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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 56 out of 4,799

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VAERS ID: 1430106 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Indiana  
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 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Hyperventilation, Tinnitus, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), 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: Flushed / Sweating-Medium, Systemic: Hyperventilation-Medium, Systemic: Tinnitus-Medium, Systemic: Visual Changes/Disturbances-Medium, Additional Details: 911 called. Patient evaluated by paramedics. Patient recovered and felt well enough to drive home. Patient refused hospital visit


VAERS ID: 1430107 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
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 EW0178 / 2 RA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Vomiting-Severe, Systemic: Nausea-Medium


VAERS ID: 1430108 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
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 EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysmenorrhoea, Dyspnoea, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Hyperventilation-Medium, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Vomiting-Mild, Additional Details: Approximately 5 minutes after administration, patient fainted while seated in chair. After awakening, patient reported feeling faint and tingling in her extremities. Patient was breathing heavily. After breathing normalized, patient reported severe menstral cramps. Patient was given Midol, water, and pretzles. Shortly after, patient stated that she was still light headed so she laid on the ground. Patient eventually recovered and left pharamcy.


VAERS ID: 1430110 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Mild, Additional Details: She has a history of vasovagal reaction to needles and blood draws. Provided her with water and crackers and observed for about 30 minutes.


VAERS ID: 1430112 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli, Vomiting
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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Vomiting-Mild


VAERS ID: 1430113 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
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 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Flushing, Hyperhidrosis, Injection site pain, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: PT SAID HE IS VERY WARM AFTER INJECTION AND STARTED SWEATING. THEN HE SAID THINS ARE VERY BLURRY AND WE CALLED 911. THEY CAME AND CHECKED ON HIM AND THEN TOOK HIM WITH THEM.-Severe, Systemic: Flushed / Sweating-Severe


VAERS ID: 1430139 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
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 - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymph node pain, Seizure
SMQs:, Systemic lupus erythematosus (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: Klonopin
Current Illness: Neuropathy
Preexisting Conditions: Neuropathy, atrial septal defect, tachycardia
Allergies: Ciprofloxacin, doxycycline
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Mild seizure Stabbing pain in lymph nodes


VAERS ID: 1430142 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: North Carolina  
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 - / UNK - / -

Administered by: Unknown       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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Hives, mostly on arm where vaccine was given


VAERS ID: 1430145 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
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 - / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Irritability, Pain in extremity
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Tendinopathies and ligament 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: Metformin
Current Illness: None
Preexisting Conditions: PCOS
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore Arm, fatigue, irritable


VAERS ID: 1430148 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Indiana  
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 EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lymphadenopathy, Tenderness
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: Albuterol inhaler as needed
Current Illness:
Preexisting Conditions: Asthma
Allergies: Ibuprofen, aspirin, flagyl, dogs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen Lymph nodes in Axilla area . Large and tender


VAERS ID: 1430155 (history)  
Form: Version 2.0  
Age: 13.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Discomfort, Feeling hot, Hyperhidrosis, Hypotension, Immediate post-injection reaction, Injection site pain, Malaise, Nausea, Pain in extremity, Pallor, Speech disorder, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient said she felt immediate, strong pain in her arm from the jab the nurse gave her. She said the needle was in her arm a lot longer than when she received her first shot. I also watched patient receive her first COVID shot from a different provider, different facility, and I was surprised by the force of the jab of this second COVID shot, and length of time the needle was in her arm. After the nurse left us in the room to wait 15 minutes, patient became more and more uncomfortable, hot, sweaty and nauseous. Within 5 minutes, she was lying down on the exam table - at which time I alerted staff at the nurse''s station in hallway that patient wasn''t well and we needed help. She said she would get "the provider" and be right in. When I walked back into the room, patient was curled up in a ball on the table, pale, clammy and not able to speak. I yelled down the hallway for help right away, and stepped back into the room. Patient then began to vomit. At least two nurses entered the room, and began to assess her vitals. Her blood pressure was low, but she was breathing fine. ''The provider" (I don''t know his name) came in and I told him about how hard she was jabbed, and that she began to feel badly immediately afterward.


VAERS ID: 1430156 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Indiana  
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 EW0196 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fatigue, Headache, Pallor, Presyncope, Tachycardia, Tinnitus, Tremor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None to date, will contact pediatrician on Monday (event happened on weekend)
CDC Split Type:

Write-up: At 1 am, my son presented with headache, dizziness, lightheadedness, shaking, ringing in ears, shortness of breath, and pallor. Vasovagal symptoms and near syncopal episode. Was able to get him to the floor to avoid a fall. Vomited several times. Severe vasovagal symptoms began to resolve within one hour. Didn?t check heart rate during initial near syncopal episode but was tachycardic after initial stabilization. Headache and fatigue persisted and is still lingering today.


VAERS ID: 1430157 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virginia  
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 - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: Cymbalta Levoxyl Losartan Gabapentin Multivitamin
Current Illness: None
Preexisting Conditions: Moderately high blood pressure Back pain Anxiety
Allergies: Penecillin Anti nausea meds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loud buzzing/ ringing in both ears


VAERS ID: 1430170 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Indiana  
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 - / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chills, Headache, Pain
SMQs:

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

Write-up: Headache, Body Aches, Chills


VAERS ID: 1430200 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-18
Onset:2021-06-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone Folic Acid Humira Methotrexate Zoloft Multi vitamin women''s health Magnesium Oxide
Current Illness: None
Preexisting Conditions: Rheumatoid Arthritis
Allergies: Codeine Erythromycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 8 days post injection, I developed a large hive in the injection area. It was very itchy, red, tender.


VAERS ID: 1430203 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Tennessee  
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 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Rash, Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tizanidine 4mg Tablets, Citalopram 40mg tablets, Alprazolam 1mg tablets, Acyclovir 400mg tablets, Acetaminophen/ Codeine #4 tablets, Meloxicam 15mg tablets
Current Illness: chronic pain, anxiety/depression, h/o shingles infections
Preexisting Conditions: chronic pain, anxiety/depression, h/o shingles infections
Allergies: none reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came to pharmacy on 6/27/21 to ask about a rash that appeared late night on 6/26/21. She received her 2nd Moderna COVID vaccine on 6/26/21, around 11am. Patient stated she noticed a tingling sensation on her upper back, at the base of her neck on the evening of 6/26/21. When she awoke on 6/27/21, there was a slight red, raised rash on both arms and legs. When she reported to the pharmacy around 11am on 6/27/21, rash on limbs was not really red anymore but still slightly raised. The rash on her upper back was still present and red, about the size of a half dollar coin. Patient stated that the tingling sensation was still present and went down a few inches form the visible red place, She reported no itching or pain and taking no medications to alleviate symptoms. I informed her to continue watching and seek medical attention if things got worse.


VAERS ID: 1430230 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Arkansas  
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 EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Dizziness, Dyspnoea, Hyperacusis, Visual impairment
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: I administered Covid 19 immunization and pt was waiting the 15 minutes for observation. About 5 minutes later, companion said pt said she felt like she was going to faint. We gave her a cold pack for neck and I was monitering breathing and consciousness. Pt said she sill felt faint, was having difficulty breathing, difficulty seeing and hearing. Lips turned faintly blue so technician called 911 and I administered 1 dose of Epipen in left thigh. A few minutes later I gave 10ml of Dihphenhydramine liquid. EMTs responded quickly, checked pt but symptoms resolved and she was not transported. After event patient did say she had not eaten that morning.


VAERS ID: 1430242 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-19
Onset:2021-06-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, 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: Chorella
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache starting day after vaccine. 06-26-21 Vomiting started without warning before dinner along with headache. Never felt sick to stomach and hadn''t ate anything since lunch time that day. Continued to vomit for a few hours, no other symptoms followed that evening or next day.


VAERS ID: 1430250 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
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 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Toothache
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: Synthroid Zomig prn Omeprazole Vit D
Current Illness: None
Preexisting Conditions: Migraines
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Teeth pain


VAERS ID: 1430257 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
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 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

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

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

Write-up: patient reported getting covid arm. Patient had itchy rash and redness at injection site


VAERS ID: 1430273 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Missouri  
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 1821287 / UNK LA / SYR

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

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

Write-up: Fever, chills, muscle aches, extreme fatigue. I took some Tylenol and went to bed.


VAERS ID: 1430280 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
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 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Feeling hot, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Patient describes wide spread tingling and warm sensation in upper body stretching to the face as well as both arms. She reports no fever but is unable to tell if any erythema as she is African American. She said it started late last night and has not changed since that time. She said it felt like she had been out in the sun all day but also the skin was tingling. Since she described tingling skin and warm sensation I had advised her to be checked for possible allergic reaction. Pt was going to go to urgent care to get checked out. Pt did report also suffering from anxiety during telephone call and was not sure it it could have contributed to the situation.


VAERS ID: 1430299 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
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 EW0180 / 2 RA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Diarrhoea, Fatigue, Migraine, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Second dose was received 4:00 PM friday, June 25. Symptoms started next morning, June 26 at 8:00am. Experienced migraine, nausea, diarrhea, chills, fatigue, stomach cramps and lasted about 14 hours. Followed by fatigue the next day.


VAERS ID: 1430305 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Georgia  
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 (MODERNA)) / MODERNA 026D21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax 2 mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had lips that were swelling one day after event.


VAERS ID: 1430346 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
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: Fall, Fatigue, Head injury, Pain, Presyncope
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Mother reported pt experiencing vasovagal rxn after unspecifed pediatric vaccine at unspecified point in past
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administered without issue to pt (behavior & appearance normal, engaged in conversation). Pt agreed to wait 15 min. for observation and left vaccination area for monitoring area. Shortly thereafter, RPh heard what sounded like pt falling. RPh observed pt lying supine on tile floor of monitoring area. RPh assumed occurance of vasovagal syncope and went to aid pt; however, pt seemed to immediately (<1 sec.) regain consciousness, was breathing without difficulty and was able to shift to chair under own power. Tech who had been monitoring remarked pt had opted to stand rather than sit after exiting vaccination area and that she''d "hit her head" upon falling. RPh provided ice pack while pt''s mother retrieved water bottle. Pt seemed alert and cognizant of situation (denied pain, was overheard saying to assumed male relative, "You didn''t help me."). RPh strongly encouraged pt to wait 30 min. instead of 15 min. but family left after original time; mother remarked pt had vasovagal rxn after an unspecified vaccine in past (RX had not been previously made aware). About 1.5 hours later, RPh called mother to follow-up & advise on signs/symptoms of concussion. At the time, mother said she would monitor pt. Perhaps another half hour later, mother called RX to ask for advice: pt complaint of pain (took Tylenol) and tiredness (despite getting enough sleep the previous night & not usually tired around that time). RPh recommended taking pt to ER as soon as reasonably possible (mother denied any other S/S like uneven pupils, confusion or being difficult to rouse). Mother seemed receptive to that suggestion as well as warning staff of vasovagal syncope for all future vaccinations, though she could not be reached for confirmation of action the next morning.


VAERS ID: 1430350 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-28
Onset:2021-06-26
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / -

Administered by: Military       Purchased by: ?
Symptoms: Echocardiogram, Electrocardiogram, Pericarditis, Troponin
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: ECHO EKG TROPONIN
CDC Split Type:

Write-up: ACUTE PERICARDITIS


VAERS ID: 1430389 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
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 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

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

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

Write-up: Wife called to report that patient developed a generalized rash throughout the body the night after receiving Moderna Covid shot. She provided him with Benadryl. Next morning his face was swollen and she decided to call the pharmacy. I advised her to provided Benadryl again and to take him to emergency room. Difficult breathing was not reported.


VAERS ID: 1430394 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Oklahoma  
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 - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: At 6:00, hives appeared on my body, left covid arm broke out first in hives. Left hand became very swollen, and got worse through the night. The next day hand was still swollen.


VAERS ID: 1430420 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-25
Onset:2021-06-26
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Feeling hot, Gait disturbance, Injection site pain, Nausea, Pain, Pain in extremity, Paraesthesia, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 10mg Lisinopril Tabs - 1 daily 25mg Hydrochlorothiazide Tabs - 1 daily
Current Illness: Alleviated Blood Pressure
Preexisting Conditions: Stomach Bloating
Allergies: None
Diagnostic Lab Data: I have not sought medical attention at this time. If I am not feeling better soon I will seek medical attention first thing tomorrow morning, June 28, 2021.
CDC Split Type:

Write-up: I was given the Covid-19 vaccine on Friday, June 25th around 8:45 am. By noon my arm started to experience soreness. The site of the shot still was sore to the touch and with movement on Saturday, June June 26th. Saturday afternoon by 2:00 pm I started to feel nauseated. At about 3:30 pm after lunch, I started to fill over-heated and light-headed. I made my way to a couch and fell asleep. I remained there for a couple of hours. Once awoke, I had he chills but still over heated. My body was sore and I experienced some light headiness. I walked to my bedroom with a little difficulty at which time. I still felt overheated and throughout the night I was experiencing the chills and soreness at the injection site when I would turned to my left. I finally awoke on Sunday morning at 3:00 am with hives and prickly like feelings on my arms and legs. This continued until I took a cool shower to calm the prickly feeling on my skin.


VAERS ID: 1430435 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Arizona  
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 EW0181 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus vaccine.
Other Medications: Trazodone
Current Illness: No other illnesses reported
Preexisting Conditions: No chronic health conditions reported
Allergies: No known drug allergies
Diagnostic Lab Data: Fire department came to check all the vitals.
CDC Split Type:

Write-up: Syncope symptoms; became pale; sweating; dizziness. Recovered in 15 minutes. Fire department came to check all the vitals. Patient and his wife declined to go to the hospital. His wife reported that he ate the night before and was on empty stomach. The same symptoms occurred when patient received the tetanus vaccine before.


VAERS ID: 1430436 (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: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Dizziness, Feeling hot, Induration, Lethargy, Lymph node pain, Lymphadenopathy
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tyrosin 125mcg
Current Illness:
Preexisting Conditions: Sjogren Syndrome
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme lethargy, body felt hot no fever, chills, joints pain, dizziness, large swelling of the left side lymph nodes from armpit to breast hard and painful at touch.


VAERS ID: 1430454 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
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 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Bed rest, Influenza like illness, Pain
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin 10mg, ,multi vit. ,relief factor, vit d3, coq10sr, ocuvite
Current Illness: none
Preexisting Conditions: none
Allergies: have had allergic reaction to anti inflammatory drugs a few times
Diagnostic Lab Data:
CDC Split Type:

Write-up: felt like i had the flu the next day. Ached all over no energy, stayed in bed all day


VAERS ID: 1430455 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Afrin, Doxycycline
Current Illness: None
Preexisting Conditions: Asthma
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: At approximately 20 mins after vaccination, patient reporting complaints of dizziness without N/V. Vitals HR 76, RR 16, BP 122/82, O2 96%. Patient reporting she has only had coffee this AM and was given peanut butter crackers. No complaint of vision changes or SOB. Patient left site at 10:30 AM.


VAERS ID: 1430465 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-20
Onset:2021-06-26
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abnormal behaviour, Body temperature increased, COVID-19, Condition aggravated, Escherichia infection, Pathogen resistance, Pneumonia, Pyelonephritis, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Urinary tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient is a 65 yo female from home with a history of complicated ESBL E. Coli urinary tract infection, nephrolithiasis, s/p stone basket removal of stone May 2020. DM, HTN, GERD, osteroarthritis, who presented to the ED complaining of AMS. The night prior to presentation, she went to sleep with a friend staying over, and this morning the friend noted that the patient was not acting appropriately. She then called EMS, and on arrival the patient had a temperature of 101.1F. She needed 2L NC. This patient was recently evaluated in the ED on 6/06, where she was diagnosed with right-sided pyelonephritis. She was sent home on cefpodoxime and Motrin. During this current hospitalization, patient was found to be COVID positive on 6/26/21 with RLL pneumonia and E. Coli ESBL complicated UTI. She did not have a prior diagnosis of COVID. Last COVID PCR test on 6/6/21 was negative.


VAERS ID: 1430507 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Guam  
Vaccinated:2021-05-18
Onset:2021-06-26
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Pain, Sneezing
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: L Arginine, L Carnitine, Vitamin E Vitamin D3 Benadryl Ibuprofen
Current Illness:
Preexisting Conditions: PTSD Fatigue
Allergies: Bell pepper Hay fever
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Allergy sneezing with body pain. arms L and R, across chest right side of face and neck


VAERS ID: 1430510 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Asthenia, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Allergic: Anaphylaxis-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Vomiting-Mild, Systemic: Weakness-Mild


VAERS ID: 1430513 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 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: Error: Booster Given Too Early-


VAERS ID: 1430518 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-23
Onset:2021-06-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immune-mediated adverse reaction, Injection site bruising, Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Site: Bruising at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Appeared to be an immune reaction to the shot, but patient was convinced it was cellulitis. She believes that bacteria got into the injection site. The pharmacist who gave her shot to her used an alcohol swab before administering the shot.


VAERS ID: 1430545 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood creatine phosphokinase increased, Brain natriuretic peptide increased, Chest pain, Myocarditis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 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: elevated troponin, CK, BNP, chest pain
CDC Split Type: n/a

Write-up: myocarditis


VAERS ID: 1430585 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic shock, Dizziness, Eye movement disorder, Loss of consciousness, Nasopharyngitis, Pallor, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKDA, NA - food allergies
Diagnostic Lab Data: Epipen 0.3 MG IM left thigh (anterior) administered on 6/26/21
CDC Split Type:

Write-up: Within minutes after receiving 1st dose of Pfizer-BioN Tech covid Vaccine 0.3 ml IM, patient complained of dizziness and fell to the ground. Patient was very pale and cold to touch, not being responsive well. Patient was losing consciousness and having difficulty keeping her head up. Patient was moved to lie down on the floor with legs up. Cold water was offered and patient took a few sip. EMS was called. Patients eyes rolled back into her head and lost consciousness/possible anaphylactic shock and not being responsive. Epipen 0.3 MG IM administered. Patient regained consciousness. Nurse practitioner was called and vitals including BP and oxygen level was performed and found to be stable. EMS arrived in few minutes and vitals were checked again by EMS personnel and patient was transferred out to nearby ER. After 3 and 1/2 hours at the ER for observation, patient was discharged.


VAERS ID: 1430640 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: headache (pain scale 3 out of 10, with zero being no pain), minor fatigue
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: by 9am on 6/26/21 a little over 1/2 a day from time of Moderna Shot #2 I had minor fatigue and a very slight headache, but my arm at injection site hurt about a 5 out of 10 on a pain scale with zero being no pain. I took 2 Tylenol gel caps about 10am, then again about 8pm that day, then on Sunday about 9am and the headache was gone. I was lucky and was functional both days following the second shot with only the very minor reaction. Today, Monday, 6/28/21, I would never know I had the shot, the arm and the headache and fatigue are gone.


VAERS ID: 1430647 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Migraine, Myalgia, Nausea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Her shot was administered 6/25/21 about 6pm. No issues until about 5:00AM on Saturday 6/26. She began to have a migraine-level headache she said was about a 9 out of 10 pain (zero being no pain), extreme fatigue, nausea and vomiting every 20-30 minutes. She was not able to keep down liquids or tylenol, so there was no relief of symptoms until she finally was able to eat a little and take tylenol late Saturday night. By 10am she said the headache was down to a 1 out of 10, felt less fatigue, muscle pain from the vomiting, and overall about 80% functional. By 2pm Sunday she said about 85-90%, and now today Monday 6/28 she feels 95% and is fully functional.


VAERS ID: 1430649 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Induration, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diltiazem Eliquis Pantoprazole Anoro Albuterol Sulfate Budesonide
Current Illness: COPD
Preexisting Conditions: COPD
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: A vein was swollen When massaged swollen went down Was sore to touch Turned into a big bruise and hard to the touch


VAERS ID: 1430664 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 - / IM

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

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

Write-up: This is day 3 of moderate to severe persistent headache. He had been alternating Motrin and Tylenol throughout the day for the last 2 days with no significant improvement. Denies hx of migraine headache. Ordered Maxalt as abortive therapy- outcome pending.


VAERS ID: 1430855 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-14
Onset:2021-06-26
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: SARS-CoV-2 test
SMQs:, COVID-19 (broad)

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

Write-up: Individual RNA PCR at Clinic, a pharmacy within a Pharmacy. Case investigation has not been completed at the time of this note.


VAERS ID: 1430866 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 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? 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: Inadvertently gave Moderna to client less than age 18


VAERS ID: 1430895 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 RA / IM

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

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

Write-up: Patient received dose #2 of Pfizer vaccine on 6/6/2021 @ Vaccination center. and was notified by email that vial was left in freezer past recommended time frame. Medication expired beyond its freezer allowable date. Email recommended patient get re-vaccinated with dose again. Affiliated Physicians re-administered dose on 6/26/2021 as recommended. No adverse reactions identified on site.


VAERS ID: 1430908 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dermatitis acneiform, 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: Keppra 500mg
Current Illness: Bronchitis
Preexisting Conditions: Seizure Disorder
Allergies: Cipro Amoxicillian
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pimpled rash all over chest, shoulders, neck


VAERS ID: 1430913 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / SYR

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

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

Write-up: Per Parent, Pt started on 06/26/2021 with headache, fatigue, and nausea at approx. 10 a.m.. Parent called our office on Monday 6/28/2021 at approx. 10:54 am and said symptoms continue.


VAERS ID: 1430914 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: Cold 3 weeks prior that lasted 5 days
Preexisting Conditions: Asthma
Allergies: Peanut and treenut allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain


VAERS ID: 1430915 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: pericarditis


VAERS ID: 1431001 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-23
Onset:2021-06-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

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

Write-up: Patient reported having stiff neck a few days after he received his 2nd vaccination


VAERS ID: 1431029 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-18
Onset:2021-06-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Work       Purchased by: ?
Symptoms: Erythema, Pain in extremity, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 8 days after my injection I have a large red raised, warm circle on the same arm I received my injection. It hurts a little and itches sometimes.


VAERS ID: 1431063 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-06-17
Onset:2021-06-26
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin XL 150mg, ProAir HFA, Claritin 10mg, Levothyroxine 50mcg
Current Illness: none
Preexisting Conditions: Hypothyroidism, Depression, Asthma
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Red welt on right arm injection site that itched. No treatment was given, event subsided


VAERS ID: 1431108 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Nausea, Pain, Pyrexia, Swelling face, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 12 hours s/p vaccine The patient developed fever to 102.5 taken orally. She had body aches, Headache, nausea and vomiting. By the second day the patient developed mild facial swelling bilaterally, this responded well to Zyrtec. There was no SOB, or dyspnea. There was no swelling of lips or oropharyngeal structures. Her symptoms persisted for 48 hours. Patient was treated at home by her mother, who is a pharmacist, with apap alternating with ibuprofen. She was also given Zyrtec as noted. The patient was seen by me this afternoon and was improved with no fever evident. However, Mom had given her 1 gram apap 1 hour prior to her visit.


VAERS ID: 1431113 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-06-26
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiac disease, hypertension
Allergies:
Diagnostic Lab Data: COVID-19 RNA detection BDMAX positive 06/26/2021.
CDC Split Type:

Write-up: Patient currently has COVID-19.


VAERS ID: 1431126 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-06
Onset:2021-06-26
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO177 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Echocardiogram, Electrocardiogram, Myocarditis, Pericarditis, Troponin increased
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Cardiomyopathy (broad), Chronic kidney disease (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG 2D Echo Troponins
CDC Split Type:

Write-up: Developed myocarditis/pericarditis with EKG changes and high troponins


VAERS ID: 1431177 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Immediate post-injection reaction, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Reaction: Pt received vaccine in L arm. Pt had immediate vagal response post vaccine administration. Friend supporting pt until staff assisted pt to floor. Pt placed supine, legs elevated, pulses present, airway patent/breathing and able to communicate with staff. Pt reported being confused. Vital signs at 1401: HR 69, Spo2 97% on RA. 1402 Pt placed on 6L 02 for comfort. 1405 HR 61 BP 135/75 RR 16 Spo2 94%. Overall vagal response lasting 20 seconds. 911 called at 1400. Prior to EMS arrival patient A&Ox4, able to move herself to chair position with stand by assist. Patient tolerated a couple bites of granola and a few sips of water and juice. Patient than lied upon chairs with staff supervision until EMS arrived around 1420. Patient ambulated out of clinic with EMS. No record available if patient seen anywhere after episode


VAERS ID: 1431302 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Dizziness, Migraine, Pain, Palpitations, Pyrexia, Sleep disorder, Tremor, Urinary incontinence, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol 1 500mg
Current Illness: Anemia, low blood pressure, low blood sugar problems, factor 5, migraine headaches, issues with bowels n bladder and fatigued ,dizziness
Preexisting Conditions: Anemic, low blood pressure low blood sugar problems, factor 5, migraine headaches, issues with bowels n bladder , fatigued and dizziness really bad almost everyday seeing specialist to see what is going on and what is causing everything
Allergies: Seasonal allergies
Diagnostic Lab Data: I didn?t go to hospital I probably should because now I think I am dehydrated
CDC Split Type:

Write-up: I was ok then about 6hours from getting second shot I started to get really sore and then around 930 pm I started to get a fever shaking n weak then around 1100pm I was really sick bad migraine headache and dizziness and high fever 102.7 n then I threw up 3 times within the night of 6/26-6/27 and I couldn?t hold my urine so I pee on myself while throwing up early morning I couldn?t sleep shaking and having to stretch n yawn a lot. I couldn?t keep anything down. Then 6-27-21 all day I had a fever couldn?t get out of bed except for bathroom and then my husband had to either carry me or guide me. I slept on n off all day but only for like 10-30 minutes like I had insomnia??? Now it?s 6/28/21 n I?m doing a very little better, bad headache migraine n weak my chest is tight n heart jumping around here n then. I just want to feel better this really hit me hard I haven?t been this sick since I was a little girl and had flu n pneumonia n bronchitis and was hospitalized for that I?m a strong woman but this vaccine really put me down n put me down hard. I have never had any other vaccine to make me sick like I am now. Anyhow I just wanted to report it.


VAERS ID: 1431316 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-27
Onset:2021-06-26
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acyclovir, albuterol nebs, diclofenac, fluticasone-salmeterol, gabapentin, hydroxyzine, montelukast, trazodone
Current Illness:
Preexisting Conditions: Vitamin D deficiency, seasonal affective disorder, reflux, radiculopathy - lumbosacral region, pes planus, obesity, neck pain, multiple allergies, herniated lumbar intervertebral disc, GERD, dysphagia, depression, COPD, chronic pain, ADD, asthma, arthritis, anxiety, allergic rhinitis, alcohol abuse, sleep difficulties, hypertension, hypertriglyceridemia, oral herpes simplex, benign neoplasm of breast, cervical spinal stenosis.
Allergies: aspirin, naproxen, jalapenos, gluten meal, salicylates, zofran.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt completed vaccination series for the COVID-19 Pfizer, with one dose received 4/6/2021 and the 2nd received 4/27/2021. Pt was seen at ED on 6/26/2021 for mental health related reasons, and tested positive for COVID-19 as part of routine admission screening. Medical notes indicate the patient was asymptomatic for COVID-19.


VAERS ID: 1431334 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Loss of personal independence in daily activities
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Patient reported shortness of breath and tightness in chest that started around 4pm on June 26, 2021 during volleyball game that led to patient not being able to continue activity. On June 28, 2021 at 11am to 1pm, pt reported the same shortness of breath that led to patient not being able to continue strength and conditioning activity. Patient has been advised to contact primary care doctor for further guidance and evaluation.


VAERS ID: 1431336 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling cold, Headache, Injection site pain, Injection site swelling, Loss of personal independence in daily activities, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: I had pain, tiredness and muscular pain after I had the first dose.
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initially I had a more severe pain than i had with the first dose. Swelling and Soreness at the injection site was worse than the first dose. Later at night when trying to go to sleep I felt a SUDDEN Onset of CHILLS. I then had Muscular Pain thruout various parts of my body. I had Headache. I felt cold thruout the first night after I got the vaccine. I felt tired and unable to do day to day tasks the following day.


VAERS ID: 1431360 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 LA / IM

Administered by: Public       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient given Pfizer as their second dose when should have received Moderna. Patients first dose was Moderna 26 days prior on 6/1/2021.


VAERS ID: 1431381 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-01-30
Onset:2021-06-26
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, Atorvastatin, Doxazosin, Losartan, Pantoprazole, Dexamethasone, Lantus, Cholecalciferol.
Current Illness: Ascending aortic aneurysm w/endovascular stent graft, hyperlipidemia, OSA, PVD, DM2, TIA, GERD, CAD w/stents and CABG, CKD Stage 4, COPD, h/o PE, BPH and L-renal stenosis.
Preexisting Conditions: Ascending aortic aneurysm w/endovascular stent graft, hyperlipidemia, OSA, PVD, DM2, TIA, GERD, CAD w/stents and CABG, CKD Stage 4, COPD, h/o PE, BPH and L-renal stenosis.
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID (+) 6/26/21 -- $g admitted to Medical Center despite being fully vaccinated.


VAERS ID: 1431395 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site hypoaesthesia, Injection site pruritus
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:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient stated her arm was numb and itchy at the injection site starting shortly after the injection


VAERS ID: 1431418 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

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

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

Write-up: PATIENT STATES SHE HAS A RED ARM THAT EXTENDS INTO HER SHOULDER BLADE AND DOWN TO HER ELBOW. SHE FEELS AS THOUGH HER LYMPH NODES ARE SWOLLEN IN HER ARM AND NECK AND SHE FEELS FLUID FILLED PATCHES (CYSTS) DOWN BY HER ELBOWS. I ADVISED HER TO CONTACT HER DR.


VAERS ID: 1431435 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Feeling hot, Headache, Hyperhidrosis, Pain, Pyrexia, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever Chills Extreme sweating and heat Body ache Headaches Lost of apetite Loss of weight


VAERS ID: 1431470 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Electrocardiogram
SMQs:, Hearing impairment (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: Lyme pending obtained 6/28/2021. EKG normal.
CDC Split Type:

Write-up: Left facial nerve palsy; started on prednisone


VAERS ID: 1431484 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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 administered a first dose of the Pfizer covid vaccine after already receiving the Janssen covid vaccine on 4/10/2021. Patient reports tolerating the Pfizer vaccine well.


VAERS ID: 1431518 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Device connection issue, Syringe issue
SMQs:, Medication errors (broad)

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

Write-up: Syringe had a crack in it where it connected to the needle and the vaccine leaked out onto patient''s arm instead of being administer. Patient was then given another dose because the patient received very little if anything at all of the initial dose


VAERS ID: 1431521 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Injection site erythema, Injection site swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Taste and smell disorders (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I do not know.
Current Illness: Hashimoto''s
Preexisting Conditions: anemia, Hashimoto''s
Allergies: nkda
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: metallic taste (saturday night for a few hours) Injection site reaction: redness, swelling face swelled: no problems breathing


VAERS ID: 1431981 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Aphasia, Balance disorder, Computerised tomogram head normal, Computerised tomogram neck, Confusional state, Dizziness, Feeling abnormal, Intracranial aneurysm, Laboratory test, Surgery
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: trazodone, pregabalin, potassium chloride, lidocaine ointment, lamotrigine, furosemide, folic acid, eszopiclone, clopidogrel, clonazepam, Breo Ellipta, baclofen, atorvastatin, aspirin, aripiprazole, albuterol inhaler
Current Illness:
Preexisting Conditions: COPD, obesity, type 2 diabetes, left internal carotid artery aneurysm with stenting, obstructive sleep apnea, coronary artery disease, bipolar depression, hepatitis C, hyperlipidemia, gastroparesis, restless leg syndrome, dysarthria, urinary incontinence, GERD, history of CVA, migraine
Allergies: beta blockers, ACEIs, diphenhydramine, cyclobenzaprine, adhesive tape
Diagnostic Lab Data: 6/28/21 CT head and neck (non-contrast) - no acute abnormality CTA head and neck - no large vessel occlusion other labs WNL
CDC Split Type:

Write-up: Patient reports that for the past two days (since date of vaccination) she has felt dizzy. She also reports ongoing confusion since her surgery for her cerebral aneurysm. She reports that for the past few days she has been bumping into walls and generally feeling off balance as well as experiencing word-finding difficulties. Patient is being admitted for MRI and neurology evaluation. CT and CTA of the head show no acute abnormalities.


VAERS ID: 1432304 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-18
Onset:2021-06-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0107 / 1 LA / IM

Administered by: Private       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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: hyperlipidemia
Allergies: seasonal allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: significant torso hives involving upper arms, trunk, neck, and groin. Occurred 6/26, treated with claritin. Recurred 6/28, treated with zyrtec


VAERS ID: 1432674 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling cold, Feeling hot, Hallucination, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Dehydration (broad)

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

Write-up: Side effects began few hours after receiving the Covid-19 Janssen vaccine. Side effects included suddenly freezing followed by full body shivers, hallucinations, extreme thirst, woke up feeling extremely hot as if overheating but no sweating, confusion, headaches/migraines, nausea, and muscle tightness.


VAERS ID: 1432930 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient stated that she always faints when she gets the vaccine however she did not mention that before she was given the vaccine. She was with her mom. she was given gatorate/ crackers and felt better. she was reponsive however it is a common side effect that she gets when she gets blood drawn or vaccines. the mom stated that she will always have to be with her when she gets vaccinated. Patinet did not want us to call 911. she was ok before she left.


VAERS ID: 1433154 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 - / ID

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Generalised tonic-clonic seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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:
Current Illness:
Preexisting Conditions: anxiety, allergic rhinitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: yelled out loudly when he received the vaccine but was fine immediately after. He was sitting for about 5 minutes before his mother said that he was feeling dizzy. The doctor was going to grab an ice pop for him when he fainted. was there as he was sliding off of the chair and had him in her arms. He then began to have a tonic-clonic seizure that lasted approximately 1 minute. The mother called 911. He woke up and asked what happened. The ambulance arrived and suggested that he go the hospital. The mother was on the phone with his father and he said he did not think an ER visit was necessary. The ambulance left and after waiting another 30 minutes, mom took home.


VAERS ID: 1433221 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 - / IM

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

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

Write-up: Mixing/Administration error: Nurse drew up 1.8ml of saline diluent and then drew up 0.3ml of vaccine concentrate from second vial. Injected patient with 2.1 ml of fluid. Did not reconstitute properly.


VAERS ID: 1433230 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Mixing/Administration error: Nurse drew up 1.8ml of saline diluent and then drew up 0.3ml of vaccine concentrate from second vial. Injected patient with 2.1 ml of fluid. Did not reconstitute properly.


VAERS ID: 1433268 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 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? 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: UNKNOWN
CDC Split Type:

Write-up: PATIENT IS 16 YEARS OLD RECEIVING MODERNA WHICH IS ONLY APPROVED FOR 18 YEARS AND UP. AFTER 20 MINUTES OF VACCINATION, PATIENT REPORTED NO SIDE EFFECTS.


VAERS ID: 1433294 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Lymphadenopathy, Peripheral swelling, Rash erythematous, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen arm (started on 06/26/2021) with a warm red rash that has started on 06/28/2021. Swelling and soreness in armpit area that started on 06/26/2021 and has continued


VAERS ID: 1433316 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Impaired driving ability, Impaired work ability, Loss of personal independence in daily activities, Migraine
SMQs:, Dementia (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: Was terrible the day after the first Pfizer shot, had freezing chills terrible fever couldn?t walk and couldn?t eat
Other Medications: Na
Current Illness: Na
Preexisting Conditions: Asthma that has receded
Allergies: Nuts in large quantities, but not processed nuts like peanut butter
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache while idle, and once I move and walk around I have random migraine spikes that last from 1-30 seconds making it impossible to drive, walk, jog, exercise, go to work, exc.


VAERS ID: 1433401 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 - / -

Administered by: School       Purchased by: ?
Symptoms: Chills, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies: Stone fruit
Diagnostic Lab Data:
CDC Split Type:

Write-up: Experienced mild headache the first day snd mild chills the second day. Sharp chest pains on the left side, the pain comes and goes. Still experiencing this pain.


VAERS ID: 1433424 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-21
Onset:2021-06-26
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: covid-19 test on 06/28/2021 was positive
CDC Split Type:

Write-up: Patient teste positive for Covid-19 on 06/28/2021, he has been fully vaccinated.


VAERS ID: 1433458 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, 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: About 24 hours after administration the patient noticed a rash on her right elbow about the size of a golf ball that was itching. The next day she noticed a rash on her left elbow about the size of a baseball that is also itchy. Patient has been washing with mild soap and water and applying lotion. She has not been using any OTC or prescription products for itching.


VAERS ID: 1433515 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-28
Onset:2021-06-26
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Diarrhoea, Fatigue, Headache, Limb mass, Skin warm
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Severe diarrhea for several days, lump on arm that was hot to the touch, bruising, headache, fatigue.


VAERS ID: 1433576 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM

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

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

Write-up: Higher than recommended dose administered to patient. Pt did not have any symptoms from injection immediately after through today, 3 days later. No complaints, local or systemic.


VAERS ID: 1433620 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM

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

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

Write-up: Patient was administered higher than recommended dose. c/o Left arm discomfort x 2 days. Denies any pain, swelling, redness today (3 days after vaccine). Pt had no other complaints.


VAERS ID: 1433703 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-06-26
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest X-ray abnormal, Chest pain, Dyspnoea, Fibrin D dimer increased, Hyperhidrosis, Nausea, Pain in jaw
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Osteonecrosis (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: abnormal chest xray, elevation of d-dimer,
CDC Split Type:

Write-up: chest pain, back pain, nausea, jaw pain, sweaty, shortness of breath


VAERS ID: 1433845 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Electrocardiogram ST segment elevation, Pericarditis, Troponin
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (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? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: nio
Allergies: no
Diagnostic Lab Data: uHS trop was 1114, crp was 80, ECG with diffuse anterolateral ST elevation
CDC Split Type:

Write-up: chest pain for last 3 day- pericarditis


VAERS ID: 1433904 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: PATIENT HAD NO ADVERSE EVENTS REPORTED. PATIENT RECEIVED MODERNA COVID-19 FOR 1ST DOSE , BUT RECEIVED PFIZER AS SECOND DOSE.


VAERS ID: 1434035 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nasopharyngitis, SARS-CoV-2 test, Secretion discharge
SMQs:, COVID-19 (broad)

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

Write-up: Cold symptoms; mucous.


VAERS ID: 1434089 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient was administered his 2nd dose of Modera Covid-19 vaccine 6 days too early. He showed up for his 2nd dose on 06/26/2021 and presented a vaccine record card with a wrong appointment date written on it. The Pharmacist who gave him is 1st dose of Moderana made his appointment for 06/25/21 (21 days). His correct appointment date should have been written as 07/02/2021 (28days). The Pharmacy Manager admitted to making a mistake when she wrote the wrong date on his record card. She said that she later tried calling him to have it corrected but she was unable to reach him at the phone number he gave that Pharmacy.


VAERS ID: 1434274 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis
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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Post COVID-19 immunization myocarditis


VAERS ID: 1434532 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-18
Onset:2021-06-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 1827289-04136 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bacterial test negative, Coma, Headache, Lumbar puncture normal, Muscular weakness, Protein total, SARS-CoV-2 antibody test positive, Vomiting, White blood cell count
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None at the time of vaccination. He did have fever and cough 4 weeks ago.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: SARS-Cov2 Antibody- reactive on 6/27/2021. Lumbar puncture showed 89 WBC and 115 protein, negative for bacteria.
CDC Split Type:

Write-up: He had vomiting, headache on 6/26/2021 and became comatose that night and got better after steroids. He is still weak in the right arm.


VAERS ID: 1434917 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Fall, Tachyphrenia
SMQs:, Anticholinergic syndrome (broad), Psychosis and psychotic disorders (broad), Guillain-Barre 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: dizziness after receiving any vaccine throughout his whole life
Other Medications: Patient denies taking prescription, over-the-counter medications, dietary supplements, or herbal remedies at the time of vaccination.
Current Illness: Patient denies having other illnesses at the time of vaccination and up to one month prior.
Preexisting Conditions: Patient denies having any chronic or long-standing health conditions.
Allergies: Patient reports to have no known allergies to food, medication, or other products.
Diagnostic Lab Data: Supervisor on duty asked the patient if he would like to be taken to the hospital emergency department, but patient stated he did not need to go and said he felt fine.
CDC Split Type:

Write-up: After receiving the Moderna vaccine, the patient was sitting in a chair in the pharmacy waiting area. About 5 minutes afterwards, he fell out of his chair. Upon asking the patient if he was okay and what happened, he reported he felt dizzy with racing thoughts on his mind. Then he lost his balance, slipped out of his chair, and fell to the floor. He stated he has dizziness after every vaccine he has received in the past. He sat back in the chair and rested, and also reported he felt better. The supervisor on duty provided the patient with water. About 15 minutes after falling, the patient stated he felt fine and wanted to leave. He was stable upon standing up from the chair. I informed him if he experiences any other symptoms, that he should call my pharmacy, or if he experiences anaphylaxis, he should call 911 and seek immediate medical attention.


VAERS ID: 1434918 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-16
Onset:2021-06-26
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Omnicef, penicillin
Diagnostic Lab Data: Had EKG, wait on hospitals call to have echocardiogram scheduled
CDC Split Type:

Write-up: Chest pain, awaiting diagnosis


VAERS ID: 1435869 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 710127 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210660805

Write-up: SLEEPINESS; STOMACH HURTS; This spontaneous report received from a parent concerned a 29 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 710127, and expiry: UNKNOWN) dose was not reported, administered on 25-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 26-JUN-2021, the subject experienced sleepiness. On 26-JUN-2021, the subject experienced stomach hurts. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from sleepiness, and stomach hurts. This report was non-serious.


VAERS ID: 1435874 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210661088

Write-up: PARTIAL DOSE OF VACCINE ADMINISTERED; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821288, and expiry: 01-AUG-2021) dose was not reported, administered on 26-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 26-JUN-2021, the subject experienced partial dose of vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of partial dose of vaccine administered was not reported. This report was non-serious.


VAERS ID: 1436992 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: Injection arm is numb


VAERS ID: 1436993 (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: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0574C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fall, Feeling hot, Flushing, Hyperhidrosis, Nausea, 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), 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: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Additional Details: Pt reported feeling "queasy", "hot", having "chills" and "sweating", pt fainted and fell out of chair. Was responsive after fainting and reports no pain, no trouble breathing. Assessed by NP from clinic, BP and HR normal. EMS was called and pt was transferred to their care for follow up. Contacted patient around 3pm same day and pt spouse reported pt feeling much better and was "doing ok"


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