK


VAERS ID: 1884287 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 LA / IM

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

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

Write-up: Patient was given first dose of Janssen Covid vaccine with no issues upon administration. He was sitting during observation period and fainted after about 10 minutes. I checked on him immediately and he was alert and responsive. EMS was called and they checked and cleared him.


VAERS ID: 1884423 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

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

Write-up: The vaccine administered expired on 11/7/2021 10 days past the expiration date. .Vaccine administration error.


VAERS ID: 1884647 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-18
Onset:2021-11-18
   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: Crying, 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), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Additional Details: Pt s/p IM vaccine laughing walking around while sister being vaccinated pt fainted while standing, pt was responsive immediately afterwards mother informed this nurse afterwards of Hx of dizziness with flu vaccine. pt was cryting s/p vaccine mom holding pt. No cervical spine or para spine tenderness. pt A&Ox3 clear speech no Hx of blood thinners. Mother ED nurse agreeable to watch pt for any issues and bring pt to ED for any issues. BP prior to leaving 114/75 LA sitting and HR 102 Regular


VAERS ID: 1884675 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 / 1 RA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1884678 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-11-01
Onset:2021-11-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Dizziness, Hypoaesthesia, Nausea, Renal pain, Spinal pain
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (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: Severe nausea, dizziness, low back pain,
Current Illness: No other illnesses. I WAS healthy before.
Preexisting Conditions: None.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe dizziness, nausea, bilateral low back, kidney pain. Still have numbness in extremities and spinal pain.


VAERS ID: 1884680 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-18
Onset:2021-11-18
   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: Underdose
SMQs:, Medication errors (broad)

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

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


VAERS ID: 1884684 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 / -

Administered by: Military       Purchased by: ?
Symptoms: Bone pain, Headache, Menstruation delayed, Myalgia, Pain, Pyrexia, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Osteonecrosis (broad), Fertility disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe headache lasting 2 days, fever, ringing of ears, aches and pains in bones and muscles, missed period


VAERS ID: 1884685 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 FH8030 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Bradycardia, Dizziness, Flushing, Hyperhidrosis, Hypotension, Pallor, Pupil fixed, Seizure, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Seizure-Medium, Systemic: Weakness-Medium, Additional Details: 5 MINUTES AFTER ADMINISTRATION, PATIENT EXPERIENCES SEIZURE FOR ABOUT 5 SECONDS, PUPIL FIXED, PALE SKIN, SWEATING, LOSS OF BALANCE. HYPOTENSION (BP 104/61) . BRADYCARDIA (HR 49). PT RECOVERED FROM BRADYCARDIA IN ABOUT 15 MINS, AND HIS LIPS COLOR RETURNED BACK TO RED/PINK. PT WAS ABLE TO COMMUNICATE HE''S FEELING BETTER. AFTER 30 MINS HIS BP 115/87 THEN 123/88. HR 70 THEN 76. OXYGEN LEVEL 99. FOLLOWED UP WITH PATIENT. HE IS HOME AND FEELING FINE.


VAERS ID: 1884689 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 FH8027 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Flushing, Hyperhidrosis, Immediate post-injection reaction, Injection site pain, Nausea, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Additional Details: Immediately after injection, pt reported severe pain at injection site, nausea, dizziness and felt like he was going to pass out. Gave pt water and he felt like he was going to vomit. Patient very weak and almost passed out while sitting in chair. Patient asked to lay on floor and was moved to floor. Pharmacist called 911 to report symptoms/ask for EMS to come check vitals. While waiting for EMS patient improved and father did not allow EMS to check patient. Patient left on own.


VAERS ID: 1884693 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-02
Onset:2021-11-18
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Decreased appetite, Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Systemic: Abdominal Pain-Severe, Systemic: Diarrhea-Mild, Systemic: Vomiting-Mild, Additional Details: Mother reported that patient has some abdominal pain on and off 3 weeks getting the 2nd Pfizer vaccine. Patient loses appetite and has severe stomach cramps. I advised mother to take patient to an urgent care or emergency room if symptoms have not subsided.


VAERS ID: 1884702 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Pain, Skin warm, Sleep disorder
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 70, March 2021, COVID 19 Moderna #2
Other Medications: Atorvastatin
Current Illness: None
Preexisting Conditions: Allergic Rhinitis
Allergies: NKMA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started feeling achy all over 10:30 PM last night after vaccine. Awake several times during the night. Wife was awakened by my shivering with chills about 3:00 AM this morning. Chilling badly with a sheet and 2 quilts on me. Awake 6:00 AM, too warm, no fever. Very sore across upper back.


VAERS ID: 1884705 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / IM

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

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

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


VAERS ID: 1884709 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 FH8030 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Nausea-Mild, Systemic: Vomiting-Mild


VAERS ID: 1884859 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: vomiting, diarrhea, chills, high fever, sweats, muscle aches Age 66, Moderna, 2nd Covid 19 vaccine, 3/18/21
Other Medications: synthroid, progesterone, estrogen, vitD, Calcium, De3 omega Benefits, AReds2, Pepcid
Current Illness: osteoperosis, bulging disc, heart aneurysm
Preexisting Conditions: same as 11
Allergies: lactose intolerant
Diagnostic Lab Data: none
CDC Split Type: 031AZ1A

Write-up: Nausea, chills and high fever for approximately 12 hours


VAERS ID: 1884870 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855191 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl, Lisinopril, Amlodipine
Current Illness: n/a
Preexisting Conditions: hypertension, hyperlipidemia, A fib, Wolfe Parkinson white syndrome
Allergies: Bupropion, clindamycin, gabapentin, morphine, pantoprazole, omeprazole, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started having dizziness at 1459. Took her back to an exam room and did vitals. Patient was hypertensive and admits to taking her BP meds this morning. She denies any shortness of breath, hives, chest pain, or chest tightness. Monitored patient for x2 rounds of vitals and patient remains hypertensive. Nurse STAT called at 1518. She is evaluated by RN and she is transferred to the urgent care for further evaluation. No medications administered. Patient took benadryl 20 min prior to her vaccine.


VAERS ID: 1884888 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Incontinence, Lethargy, Pyrexia, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Metoprolol, Sertraline
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: She was evaluated at the local Hospital ER
CDC Split Type:

Write-up: Fever of 103, Mental Confusion and unresponsiveness, Incontinence, extreme lethargy


VAERS ID: 1884920 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-09
Onset:2021-11-18
   Days after vaccination:9
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: Food allergy, Lacrimation increased, Lip swelling, Ocular hyperaemia, Paraesthesia oral, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Eczema
Allergies: fragrented soaps, detergents, etc
Diagnostic Lab Data: Scheduled for allergy testing 11/22/21
CDC Split Type:

Write-up: New onset of tree nuts allergy 9 days after receiving vaccine. Tingling of mouth, eyes became red, itchy, and watering, vomited twice, slight swelling of lips. Symptoms relieved with benadryl.


VAERS ID: 1884929 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 RA / IM

Administered by: Work       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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: On cdc checklist pt states they are immunocompromised and should have received a 0.5ml dose but instead received 0.25ml.


VAERS ID: 1884936 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
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: Public       Purchased by: ?
Symptoms: Body temperature increased, Injection site pain, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid vaccine (moderna) pain in injection sight. January 5, 2021. Age 45.
Other Medications: valacyclovir
Current Illness: none
Preexisting Conditions: shingles
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in arm at injection sight. Elevated temperature. Full body aches.


VAERS ID: 1884951 (history)  
Form: Version 2.0  
Age: 4.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-18
Onset:2021-11-18
   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: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1884954 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Computerised tomogram head, Gait inability, Laboratory test, Pyrexia, Rash, Urine analysis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, insulin, dyazide, lisinopril, Zetia, colchicine,
Current Illness: none
Preexisting Conditions: diabetes, Ava, hypertension, hyperlipidemia, CAD, cardiac stent
Allergies: niacin, iodine, statins
Diagnostic Lab Data: Head CT, CXR, UA, and lab work.
CDC Split Type:

Write-up: Severe weakness and inability to walk and prompted an emergency room visit after an ambulance ride. Fever and a mild rash also noted. Weakness has lasted approx. 9 so far, fever has diminished.


VAERS ID: 1884955 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 / IM

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

Write-up: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1884966 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-25
Onset:2021-11-18
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies: Ceclor
Diagnostic Lab Data: 11/18/21 COVID-19 RESULT detected Abnormal
CDC Split Type:

Write-up: 11/18/21 Unknown, nothing listed in note


VAERS ID: 1884968 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 FH8027 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram normal, Hyperhidrosis, Loose tooth, Loss of consciousness, Pyrexia, Skin laceration, Sleep disorder, Syncope, Tooth fracture
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), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: ER visit within 30 minutes of event. All CT / blood tests came back negative. ER Doc implied that it was part of an extreme immune reaction to the Pfizer Booster shot, and possibly dehydration due to lost fluids overnight (fever sweats). Dentist estimates 4-6 weeks for fracture to heal. Cannot bite with front teeth until then.
CDC Split Type:

Write-up: Fever / chills began at bedtime. Barely slept, alternating between chills and profusely sweating all night. In morning, took a shower and fainted / lost consciousness without any warning in shower. Impacted side of tub and impact caused large laceration in chin (lower incisors cut all the way through) and loosened/mobile lower teeth, including small lower tooth fracture discovered by dentist x-rays. (Patient is healthy with clean medical records. Never fainted or abruptly lost consciousness before; no history of such events.)


VAERS ID: 1884979 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

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

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

Write-up: Coordinator is responsible for filling syringes with Moderna vaccine for mass injection sites. A few syringes with retractable needle were aspirated/being prepared for drawing up vaccines from multi dose vial of Moderna Booster. They got mixed up with the vaccines that already were filled with a dose of Moderna. RN administered one on patient at 8:34am. Upon doing so she noticed that it felt very "Airy". She then let me know of the empty syringes and I removed them. I prepare 20 vaccines at a time and place 10 at a time to administer so only the one was missing. Provider spoke to patient and asked if he was feeling any symptoms like he felt when he first got the two first full doses. He states he was not having those symptoms, provider recommended he come back in two weeks and we can administer the booster again. No other symptoms or physical complaints from patient.


VAERS ID: 1884988 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, 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), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Additional Details: Experienced syncope within 5 minutes of receiving vaccine. He bumped his head when he fell. Paramedics showed up and determined he didn''t need emergency care. He was given an ice pack for his head and wasn''t sure if he would go to urgent care after to treat his head. He denied experiencing any confusion or nausea after hitting his head.


VAERS ID: 1884994 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb injury
SMQs:, Accidents and injuries (narrow)

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

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1884997 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 FH8030 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysphagia, Flushing, Hyperhidrosis, Hypotension, Nausea, Seizure, Syncope, Throat tightness, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Nausea-Medium, Systemic: Seizure-Mild, Systemic: Vomiting-Mild


VAERS ID: 1885025 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 FH8028 / UNK RA / SYR

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

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

Write-up: Chills, fever, headache, body aches, swollen lymph in armpit


VAERS ID: 1885032 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain, Headache, Hypertension, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient stated that he had Headaches, Fever, Lower back pain, chest pain, heart palpitations, and high blood pressure.


VAERS ID: 1885033 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 PHIZZER FF2590 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 20 mg Acetaminophen 500 mg Vitamin D 125mcg Iron 65 mg
Current Illness: Diabetes A1C 7.0
Preexisting Conditions: Osteoarthritis in both hips
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm was very soar on 11/18/2021 The same day I noticed under my left armpit swelling and it is very soar. I am waiting to see if these symptoms go away. If the symptoms do not go away I will follow up with my primary care doctor.


VAERS ID: 1885042 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Amlodipin valsartan Acyclovir
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: Sulfas Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever Chills Body aches Nausea Very bad headache


VAERS ID: 1885045 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-11-18
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010MZ0A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID PCR positive 11/18/21
CDC Split Type:

Write-up: Breakthrough COVID admission 11/18/21


VAERS ID: 1885046 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 320308D / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose, Blood magnesium, Dyspnoea, Electrocardiogram, Full blood count, Hypotonia, Seizure
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), 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: Hydrochlorothiazide 25mg by mouth for high BP; Flonase 2 sprays each nostril (inflammation of nose due to allergy); Valacyclovir 500mg tab; Ascorbic acid, Vitamin C 100mg tablet daily by mouth; Cholecalciferol, Vitamin D3 25mcg (1.000 unit
Current Illness: Anxiety disorder
Preexisting Conditions: Unknown. Co-worker stated patient has a tumor on the spine and went to the hospital in August for seizures.
Allergies: Morphine (hives)
Diagnostic Lab Data: CBC, MG, Glucose, EKG.
CDC Split Type:

Write-up: 11/18/2021, at 1:17 pm: Received Pfizer (1st dose). 11/18/2021, at 1:25 pm: She had trouble breathing. Assisted to a nearby chair closer to the treatment room, then directly assisted to a treatment room a few feet away. Blood pressure being taken when she became limp. Immediately assisted to the floor. 911 called. B/P 184/71-97- 98 percent O2 SAT. She had 4 seizures before ambulance service arrived. 11/18/2021, at 1:32 pm ambulance arrived. VS taken: B/P 145/78-113-O2 SAT 98 %. She is conscious, brought pocketbook to her. Family notified by phone. Patient on stretcher and transferred to ED.


VAERS ID: 1885052 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 LA / IM

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

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

Write-up: No adverse event. This dose was administered after the expiration date.


VAERS ID: 1885064 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Similar reaction to second Moderna.
Other Medications: Lotrel; Pravachol; levothyroxine; gabapentin
Current Illness: Sinusitis
Preexisting Conditions: HTN, hypothyroidism, hyperlipidemia,
Allergies: Latex; penicillin; macrodantin; tetracycline
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever maxed at 101.7 Heart rate 110-120 Nausea Chills Body aches Severe headache


VAERS ID: 1885072 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 RA / IM

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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Amlodipine, Iron, Gabapentin, Metoprolol, Asmanex, Miralax, Systane Eye drops, Warfarin
Current Illness: NA
Preexisting Conditions: Heart conditions, Hx of CVA, CKD, Anemia,
Allergies: Statins, Benadryl, Requip
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given a dose (0.5mL) of Moderna out of a vial that had been opened $g12hours.


VAERS ID: 1885073 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-02
Onset:2021-11-18
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bundle branch block left, Electrocardiogram abnormal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, Thyroxine, Lipitor, Metformin, Piaglitazone, Lasix. Omeprazole
Current Illness: None
Preexisting Conditions: Diabetes Type 2 Hypertension Hypothyroid
Allergies: None
Diagnostic Lab Data: EKG on 11/18/2021
CDC Split Type:

Write-up: I have developed partial LBBB on EKG. No other symptoms - could be coincidental


VAERS ID: 1885076 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Swollen lymph nodes in neck opposite side of first injection
Other Medications: None
Current Illness: Allergy-seaonal
Preexisting Conditions: None
Allergies: Penicillin,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen lymph nodes within approx 24 hrs of vaccine on left side between under arm a breast. - still extremely swollen. Fever starting approx 12-16 hours later lasting 24 hours . Note: I had extreme lymph node swelling in right side of my neck following my first shot ( nothing for second shot)


VAERS ID: 1885078 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 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: none
Current Illness: none
Preexisting Conditions: auto immune disorders
Allergies: nka
Diagnostic Lab Data: none needed
CDC Split Type:

Write-up: patient received .25 ml of booster but thought he received a full dose for a 3rd dose. Dr told him to come get a 3rd dose but had booster. Patient informed that it was .25 not .5 and he was told he could receive the other .25 ml but did not want restuck. He said he may return in the next 2 weeks to receive the other .25 and was told after that he would need to wait for 6 months if a booster was then wanted. No adverse effects to patient just not the full dose given for a 3rd dose for immunocompromised individual.


VAERS ID: 1885080 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-18
Onset:2021-11-18
   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: Incorrect dose administered, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no medications on file
Current Illness: contact dermatitis diagnosed 11/6/2021
Preexisting Conditions: HSP (Henoch Schonlein purpura) Juvenile xanthogranuloma Compulsive Behavior Nonintractable headache
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pfizer Covid-19 adult dose given in error. Peds dose was ordered but not given. Sore arm, no other symptoms


VAERS ID: 1885083 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-16
Onset:2021-11-18
   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 / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Pain, Pruritus, Skin warm, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Large red spot (size of baseball) around injection site. Hot, slightly itchy, tender. Ibuprofin minimizes the pain and swelling.


VAERS ID: 1885087 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Seizure
SMQs:, Anaphylactic reaction (narrow), Systemic lupus erythematosus (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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:
Other Medications: Dupixent, gabapentin, cymbalta,
Current Illness: None
Preexisting Conditions: Asthma, chronic sinusitis, fibromyalgia , CFS
Allergies: NSAIDS
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anaphylaxis & seizures


VAERS ID: 1885094 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-12
Onset:2021-11-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Angiogram cerebral normal, Anticoagulant therapy, Arteriogram carotid normal, Blood glucose increased, Chest X-ray normal, Computerised tomogram head normal, Confusional state, Dysarthria, Full blood count, Haemoglobin decreased, Hypertension, International normalised ratio normal, Ischaemic stroke, SARS-CoV-2 test negative, Troponin normal, White blood cell count normal
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine/benazepril, ascorbic acid, aspirin, atenolol, atorvastatin, celecoxib, cyclobenzaprine, glucosamine/chondroitin, levothyroxine, misoprostol, multivitamin, nystatin, omeprazole, Senna, trazadone
Current Illness: s/p lumbar spinal fusion 10/5/21
Preexisting Conditions: hyperlipidemia, hypothyroid, hypertension, DVT (~2011), CAD, carpel tunnel, arthritis, 3 cardiac stents placed ~2003
Allergies: codeine
Diagnostic Lab Data: CT Head: Unremarkable. No hemorrhage or acute changes. CTA Head: Unremarkable. No large vessel occlusion. No high grade stenosis. No aneurysm. CTA Neck: Unremarkable. No large vessel occlusion. No high grade stenosis. No dissection
CDC Split Type:

Write-up: 11/18/21: pt presents to ED with slurred speech and confusion for an hour pt was worked upi with following note: ] "Acute ischemic stroke (HCC) Hypertension, unspecified type Diagnosis management comments: Patient presents to the emergency department slurred speech. Brain attack protocol was initiated. CT the brain shows no acute intracranial findings. Chest x-ray shows limited evaluation with no radiographic evidence of acute cardiopulmonary disease. CTA head and neck shows1. No hemodynamically significant stenosis at the extracranial carotid or vertebral arteries. 2. No intracranial large vessel occlusion or flow-limiting stenosis. CBC shows a normal white count and hemoglobin 11.7. INR is normal. Chemistry shows a glucose of 124 otherwise normal. Troponin is normal. Covid is negative. Brain attack protocol was initiated. The eICU neurologist evaluated the patient and felt that he should get TPA. She discussed with wife at bedside and consulted for the TPA. Patient and wife did agree to the TPA. " - TPA given 11/18/21 14:05


VAERS ID: 1885096 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Pain
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Lymph nodes swollen on left side of neck (right above collarbone) & in front of left armpit. Started to hurt the middle of yesterday and puffed up more overnight (2nd night after vaccine). General body aches yesterday (day after shot) but not as many today although swelling is a bit worse. Tender to the touch.


VAERS ID: 1885101 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Heart racing, fainting (even while laying down), cold sweats. The alarming part was my heart and the fainting response even while laying down.


VAERS ID: 1885106 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 / 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: A 12-year-old patient received the wrong dose of Pfizer vaccine (patient underdosed). Instead of receiving the adult Pfizer-BioNT dose, patient received Pfizer-BioNT COVID-19 tris (5 to 11-year-old) VAC (PF)10 mcg/0.2mL IM susp (EUA). Parents notified of underdosing and declined the recommended additional immediate vaccination with Pfizer adult dose. Parents plan to have their child receive the second vaccine in 21 days.


VAERS ID: 1885115 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pain in shoulder, but not as bad as with the booster.
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling of upper arm and pain at injection site. Started to feel some pain in shoulder. Still painful on 11/19. Moving it to keep it from getting stiff and taking over the counter pain med IBU. No pain in shoulder now. just around area of injection .


VAERS ID: 1885116 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 FE3590 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, singulair, Zyrtec.
Current Illness: none.
Preexisting Conditions: asthma, allergies.
Allergies: tree nuts and eggs.
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: Child was given adult dose of Pfizer Covid-19 vaccine; Instead of 0.2ml he received 0.3ml. No immediate reactions or side effects. After waiting 30 minutes, still no reactions and child went home with his mother symptom free. Will call next day to check on child.


VAERS ID: 1885126 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Eye swelling, Fatigue, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, fatigue, chills, face rash and swelling of the eyes.


VAERS ID: 1885137 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-18
Onset:2021-11-18
   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 EN6207 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest discomfort, Cough, Nausea, Rhinorrhoea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: past medical history of asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presents to the ED for evaluation of cough. The patient states she has been tested positive for the COVID-19 on November 2nd. The patient admits having a severe cough that has worsened today prior to coming to ED. She states that she so not uses an oxygen. She admits having a chest tightness as well as runny nose, nausea and vomiting.


VAERS ID: 1885140 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 30155BA / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Oropharyngeal pain, Pain, Pharyngeal erythema
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Lexapro
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, Body aches, headache, sore/red throat. Lasted 24 hours.


VAERS ID: 1885141 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   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
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7411LA / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vaccine that had been out of fridge for $g12 hrs was administered. No adverse reactions have been reported.


VAERS ID: 1885145 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 FH8027 / 3 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 reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient was given booster vaccine over 2 weeks too short of 6 months from second dose.


VAERS ID: 1885146 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Injection site pain, Nasal congestion, Pain, Paranasal sinus discomfort, Rhinorrhoea, Sinus headache
SMQs:, 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: Sinthroid Estrogel ProBono vitamins Fish oil Cinnamon Vitamin D Turmeric Methyl Protect
Current Illness: None. Completely healthy for 23 months straight.
Preexisting Conditions: Diverticulosis, Arthritis
Allergies: Septra, Ibuprofen, Vicodin, Gluten
Diagnostic Lab Data: None do far
CDC Split Type:

Write-up: Sinus headache/pressure, body ache, stuffy but runny nose, chills, low energy, sore arm at injection site.


VAERS ID: 1885150 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vaccine that had been out of fridge for $g12 hrs was administered. No adverse reactions have been reported.


VAERS ID: 1885162 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-14
Onset:2021-11-18
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: presented to emergency department at hospital for shortness of breath and chest pain on 11/18/2021


VAERS ID: 1885171 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-02
Onset:2021-11-18
   Days after vaccination:289
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

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

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

Write-up: Tested NAAT positive for COVID 11/18/21 after being fully vaccinated.


VAERS ID: 1885175 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Chest pain, Chills, Dizziness, Dysstasia, Feeling abnormal, Headache, Injection site urticaria, Mobility decreased, Muscle spasms, Nausea, Pain, Pain in extremity, Pyrexia, Swelling, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 2nd shot - 2/10/21
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to Flu vaccine and Hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9:30 Headache at first and slight nausea. By noon I was light headed and sick to my stomach. Continued to feel bad. By 9pm- small hives at injection site; throwing up; fever, and sore arm. 2am- woke up with chills and fever and uncontrollable muscle spasms over my body. Sick to stomach and pain all over my body. Chest pain. Can?t move my left arm as it?s swollen and shoulder blade swollen. 8am next day- Lightheaded and can?t stand for more than a minute. Dizzy, high fever, vomiting, hives at injection site, headache, body pain all over. Can?t lift left arm up to dress or do anything. Chest pain.


VAERS ID: 1885176 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-21
Onset:2021-11-18
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Dyspnoea exertional, Fatigue, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented to ED with nausea, vomiting, epigastric abdominal pain, fatigue, fever. Symptoms for the past few days, Some shortness of breath on exertion


VAERS ID: 1885177 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Aura, Condition aggravated, Epileptic aura, Partial seizures, Stress
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 4 focal seizures with second dose of Moderna Covid-19; 3/6/21; previously reported to CDC).
Other Medications: Levetiracetam; Zonisamide; Levothyroxine; Atorvastatin
Current Illness: None
Preexisting Conditions: HSV-1 encephalitis (acute, 2014) causing left temporal lobe lesion and focal seizures (not well controlled)
Allergies: Kiwi
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Focal seizure (premonition, aura, aphasia) lasting less than 2 minutes. Triggered by stress associated with vaccination (I also reported 4 seizures associated with second dose).


VAERS ID: 1885181 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Incorrect dose administered, Injection site pain, Product preparation issue
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

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

Write-up: Incorrect diluent volume resulting in a higher-than-authorized dose. Patient had arm soreness at the site of injection 12 hours after vaccination. Recommended symptomatic care.


VAERS ID: 1885187 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-14
Onset:2021-11-18
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No primary care provider listed. Please contact patient for further history.
Current Illness: No primary care provider listed. Please contact patient for further history.
Preexisting Conditions: No primary care provider listed. Please contact patient for further history.
Allergies: No primary care provider listed. Please contact patient for further history.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated against and then tested positive for COVID-19.


VAERS ID: 1885191 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 - / UNK - / -

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

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

Write-up: Chills, fever, achy, headache.


VAERS ID: 1885193 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-16
Onset:2021-11-18
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Confusional state
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: presents toBeaumont Dearborn hospital emergency department for evaluation of confusion and generalized weakness. His caregiver is at bedside and states he has diabetes and multiple sclerosis


VAERS ID: 1885197 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-18
Onset:2021-11-18
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood creatinine increased, Blood urea increased, C-reactive protein increased, COVID-19, Computerised tomogram head normal, Computerised tomogram neck, Diarrhoea, Dysarthria, Dyspepsia, Electrocardiogram normal, Facial paralysis, Fall, Influenza virus test, Limb injury, Magnetic resonance imaging head normal, Neurological symptom, Procalcitonin increased, Productive cough, Red blood cell sedimentation rate increased, SARS-CoV-2 test positive, Sputum discoloured, Troponin increased, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus testing: 11/17/2021: Detected
CDC Split Type:

Write-up: ADMITTED: 11182021: History of Present Illness: patient is an 86 yr old male with medical history significant for CAD, diastolic CHF, COPD, afib, history of TIA and SDH, orthostatic hypotension, and bladder cancer. He is the grandfather of APRN. Today, his son noticed that speech was slurred all day, but could not say for sure when symptoms started. L facial droop was also noted. He reports a history of TIAs with similar symptoms. Pt backed up to sit in his recliner, but missed the chair and landed on his buttocks on the floor. He also believes he may have hit his shoulder when he fell. He denies any pain in hips or shoulders. He c/o weakness and also has had a cough for 3 days productive of yellow sputum. He denies fevers/chills and is afebrile in ER this evening. He also reports heartburn yesterday but none today. He had 2 episodes of diarrhea on 11/16 but none since. Due to stroke-like symptoms, he was brought to the ER for further evaluation In the ER, MRI brain is without acute process. CTA head/neck shows no large vessel occlusion or flow-limiting stenosis. Slurred speech has resolved. Pt still appears to have L mouth droop but when he smiles, droop disappears. He is moving all extremities well. Labs in ER significant for WBC 15.9 with left shift, procalcitonin 0.15, sed rate 47, crp 4.6, BUN 28 with Cr 1.5 (appears consistent with recent baseline). EKG shows NSR with rate 70, trop 5Gen is 13.4. COVID/flu ordered and results pending. Addendum: COVID results returned positive, pt is fully vaccinated, received last injection in March/April. Pt is a candidate for monoclonal antibody treatment, as he is hospitalized for reasons other than COVID and is not requiring oxygen therapy. This treatment has been ordered. PT REMAINS INPATIENT - NO DISCHARGE DATE AT THIS TIME.


VAERS ID: 1885202 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 FH8027 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol PRN
Current Illness: n/a
Preexisting Conditions: History of mild persistent asthma without complications
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose was administered after expiration time. Vaccine had been diluted for 7.5 hours. Patient had no reaction to vaccine.


VAERS ID: 1885222 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Nausea, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (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: Severe urticaria and diarrhea after receiving HPV vaccine.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: One day after receiving my first Pfizer vaccine, I experienced 2 episodes of diarrhea and throwing up while at work. I then developed a horrible rash on both legs. Two days after receiving the vaccine, I experienced another 2 episodes of diarrhea and severe nausea. Whatever is in this vaccine my body is rejecting it. 1-2 episodes of diarrhea would be understandable but 4 episodes within less than 48-hours is not normal.


VAERS ID: 1885236 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Pain
SMQs:, Anticholinergic syndrome (broad), 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:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin and naproxen allergy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt started experiencing dizziness, severe fatigue, generalized body aches 1-2 hours after 2nd vaccination w/ moderna


VAERS ID: 1885238 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
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: Dizziness, Headache, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received Moderna 0.25ml IM booster in his left deltoid at12:35pm on 11/18/21. Within minutes (2-3) he complained of a headache followed my very sore arm then dizziness and nausea. He was escorted to a stretcher and given water and a cool pack and then laid down. Vitals at 12:45pm: 140/90, 76 , 94%. Vitals at 1pm: 130/9, 76, 95%. Pt fell asleep and was monitored continuously by writer. Pt continued to have a headache but refused to be sent to the ED. His wife, a nurse, was contacted by writer and she came to pick up her husband at approximately 2pm. Pt was escorted to the car by writer. Pt did report to work on the morning og 11/19/21 ans stated that he felt better.


VAERS ID: 1885245 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 - / 3 - / IM

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

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

Write-up: Pt requesting Janssen booster. Pfizer booster given. No adverse reactions observed.


VAERS ID: 1885248 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-02
Onset:2021-11-18
   Days after vaccination:289
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient is a 62 y.o. female with a PMH significant for insulin-dependent diabetes mellitus, hypothyroidism, HTN, CKD stage III, anxiety, GERD, HLD, HTN, OSA on CPAP who presents as a transfer from hospital due to hypoxic respiratory failure due to COVID-19.


VAERS ID: 1885249 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-11-18
   Days after vaccination:260
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Pt has chronic kidney disease stage IV and diabetes mellitus type 2. He comes to the hospital due to vomiting and is found to have COVID pneumonia.


VAERS ID: 1885267 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-17
Onset:2021-11-18
   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 FK5127 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Chest pain. Took Tylenol and resolved within 30 min. Rest of day was normal.


VAERS ID: 1885270 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 FE3590 / UNK - / IM

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

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

Write-up: Patient received a full dose of the Pfizer/BioNTech adult dose


VAERS ID: 1885273 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-03
Onset:2021-11-18
   Days after vaccination:288
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulation drug level above therapeutic, COVID-19, Cough, Respiratory symptom, Respiratory tract congestion
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt has had upper respiratory symptoms that have persisted, such as cough and congestion. Was found to have COVID and supratherapeutic INR.


VAERS ID: 1885275 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dermatitis atopic, Extra dose administered, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: AFTER RECEIVING 3RD DOSE PATIENT DEVELOPED MILD RASJH/ATOPIC DERMITITS ON RIGHT HAND ABOUT 10 MINUTES AFTER RECIEVING THE DOSE. PATIENT WAS A/Ox3 AND WAS GIVE 25MG DIPHENHYDRAMINE TO TAKE. SHE SAID SHE WOULD TAKE IT WHEN SHE GOT HOME. NO THROAT OR SOFT TISSUE SWELLING OBSERVED AND WAS RELEASED TO HOME. NOTE: PREVIOUS DOSES ON 2/4/21 AND 3/4/21 AND HAD A SIMILAR REACTION THEN ALSO.


VAERS ID: 1885277 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 FH8030 / 3 RA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1885282 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Within a few minutes after vaccine, I fainted and fell out of my chair onto my head. That night, I had headache, nausea, chills and pain at the vaccine site.


VAERS ID: 1885285 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-07
Onset:2021-11-18
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cellulitis orbital
SMQs:, Ocular infections (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized in for unrelated concern of orbital cellulitis


VAERS ID: 1885286 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-19
Onset:2021-11-18
   Days after vaccination:303
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Dizziness, Dyspnoea exertional, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Pt with a history of prostate cancer and currently on radiation therapy. Presents with lightheadedness and dyspnea on exertion. Admitted for hypoxic respiratory failure secondary to COVID pneumonia.


VAERS ID: 1885293 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-11-18
Onset:2021-11-18
   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 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Miralax, Colace, Tylenol Liquid 650mg, Famotidine, Enteral bolus feedings Jevity 1.5 3x day
Current Illness: N/A
Preexisting Conditions: Achalasia of cardia
Allergies: NKDA
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Patient reported he got up last night, walked to the door and "everything got dark" He said, "I may have blacked-out." Glucose level checked and blood sugar fine. He reported he ate breakfast and lunch today. Complained of mild flu-like symptoms. Denied any further episodes of changes in LOC.


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