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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 55 out of 4,799

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VAERS ID: 1429473 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Migraine
SMQs:

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

Write-up: Bad migraine in child. Throbbing headache


VAERS ID: 1429491 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chill, headache


VAERS ID: 1429518 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Immediate post-injection reaction
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: immediately felt lightheaded, dizzy, sweaty. resolved momentarily


VAERS ID: 1429534 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Vitals: Temp: 97.9 Pulse: 68 Respiration: 14 SPO2: 98 B/P: 118/78 Physical Exam: Normal
CDC Split Type:

Write-up: AE: patient felt warm pain on the right arm after 1 minute of vaccine administration. As per the patient, never felt this kind of pain before. there was no numbness, no tingling. it did not hurt upon palpitation. Treatment: patient was offered water to drink and kept under observation. Approximately 10 minutes after observation, patient symptoms improved. Outcome: Patient was discharged to POV/Home.


VAERS ID: 1429539 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nervousness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: AE: patient feeling light headed and dizzy upon vaccine administration. Patient states that she has not eaten anything this morning prior to the vaccine. Patient also states that she feels nervous and sweaty. Treatment: patient was placed on the Trendelenburg position as well as offered water and crackers. after few minutes, patient stated she no longer feels light-headed or dizzy. outcome: Patient was discharged to /Home.


VAERS ID: 1429549 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-24
Onset:2021-06-26
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ophthalmic herpes zoster
SMQs:, Ocular infections (narrow), Opportunistic infections (narrow)

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

Write-up: HERPES ZOSTER OPTHALMICUS


VAERS ID: 1429561 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014CZ1A / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014CZ1A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Fever and chills began at 3 am. Fatigue and headache started at 4 am.


VAERS ID: 1429563 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

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

Write-up: Miscalculated the days between the patient''s first and second dose of Pfizer vaccine. The patient received his second COVID vaccine 15 days after his first, instead of 17 days.


VAERS ID: 1429567 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Nervousness, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Patient vomited about 5 minutes after receiving vaccine. She said she thought maybe her blood pressure had dropped because she felt very nervous about getting the vaccine.


VAERS ID: 1429576 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-23
Onset:2021-06-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / SYR

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

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

Write-up: I?m itchy all over, with white bumps & red hives


VAERS ID: 1429582 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: None
Preexisting Conditions: COVID positive March 2020, history of epilepsy
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is experiencing red rash (raised red circular bumps) in armpits and on back


VAERS ID: 1429585 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: hypothyroidism
Preexisting Conditions: hypothyroidism, possible orthostatic hypotension
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came in for the Jansen COVID shot around 11:00, after receiving it he went to the waiting area and a few minutes later seemed to momentarily pass out in his chair, his wife called us over and Pt described feeling warm and dizzy. He drank some water and ate a candy bar over the next few minutes. Pt continued to feel dizzy and was sweating. After a few minutes Pt appeared to continue having extreme syncope and we called 911. Paramedics arrived a few minutes later.


VAERS ID: 1429588 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), 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: NONE
Current Illness: PER PT NONE
Preexisting Conditions: PER PT NONE
Allergies: NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PT REC JANSSEN VACCINE @0800 WALKING TO OBSERVATION AND STARTED TO FEEL WEAK . SYNCOPE EPISODE.


VAERS ID: 1429592 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg Prescribed Chinese hypertensive medication
Current Illness: Reported daily morning headaches
Preexisting Conditions: Hypertension
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Participant reported headache eight minutes after vaccine was administered. Reported taking six baby aspirins prior to arrival at clinic due to headache. Vital signs at 10:48 BP 212/98 P 70 R 24 Pulse OX 96%on RA.. 10:50AM BP 220/108P77R24 Pulse Ox 97% on RA. 10:53AM Emergency Department RN arrived and transported patient to the ED in her own Wheelchair.


VAERS ID: 1429593 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches; fatigue; electrical tingling sensation in face and hands.


VAERS ID: 1429598 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK UN / IM

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

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

Write-up: PT FELT DIZZY AND LIGHTHEADED KEPT PT IN OBSERVATION FOR ADDITIONAL 30 MINS / UNTIL PT FELT NO ADVERSE


VAERS ID: 1429600 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient stated that she had a similar reaction to a vaccination, but thought that it was due to her not having eaten anything be
Other Medications: None
Current Illness: None
Preexisting Conditions: Lichen Sclerosis
Allergies: Bactrim
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient felt dizzy. Patient first sat in a chair and then, after a few minutes, decided to lay down. She stated that she felt anxious before the shot. She did not have any itching or respiratory distress, just dizziness. She was given some water to sip on, and she sat up again for about 20 minutes. After that time she stated that she felt better and that she was now ok and decided to go home.


VAERS ID: 1429607 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: PT REPORTED FEELING DIZZY AND WEAK KEPT PT WAS KEPT IN OBERSEVATION FOR ADDITIONAL 45MINS UNTIL HE FELT BETTER


VAERS ID: 1429613 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

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

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

Write-up: Became pale, diaphoretic, nauseous and had an emesis. B/P and pulse were stable. She was given water and a granola bar. She was also leaned back and feet were put up in the chair to raise them above her heart.


VAERS ID: 1429617 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: PT FELT WEAK AND DIZZY WANTWED TO LAY DOWN ON FLOOR. FELT A LITTLE BETTER AFTER LAYONG ON FLOOR. KET T ON FLOOR FOR 15MIN THEN PT SAT ON FLOOR FOR ADDITIONAL 15MIN/ NO LONGER DIZZY.


VAERS ID: 1429620 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: He became dizzy and nauseous after about 10 minutes of sitting following the shot. Blood pressure and pulse were stable he was given water and a granola bar and his feet were put up. He was fine after 10 minutes and went home with his mother.
CDC Split Type:

Write-up: He became dizzy and nauseous after about 10 minutes of sitting following the shot. Blood pressure and pulse were stable he was given water and a granola bar and his feet were put up. He was fine after 10 minutes and went home with his mother.


VAERS ID: 1429648 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Heart rate increased, Pain, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

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

Write-up: pain in the arm I got the vaccine in, elevated heart rate, body aches


VAERS ID: 1429659 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: n/a
Current Illness: leukemia
Preexisting Conditions: leukemia
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient threw up minutes after the vaccination.


VAERS ID: 1429660 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-01
Onset:2021-06-26
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Dyspnoea, Fatigue, Palpitations, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: By the time blood tests were (May 25th, week 5) came back normal.
CDC Split Type:

Write-up: Heart Palpitations started 2 hours after the shot. Heart pounding for 48-60 hours. Unable to sleep as a result of pounding. After heart palpitations stopped, fatigue started. Fatigue went on for 6 weeks after shot. Included occasionalll breathlessness and extreme tiredness.


VAERS ID: 1429661 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Cold sweat, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? 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: Pericarditis. Strong chest pain cold sweats


VAERS ID: 1429662 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted approximately 15 minutes after administration. He felt nauseated immediately before, then fainted, falling to the floor and striking his head.


VAERS ID: 1429665 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: PT TAKES SERTRALINE, HYDROXYZINE, AND GIANVI DAILY. SHE TOOK THEM AS USUAL BEFORE THE VACCINE PER MOM. PT USED PERSONAL ALBUTEROL INHALER AFTER VACCINE ADIMINSTRATION.
Current Illness: NONE NOTED
Preexisting Conditions: SLIGHT ASTHMA NOTED
Allergies: NKDA
Diagnostic Lab Data: BP/PULSE BY EMS
CDC Split Type:

Write-up: PT WAS GIVEN FIRST DOSE OF PFIZER IM LEFT ARM. APPROXIMATELY 3-5 MIN AFTER ADMINISTRATION PATIENT PASSED OUT. 911 WAS CALLED, PT BECAME ALERT, NO EPI-PEN NEEDED, COMPLAINE DOF HEADACHE AND NAUSEA. SHE USED HER ALBUTEROL INHALER. BP TAKEN 101/67 PULSE 85. EMS ARRIVED AND TOOK MORE VITALS. PT IMPROVED ENOUGH TO WALK TO CAR TO GO HOME FOR OBSERVATION. MOM WAS PRESENT AND OPTED NOT TO GO TO ER


VAERS ID: 1429666 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-06
Onset:2021-06-26
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Computerised tomogram thorax, Dyspnoea, Pain, Painful respiration, Pericardial drainage, Pericardial effusion, Pericardial excision, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rosuvastatin, metoprolol, lyrica
Current Illness: No
Preexisting Conditions: BP and cholesterol - controlled with medication neuropathy feet, cause not known
Allergies: No
Diagnostic Lab Data: X-rays, cat scans other tests related to heart. between 6/2/21 and 6/5/21.
CDC Split Type:

Write-up: Recurring bouts of fever, aches. Pain when taking deep breath. eventually shortness of breath and pressure high in chest. Diagnosis : Pericardial Effusion. Treatment : Surgery to drain fluid. install drain. install pericardial window. 5 days in hospital.


VAERS ID: 1429672 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Hypertension, Loss of consciousness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypertension (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Hypertension-Medium, Additional Details: Patient said she sat down after vaccine. She said as she was sitting she passed out and fell to the side and hit her head on top. She had a small amount of blood in her hair. We sat her back in a chair and her bp was taken --169/96 and pulse 80. 911 was called and paramedics came to check her out. They said she was okay and she said she was okay to drive. She left on her own.


VAERS ID: 1429674 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fall, Feeling hot, Flushing, Hyperhidrosis, Nausea, Pyrexia, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Fever-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Additional Details: Pt was seated during 15 minute mandatory observation period. Within 10 minutes, Patient fell out of chair and was found on the floor conscious within seconds of her fall. Pt reports feeling queasy, lightheaded, flush, hot and having chills prior to fainting. Pt was assessed by nurse practicioner, bp, breathing, pulse reported to be normal. EMS was called and pt assessed by paramedics. Pt reports feeling better.


VAERS ID: 1429678 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 - / IM

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

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

Write-up: Patient felt nauseous and dizzy after receiving the vaccine. Patient felt better after sitting for few minutes


VAERS ID: 1429682 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 61207A21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CoQ10, R-ALA, acetyl?l?carnitine
Current Illness: None
Preexisting Conditions: None
Allergies: No, known
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Muscle Aches, EXTREME kidney pain (I''m going to drink cranberry juice after work, Hopefully that will help)


VAERS ID: 1429690 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: After receiving the vaccination, patient experienced nausea , dizziness and sweating. He was instructed to lay down. Ambulance was called. Upon evaluation by the paramedics, patient''s vital signs were stable, but the patient asked to go to the hospital for further evaluation.


VAERS ID: 1429696 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Pallor
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I am not aware of other meds or supplements
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No tests done other than the Blood Pressure taken
CDC Split Type:

Write-up: Patient was in the designated waiting area after having received a vaccine. He was seated in a chair just outside the vaccination room. After about 10 minutes he was observed to suddenly fall to the side of his chair to the floor. The Cashier quickly called to me for help, I quickly ran out to the patient and found him face down on the floor attempting to raise his head and look around, I told him to remain on the floor and we turned him over and kept him lying down on the floor. I asked him what he could see, if it was fuzzy or unclear. He stated that I seemed to look clear to him. He stated that he didn''t want to be on the floor and wanted to sit down, so I helped him into the chair and I sat down in a chair directly in front of him. With in a minute he stated that he was beginning to be light headed again. I noted that he was losing his color. I asked him to lay down on the floor again. We got him a pillow for his head and a bottle of water to hydrate him. We also put a cool compress on his forehead. Through questions I asked, again it was determined that he has had no history of any seizures, and had fainted before when it had been too hot. We were able to have him get us his father''s phone number and we called him to come to the pharmacy from home. Patient remained on the floor till the father arrived and we asked him a few questions. Father wanted the BP taken, so we did, it was 122/69 Pulse rate was 72. Father wanted to give him a sugar pill because he thought that might increase the blood pressure some. So we gave him one glucose tablet. Patient then expressed that he was ready to try and stand again. We helped him stand up and allowed him to take a few steps and to monitor him. We brought over a powered scooter to have him sit on out to his dad''s vehicle. It didn''t have enough power so we had my Tech and the Patient''s father escort him out to the car with out incident. We asked them to call us if they had any questions. The Father was asked if he was going to take his son to be checked out and he didn''t feel it was necessary.


VAERS ID: 1429703 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Nasal injury
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: patient felt light headed upon standing and fell to the ground; patient hit nose and started to bleed; patient felt fine after consuming a candy and some water


VAERS ID: 1429706 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions: Chronic Cough Hyperlipidemia
Allergies:
Diagnostic Lab Data: Covid 19 Vaccine J&J
CDC Split Type:

Write-up: Chest Heart Burning beginning 5 minutes after injection and continuing for approximately 30 minutes Lightheadedness/dizziness beginning 15 minutes after injection and continuing intermittently for approximately 20 minutes Slight headache at left lower side base of skull. Currently, the dizziness has subsided. Heart burning sensation has alleviated and gone to none and then back to warm but not burning. headache slight still as of 5:15pm


VAERS ID: 1429709 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Fall, Hyperhidrosis, 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), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None His vitals were as follows 120/90 58 20
CDC Split Type:

Write-up: During the post vaccine observation period, patient had a sync opal episode and fell off a charge face down on the floor. He was turned over he came to immediately and was oriented to place, person, time ,and ,situation . He was noted to be diaphoretic. He reported to staff that he usually passes out after a vaccination and had not had eaten. He was observed for an additional 45 mins before leaving the site of the vaccination.


VAERS ID: 1429716 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dupixent every other week
Current Illness: none
Preexisting Conditions: eczema
Allergies: Seafood and oats. Patient found out today she may be allergic to oats. She had it for breakfast broke out in hives. Her hives may be from the oatmeal this morning.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient has hives 30 minutes after vaccination. Patient states she found out she''s allergic to oat this morning after having oatmeal for breakfast (she broke out is hives and itchy mouth). After her hives died down she came in to get her vaccine then had hives again 30 minutes after. She took benadryl and felt better after.


VAERS ID: 1429720 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Hyperhidrosis, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Mild- moderate soreness and fatigue
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies: None Known
Diagnostic Lab Data: Blood pressure checked and the parameters appear in normal range: BP-111:72; Pulse-57. Patient does not know if these are his usual BP readings therefore we assume his vitals are within his normal range.
CDC Split Type:

Write-up: After 2-3 minutes given the shot, patient reports feeling ill, nauseous, dizzy and sweaty all over. He denies difficulty of breathing, hyperventilation, or rashes. He asked to use the bathroom facility in case if he vomit. He did not vomit. He splashed water onto face and reported that made him felt better. He rested on a sofa in the pharmacy and was given a cup of water. After 3-5 min, he reports all symptoms have subsided and thought maybe he was too anxious due to anticipation of severe reactions after the second shot. Patient continues to deny trouble of breathing nor rashes throughout the 20 minutes resting in the wait area. Benadryl & Epi-Pen were not needed nor given.


VAERS ID: 1429734 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine 20mg
Current Illness: None
Preexisting Conditions: Unknown
Allergies: Cefaclor
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient immediately complained of Nausea and then seemed to pass out and need to be guided to the floor


VAERS ID: 1429739 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None disclosed.
Preexisting Conditions:
Allergies: Latex, wheat, shellfish, mentioned a small amount of tongue swelling after getting Bamlanivimab when treated for COVID in January.
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: tongue swelling that patient felt was onset of anaphylaxis, began about 5 minutes after vaccine was given, pt was given one dose of EpiPen and went to ER where they received IV steroids, benadryl, pepcid and observed for 45 minutes. Upon discharge they were prescribed a 5 day course of prednisone


VAERS ID: 1429740 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blepharospasm, Dizziness, Malaise, Pallor, Retching
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad)

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

Write-up: After receiving vaccine, Patient was waiting in front of the pharmacy when parent yelled for my attention. I went out immediately to check on patient. She was swaying and eyes were fluttering. Patient was still communicating verbally and said she felt light-headed, was feeling sick, and extremely pale. Got patient a trash can and cold compress to apply to neck and face. She dry heaved, but no vomit was produced. Parents stayed next to patient and I checked on her every 5 minutes. She was okay to leave after sitting for approximately 30 minutes with color returning to her face. No other reaction occurred during this time.


VAERS ID: 1429741 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Rash on my left foot and was unable to walk properly as of ankle got twisted


VAERS ID: 1429748 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, 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: PATIENT RECIEVED SECOND DOSE OF PFIZER COVID VACCINE AT 2 WEEK INTERVAL INSTEAD OF 3 WEEKS. PATIENT WAS MADE AWARE OF MISTAKE. SO FAR, HAS REPORTED NO ADVERSE EVENTS BUT SHE JUST RECIEVED THE VACCINE TODAY. 6/26/21


VAERS ID: 1429749 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / SC

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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lung issue
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came in and asked for Pfizer vaccine, stated on consent she had not received a previous dose of COVID vaccine but in actuality had already received Moderna. Doctor had told her to go get Pfizer but she did not tell us till after.


VAERS ID: 1429759 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Heart rate decreased, Hypotension, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), 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: atorvastatin, tamsulosin
Current Illness: none known
Preexisting Conditions: none per patient, but has had fainting when giving blood in the past (not for vaccines)
Allergies: nkda
Diagnostic Lab Data: Blood pressure of 99/65 (59 pulse)
CDC Split Type:

Write-up: Patient fainted while sitting upright in chair approximately 2-3 minutes after receiving Moderna shot. He was unresponsive to touch or sensation for about 3 minutes but did stop breathing/circulation. He had some clamminess and low blood pressure/pulse during the event. However, he did not show symptoms of swelling, itching, or anaphylaxis. We applied a cool towel to his head and neck, and when he became conscious, gave him a bottle of water. Patient waited until EMS arrived where he was found to have had syncope/hypotension. Patient remained in pharmacy area another 15 minutes after being cleared by EMS before leaving. He did not require any further medications or treatment.


VAERS ID: 1429760 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: client complained of lightheadedness . feeling like she "couldnt breathe." Also states feeling numbness to left arm that radiates to chest and up to neck Client reports history of panic attacks. Seen by NP: Vitals obtained : o2sat at 157pm o2sat 98% HR 88, 207pm o2sat 99% HR 87, 221pm o2sat 99% and HR 81. Client left site after over 30 mins in observation, reported feeling better her sister at her side.


VAERS ID: 1429768 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pain, Skin warm, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (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: lisinopril vitiman d
Current Illness: none
Preexisting Conditions: none
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: localized swelling redness hot... sensitive to touch.. painful


VAERS ID: 1429770 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure abnormal, Cold sweat, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (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: Patient dob 9/10/1955 walked in for a covid vaccine on 6/26/21. About 10 minutes after administering the 1st Moderna vaccine at 4:27pm the patient fainted on his chair. A man waiting in line for pickup noticed the patient and luckily supported the patient to prevent him from falling off the seat. We provided the patient with a cold compress, cold bottle of water, and some life saver candies as the wife stated he hadn''t eaten anything since the morning. We instructed patient to lie down on the back with legs elevated, but the patient refused. Patient also refused calling for ambulance. A member of management was also notified. The blood pressure was monitored at 100/70, 118/78, then 126/84 all taken approximately 10 minutes apart. Patient initially looked pale and felt clammy. With his BP returning to normal, patient is looking more alert and color back. Patient authorized us to contact Dr. his PCP. Patient was with his wife who will be driving him home. Patient stayed for at least 45 minutes before leaving pharmacy.


VAERS ID: 1429774 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Miosis, Neck pain, Sluggishness
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Arthritis (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: Kidney cysts
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Paramedic noticed that client was holding the left side of her neck and moving her head side to side. Paramedic approached client who stated she was feeling a little dizzy from the heat in the room and that she felt a : "stabbing pain" in her neck which she rated a 5/10. Client denied any other symptoms such as headache, chest pain, vision changes, nausea, abdominal or back pain and shortness of breath or swelling of lips, mouth or tongue. Client denied any recent illness or injury and denied any allergies to medications/food/environment. Client stated she had a positive history for kidney cysts. Client claimed her last oral intake of food or liquids was at 1330. Client was offered a bottle of water which she took and sipped on. At 1420 Paramedic obtained a first set of vitals: Blood Pressure (BP): 118/60, Heart rate (HR) 96, Respiratory Rate (RR): 14, CAOx4. Paramedic noted that client''s pupils were pinpoint and that client was sluggish, skins were normal for ethnicity, warm and dry. At 1422 client reported that her symptoms of dizziness and neck pain were completely resolved and that she was symptom free. At 1425 Paramedic took a 2nd set of vitals: BP 120/70, HR 104, RR 16, CAOx4, pupils remained pinpoint, skins normal for ethnicity, warm and dry. At 1427 client was advised by Paramedic to stay an additional 30 minutes. Client refused and stated she needed to leave right away. Paramedic gave ER precautions and advised to stay hydrated and to seek medical attention if symptoms returned or worsened. Client ambulated away from site on her own accord with a steady gait.


VAERS ID: 1429782 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Face injury, Fall, Hyperhidrosis, Hypotension, Nausea, Pallor, Presyncope, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: not known
Preexisting Conditions: not known
Allergies: nka
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: RN to J&J vaccine about 3-5 min after delivery. Assuming Vasovagal response. His brother reports that patient was sitting there and his eyes rolled back in his head and he fell off his chair and hit his head/right eye. Employee got out there and he was a bit combative and saying "whats going on, whats going on". I asked him to sit down and employee called 911. We put pressure on his eye area to stop the bleeding. He was sweating, shakey, pale, and nauseous. Paramedics arrived quickly and eventually took him away on a strecher. Update: mom came back a couple of hours later to thank us and let us know that he is home and resting. He did get 3 stiches by his eye and the reason they took him via strecher was because his blood pressure was staying so low while they were here.


VAERS ID: 1429785 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 1455: Pt c/o of dizziness, diaphoresis with hx: of anxiety, NKA. Laid pt down to floor and elevated legs on chair. 1500 called EMS. 1st vitals: 102/60 02 99 HR 84. 1500 NP assess pt, she stated her face was pale. NP instructed her to deep breath and increase oral fluids. Pt states she was dizziness. Sat patient up 2nd vital 85/56 O2 97 HR92. 3 vital patient sitting on chair 101/66, O2 90, HR 92. NP assessed patient. Patient denies dizziness was able to stand and walk to car.


VAERS ID: 1429795 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient received second Moderna vaccine at approximately 6:05pm. At approximately 6:15pm, she came over to the pickup and stated she had tingling in her feet and felt nauseous. I told her to sit down. She was given a shopping bag and did vomit some into the bag. I gave her an ice pack. She said she had a bad headache, but no dizziness. Her blood pressure was 126/90 at 6:26pm. She does not know her typical blood pressure reading. She stated she was feeling a little better and was ready to leave approximately 6:40pm. She stayed until approximately 6:50pm and left with her husband.


VAERS ID: 1429796 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Nausea, Pallor, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: Has upcoming appointment with a physician for possible heart valve issue .
Allergies: No known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Felt nausea, dizziness, Felt something in throat, after couple of minutes, At mention of throat 911 was called, EMS arrived less than 5 minutes, observed, took blood pressure, checked pulse, blood oxygen checked. Ems said he looked pale, continued to observe patient for about 30minutes, Mention of patient possibly experiencing panic attack, had history of in past. He was feeling fine by then, no need to go to hospital. Police followed him home. I called patient at 3:33PM he was home, said throat was fine, he just felt tired, He said he was o k .


VAERS ID: 1429797 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

Administered by: Public       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: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given first dose Moderna vaccine series at a vaccination clinic. Gave second dose Moderna vaccine as directed and advised by Health Director.


VAERS ID: 1429800 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Flushing, Hyperhidrosis, Hypotension, Nausea, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Nausea-Medium, Systemic: Vomiting-Severe


VAERS ID: 1429806 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

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

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

Write-up: Patient was underage at time of vaccination. Patient received her first dose of Moderna at Pharmacy on 5/28/21. She returned for her second dose, but they were out of stock. She came here to complete her series. I called pharmacy to verify, and the pharmacist stated that he had received an email that approved Moderna for 16+ years old but now could not find it. Patient experienced no side effects after her first dose. I completed her series with her second dose.


VAERS ID: 1429825 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-21
Onset:2021-06-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Epistaxis, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA, atorvastatin, diazepam, HCTZ, losartan, metformin, protonix, actos, repaglinide, risperidone, Viagra, trazodone, insulin
Current Illness:
Preexisting Conditions: leukemia, DM, HTN
Allergies: NKA
Diagnostic Lab Data: low platelets- 120,000
CDC Split Type:

Write-up: nosebleed an low platelets- started one week after vaccine, came to ER on day 7 when bleeding wouldn''t stop.


VAERS ID: 1429836 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fluid replacement, Hypotension, Presyncope
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (narrow), Hypokalaemia (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: Near syncope-reported feeling like about to pass out. Brought via wheelchair to med screening for evaluation by medics. Hyotensive. 66/30. Pt. laid down and monitored by EMT/paramedic for at least 10 mins. Oral hydration brought BP up 120/75. Patient observed another 10 minutes. Then released with husband . Patient and husband traveled from South America, over night for Vaccine. Recorded by RNs


VAERS ID: 1429849 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-20
Onset:2021-06-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site warmth, Skin reaction
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: appears to be a delayed localized cutaneous reaction developing 6 days post vaccination, that spans about 6-8 inches in diameter and is hot and itchy. referred to Md


VAERS ID: 1429854 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0818 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Retching
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vestibular disorders (broad)

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

Write-up: Patient got overheated, lightheaded, dry heaving. EVerything started about 10 minutes after injection. Patient ended going with EMS to hospital upon her request.


VAERS ID: 1429859 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (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: paramedics and emts arrived very shortly after the event, paramedic described it as vasovagal syncope. patient declined going to hospital
CDC Split Type:

Write-up: after giving the vaccine the patients arms and head jerked around and then he fainted. all in about 60 seconds. he was able to breathe after gaining consciousness


VAERS ID: 1429862 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Patient was given vaccine, 15 min after receiving the vaccine the patient experienced SOB. Pt stated she has anxiety and asthma. I was going to give her an EPI pen but she denied it. Said she was fine and it was her asthma. I asked if she was experiencing tightness in her chest/throat. She stated no and there was no signs of rash or swelling. Patient took her inhaler and was given water. She was monitored for 15 more min and was fine.


VAERS ID: 1429874 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Malaise, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: UNKNOWN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: UNKNOWN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Wife present with pt and she stated before he received his vaccine that he has been known to pass out during a vaccine or after getting a vaccine. Pt''s wife came and got me from exam room around 2:50p (about 10 mins after receiving vaccine and while pt was sitting in waiting room) stating that he didn''t feel well. Pt''s face was pale and skin was cool and clammy but alert when I asked him if he''d like to return to an exam room to lay down. He stated that he wanted to stay in waiting room sitting with his wife. I gave pt 2 small bottles of water but he declined them at that time. I started to check his BP and he became unreponsive but eyes still open. This episode last approximately 20-30 seconds and then color return to pt''s face and he became responsive and answer questions appropriately. I asked pt again if he wanted to come into an exam room and lay down but he decline again. I advised pt and wife to stay in waiting room and asked his wife to watch for any other symptoms and advised them to stay an additional 15-20 mins. Both verbalized agreement and understanding. Pt''s wife said he was feeling better at 3:15pm and after drinking the water I gave him and they left. Pt was alert and ambulatory upon leaving, steady gait.


VAERS ID: 1429894 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-06-26
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001652 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Blood glucose normal, Blood test normal, Dyspnoea, Electrocardiogram abnormal, Fatigue, Headache, Heart rate decreased, Joint range of motion decreased, Joint stiffness, Joint swelling, Limb discomfort, Nausea, Pain in extremity, Vitamin B12 decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nothing
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: May 11 3:05pm - full slate of bloodwork (including fasting glucose) and ECG (done the same day). (Pulse 44 during ECG). Follow-up visit May 27 appt Dr. B12 level low, all other results normal.
CDC Split Type:

Write-up: Later that day - blinding headache that lasted for 5 days, utter fatigue (3 days); nausea; joint pain, stiffness and aching (5 days); sore arm (unable to raise - 3 days, discomfort lasted 5-6 days). May 8 - Telephone appt with physician at 9:30am re - severe shortness of breath, ankles swollen, prolonged ''fluttering'' in left leg from knee to ankle. Expressed concern re thrombosis and urge immediate visit to emergency or medical clinic. Phoned emergency number and attended by Nurse around 1130. Pulse very low ( 44) concern re angina, hypothyroidism, blood clots. Saw DR on May 11 - (pulse 60). Follow-up visit May 27 - B12 level low, all other results normal.


VAERS ID: 1429902 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hypotension, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient slumped over in chair while waiting the required 20 minutes after the vaccine. Her father stated that she had a loss of consciousness but did regain consciousness. Patient had low blood pressure when taken by the pharmacist of 85/65. Patient was very pale, gray coloring in face and extremities. Rescue squad was dispatched and transport to hospital was ensued.


VAERS ID: 1429903 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Fatigue, Feeling abnormal, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (narrow), Hypersensitivity (broad)

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

Write-up: Patient received the vaccine. He stated he felt fine-not dizzy/etc He stood up and I walked him to the vaccination waiting area. Myself as well as 2 of my technicians checked in on him for a total of 3 checks. He was waiting for another person to get their vaccination. Upon checking in on the other person (he was still sitting in the waiting area) I asked him how he was feeling. Approximately 25 min had elapsed. He said his throat felt weird like closing. I had him remove his mask immediately. I assisted him to the immunization booth. He was able to walk on his own. I observed him. He said it felt the same maybe a little worse. No other signs of allergic reaction. Technician called 911. He said he was not dizzy and his color was normal. His blood pressure was slightly elevated. He said he had to keep yawning and felt tired and his throat seemed to be getting worse. I administered an epipen and immediately afterwards the paramedics were there. He walked to the stretcher and they took him to the hospital for further evaluation.


VAERS ID: 1429906 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Feeling abnormal, Feeling hot, Pharyngeal paraesthesia
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: 9:48am during his 15 minute wait time, reported having a tingling in tingling in his throat, feeling flushed, and light headed. Declined us calling 911. He reported that he has a lot of allergies to foods and has experienced this reaction after having exposures to poultry products. Patient was brought in the nurses office and vital signs checked and stable. Lung sounds clear on auscultation. Given benadryl 50mg and monitored in office. Once patient reported feeling back to normal he asked to leave and went home. We called patient to verify that he got home and continued to feel fine.


VAERS ID: 1429916 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

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

Write-up: Approximately, 7 to 10 minutes after the pharmacist administered the vaccine to the patient, the patient experienced a vasovagal syncope event. The patient briefly lost consciousness for approximately 60 to 90 seconds. The pharmacist was able to catch the patient as she lost consciousness and began to fall from the chair where she was seated. The patient was then moved to a recovery position on the floor, where she then regained consciousness shortly thereafter. The pharmacist attended to the patient while she was unconscious and as she began to regain consciousness. The patient''s husband was contacted and he then presented to the pharmacy. After being monitored in the pharmacy area for approximately 15 to 20 minutes after fully recovering, the patient''s husband then took the patient home.


VAERS ID: 1429935 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 and legal guardian stated they were of age to receive the vaccine. After further investigation the patient was in fact 11 and not 12.


VAERS ID: 1429943 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Nausea, Tinnitus, Visual impairment
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No known
Diagnostic Lab Data: BP: approx. 80/60
CDC Split Type:

Write-up: The patient began to feel dizzy within a few minutes (2 to 3 minutes) of receiving the vaccine. We had the patient sit and drink a small water bottle and called 911. They complained of ears ringing, nausea, stomach pain, and black spots in their vision. We had them lie down on the floor until the paramedics arrived (within a few minutes, approximately 3). They took a BP reading of around 80/60 and advised the patient to go to the hospital and the patient agreed and was taken out on a stretcher.


VAERS ID: 1429947 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-19
Onset:2021-06-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth, Pain in extremity
SMQs:, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone 100mg once a day, prenatal, Claritin, krill oil
Current Illness: Sinus cold two weeks prior
Preexisting Conditions: no
Allergies: No Known food or drug allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I had a sore arm for a few days following the injection, which was to be expected. Today, however, exactly one week post injection, I noticed some itching at the injection site. Upon visualization, there is an area of localized small raised and reddened areas at the injection site. There is also warmth present at the site of injection.


VAERS ID: 1429952 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-23
Onset:2021-06-26
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Acoustic stimulation tests, Deafness, Ear, nose and throat examination abnormal, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, fosamax, multivitamin, vitamin D, glucosamine chondroitin, Tylenol extended release
Current Illness:
Preexisting Conditions: High blood pressure, arthritis
Allergies: Keflex
Diagnostic Lab Data: 4/28/21 hearing test and appt with ENT
CDC Split Type:

Write-up: Hearing loss and tinnitus


VAERS ID: 1429955 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK UN / IM

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

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

Write-up: DIZZY AND LIGHT HEADED . LOWER PT TO FLOOR AND OBSEVER FOR ADDITIONAL 30 MIN.


VAERS ID: 1429957 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine,fluticasone, vesicare, lisinopril, humalog 75/25, atorvastatin,oxybutynin, sertraline,metoprolol, cetirizine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: expired left out of fridge greater than 12 hour moderna covid 19 administered


VAERS ID: 1429960 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none stated
Current Illness: none stated
Preexisting Conditions: none stated
Allergies: none stated
Diagnostic Lab Data:
CDC Split Type:

Write-up: a man came to the pharmacy this morning stating his wife has been experiencing a tingly arm and puffy face after receiving the Moderna covid vaccination. He said she had taken benadryl with no resolution of side effects. It was recommended that she contact her Doctor and to go to be seen.


VAERS ID: 1429966 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

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

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

Write-up: Moderna Covid vaccine administered to 16 yo, currently approved for only 18years and older.


VAERS ID: 1429970 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, 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), 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: ceftin=rash, soy intolerance
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was nervous about getting a covid shot so decided to get the Janssen as it was one shot and more like the flu shot, I gave him the vaccine in his right deltoid and he had some blood drip which I cleaned up after putting on cotton ball with bandage as I was cleaning up and talking to him he got pale and passed out in the chair. I called to someone to call 911 as he i was getting him lowered, I removed his mask to help with breathing, and hugged him to lower him to the ground, while I was lowering him he came too and kicked as he was startled. I laid him on the ground in imz booth and had someone get my garden pad I keep in the pharmacy to place under his head. I had someone get him damp paper towel for his forehead. The floor was cool on his back which helped cool him down. The color came back to his face and He said he felt fine but was embarrassed which we reassured him it was all good. He said he felt more awake then when he came in. The ambulance arrived and he stood up and he was fine and didn''t go with them. I gave him a vial of water and thanked us and went on his way.


VAERS ID: 1429971 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness and anxious Complained injection was too fast Patient hasn''t had any food until 18:10 Patient was given snacks and bottle of water and was observed for 30 minutes


VAERS ID: 1429983 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

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

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

Write-up: PATIENT FELT LIGHTHEADED, NAUSEATED.


VAERS ID: 1429984 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-23
Onset:2021-06-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Myocarditis, Troponin
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin 329 (6/26/2021)
CDC Split Type:

Write-up: Myocarditis


VAERS ID: 1429985 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-05
Onset:2021-06-26
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E1686 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Impaired work ability, 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: Reason for test: day 5 travel. Last day worked: 6/11/21 full work day. EE no longer employed. Did an exit interview 6/25/21. Day called in sick ?day absent?: 6/11/21EE then was on PTO 6/13-6/21. Date Tested/Results: 6/25/21. COVID-19 Vaccine Yes/No: 2 doses. Date of last dose: 1/23/21. Notes: Received call stating EE is COVID Positive. EE day 5 post travel testing, 6/25/21 resulted COVID Positive. EE travelled from 6/15/21-6/20/21. EE is fully vaccinated for COVID, last dose received 1/23/21. Called EE to notify her that she is COVID positive and will need to quarantine. She is asymptomatic. EE was at the beach with her kids when notified. Instructed EE that she will need to leave the beach and begin quarantine. EE stated that she is no longer a Employee. She did her exit interview on 6/25/21. EE did not do QUASAR study. EE states she now works at Medical Center. Employee Health notified. Instructed EE that she will be contacted for further follow up and contact tracing. She should also let her current employer, Medical Center, know of her positive COVID result and to only return after she is released.


VAERS ID: 1430000 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Erythema, Feeling abnormal, Hyperhidrosis, Nausea, Retching, Skin warm
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Attendee received second dose Pfizer vaccine at 12:34 pm in the right arm. Lot# ER8729. Attendee was directed to observation area. At 13:00 voiced complaints of Nausea. 85 degrees at the site today. Attendee''s respirations were not tachyphemia or dyspnea. Attendee assisted to the cot, but refused to lie down. 13:05 ? Dry heaving. Stated that the nausea started immediately after the vaccination, but didn''t let the staff know until she was really feeling bad. HR: 88 BP: 122/84 RR: Not recorded O2Sat%: 96. 13:15 ?No longer dry heaving HR: 93 BP: 128/85 RR: 16 O2Sat%: 97 Temp: 98.1


VAERS ID: 1430005 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Client received the 1st dose of the COVID vaccine (Pfizer Lot #EW0186 expiration date 07/12/2021) at 1309. At 1326, the client called EMT over and said "I''m having itching and something in my chest." PHN responded. The client stated, "I''m not having any trouble breathing or any swelling. When I breathe in, I feel something in my chest. It comes and goes. I have itching in my left palm but its already going away." Client was alert and oriented times four. EMT and PHN escorted the client to the zero gravity chair. Vital signs taken at 1329 (blood pressure 130/60, heart rate 83, oxygen 97%). At 1330, PHN offered the client Benadryl which he refused and stated, "I don''t feel the itchiness anymore." Client stated, "I don''t like needles. I was nervous about getting the vaccine." Client denies any medical conditions and allergies. The client is taking Zyrtec and prescription eye drops. At 1338, client stated, "I haven''t felt the feeling in my chest since we moved over here." Vital signs taken at 1340 (blood pressure 132/78, heart rate 76, oxygen 96%). At 1345, the client stated, "my chest feels fine." Vital signs taken at 1351 (blood pressure 130/74, heart rate 82, oxygen 97%). PHN provided client with education on when to seek emergency services, and to follow up with his primary care provider. Client left unassisted with a steady gait at 1356.


VAERS ID: 1430013 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-18
Onset:2021-06-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site nodule
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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: pt states that today she noticed her arm had a red knot at the injection site, up until now it was fine


VAERS ID: 1430026 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: No known medical conditions
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: BP 192/91 and second BP 45 minutes later 184/82 06/26/2021
CDC Split Type:

Write-up: Patient start sweating on his head, face and hands and a 30 seconds brief loss of consciousness.


VAERS ID: 1430029 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Denies
Current Illness: Denies
Preexisting Conditions: Denies
Allergies: KNA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient complaint of Body aches, nausea, headache, and sore arm. Patient was given Tylenol 650 mg TID PRN for pain X 7 days.


VAERS ID: 1430043 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Tamsulosin, Escitalopram
Current Illness: N/A
Preexisting Conditions: Depression, Hypothyroidism, BPH, alcohol use
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received dose #2 of Pfizer-BioNTech COVID-19 vaccine on 6/26/2021. Pt had a witnessed seizure at home shortly therafter. No history of seizures in the past. Pt admitted to the hospital and later noted to be febrile to 102.5 degrees F. Currently undergoing work-up for infection.


VAERS ID: 1430045 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Chest pain, Pain, Pain in extremity, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

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

Write-up: Chest pain radiating down L arm, elevated blood pressure significantly above his normal (controlled BP), tachycardia, hand pain


VAERS ID: 1430053 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Injection site swelling, Nausea, Skin warm
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Adderall xr
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nauseas the day of the shot and the next day. Red hard warm bump at injection site. Arm pit pain on the injection arm.


VAERS ID: 1430059 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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: birth control
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: fever, chills, headache, nausea, fatigue, weakness


VAERS ID: 1430061 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Other       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seizure medication unknown
Current Illness: Seizures
Preexisting Conditions: Seizures
Allergies: Denied
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. was observed having a syncope episode. Pt. slumped into husband. Pt. was assisted to lay on yoga mat once they felt that it was safe to do so. Pt. reported she had passed out in the past due to an injection, but she tolerated her last flu vaccine. Pt. stated she did not report to the vaccinating nurse that she had a history of passing out due to an injection. Pt. rested and vital signs within normal limits. Pt. felt better after some time and left home. Pt. agreed to follow up with her doctor and emergency room precautions reviewed.


VAERS ID: 1430081 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Fatigue, Thrombosis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Blood Clots, 5:20 PM, 7 hours Abdominal Pain, 5:00 PM, 7 hours Tiredness, 5:00 PM, 7 hours Back Pain, 6:50 PM, 5 hours


VAERS ID: 1430085 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / -

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Nausea, Pain, Sinus headache
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: None
Current Illness: Previously ill with COVID-19
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My husband complained of nausea Thursday. Then extreme nausea, body aches, sinus headache, and cold chills Friday. Saturday, he said that he has had chest pain and tightness from the time he woke up, until the early hours of Sunday, around 1AM. He had taken Aleve around 8PM previously, as it is an NSAID and we had read that that may help. We suspected myocarditis or something similar.; my husband has never reacted to vaccines before and there has been linkage between Pfizer and small amounts of persons coming down with it. We opted to treat at home first. My husband''s breathing and heart rate regulated a little after 2AM. He said it was just like when he had COVID. It hurt to breathe.


VAERS ID: 1430090 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: painful large swelling in armpit of side vaccine received.


VAERS ID: 1430095 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-25
Onset:2021-06-26
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Muscle spasms, Pain in extremity
SMQs:, Dystonia (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: ibuprofen
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Painful leg muscle cramping. Began in right calf. Spread to both legs and feet by 4:00 p.m.. Stretching did not relieve. Ibuprofen did not relieve. Used heating pad in bed 9:00 p.m. Pain subsided about 11:00 p.m.


VAERS ID: 1430097 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Fall, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Flushed / Sweating-Severe, Additional Details: Patient reported extreme dizziness and light headedness; found on floor in waiting error. Remained conscious the entire time. Improved with water and cold compress. Called 911 but by the end of conversation patient was up and moving, no need for them to respond.


VAERS ID: 1430099 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Diluent Administered Instead of Vaccine-


VAERS ID: 1430101 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Diluent Administered Instead of Vaccine-


VAERS ID: 1430105 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anxiety, Intensive care, Malaise, Pallor, Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81mg, Iron, zoloft, neurontin, melatonin, preservision vitamin supplement
Current Illness: Dementia, anemia, colon cancer, gerd
Preexisting Conditions: dementia, colon cancer
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident had Johnson Vaccine on 6/25 at approximately 11:30am, had no initial symptoms on the day of vaccination. On 6/26, resident was alert and verbal all day, VS 98.1-93-18-119/77-95% on R/A , respositioned frequently in bed, at 5pm CNA was doing care and alerted nurse of res c/o not feeling well " I feel like im going to die" fingertips purple unable to obtain 02sat, color pale temp 98.3, pulse 110, RR 22, BP 87/53 res stating " please rush me to the hospital" , HCP and MD contacted, transfer orders given, resident left facility via ambulance at 5:20pm. Per hospital on 6/27 at 7:00AM resident in the ICU at this time.


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