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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 573 out of 10,317

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VAERS ID: 1873575 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (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: diabetic
Allergies: prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: high blood sugar


VAERS ID: 1873578 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: on hospice
Preexisting Conditions: not aware
Allergies: nkda
Diagnostic Lab Data: No known
CDC Split Type:

Write-up: Patient Went to her room with her nurse and after 15 or 20 minutes she was unresponsive. The nurse took her blood pressure and pulse and there was not any response. Patient is on hospice. The nurses ran and got me. Since she was not responding we administered one dose of epinephrine in her thigh. She started opening her eyes after this. She also had a pulse and we were able to take her blood pressure. The nurse wanted to give her 2 tablets of 25mg of Benadryl. She crushed them for the patient and put under the tongue. Patient was seen by her hospice nurse, and her family was made aware of incident.


VAERS ID: 1873579 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-12
Onset:2021-11-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Magnetic resonance imaging head, Nausea, Tinnitus, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Healthy
Allergies: Ceclor
Diagnostic Lab Data: MRI of brain 11/16/2021
CDC Split Type:

Write-up: Whole body visually shaking, tinnitus, nausea


VAERS ID: 1873586 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-19
Onset:2021-11-16
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873593 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-15
Onset:2021-11-16
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 RA / IM

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

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

Write-up: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873594 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-12
Onset:2021-11-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site swelling, Swelling face
SMQs:, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Percocet.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling in the face on the side of injection site.


VAERS ID: 1873600 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-15
Onset:2021-11-16
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873601 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-15
Onset:2021-11-16
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873608 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-21
Onset:2021-11-16
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873614 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Patient came into vaccination pod and was accompanied by a previous patient whom got her first dose earlier that morning. The guardian was vaccinated with a 12+ pfizer vaccine and requested the same for the patient she brought in. The administrator for the day registered the patient into the clinic system before the PrepMod system and proceeded to vaccinate the 11 year old with a (0.3mL) dose rather than a (0.2mL) dose. The pediatric patient showed no adverse symptoms and was called a few hours to check in on the patient and inform them of the mistake. The patient''s guardian reported only muscle ache on the injected arm - nothing else. She was informed to please inform of the patient''s age and required dose when returning for the second dose.


VAERS ID: 1873618 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-17
Onset:2021-11-16
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

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

Write-up: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873619 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-20
Onset:2021-11-16
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

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

Write-up: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873620 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Low grade fever- 100, upset stomach, bad headache


VAERS ID: 1873621 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-14
Onset:2021-11-16
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873628 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-21
Onset:2021-11-16
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873629 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-16
Onset:2021-11-16
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 RA / IM

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

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

Write-up: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873632 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-14
Onset:2021-11-16
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873634 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-14
Onset:2021-11-16
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873635 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-14
Onset:2021-11-16
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873636 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-21
Onset:2021-11-16
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873638 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-14
Onset:2021-11-16
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873640 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-20
Onset:2021-11-16
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873643 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-14
Onset:2021-11-16
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873648 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-14
Onset:2021-11-16
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873650 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-11-16
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873652 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-18
Onset:2021-11-16
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873653 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-11-16
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873655 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: Patient moved as injector was administering the vaccines and some of the dose was lost from end of needle onto patient arm before being fully inserted into muscle


VAERS ID: 1873656 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-22
Onset:2021-11-16
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: unknown. product administered when stored in freezer beyond the 21days that pfizer has data to support.


VAERS ID: 1873657 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-11-16
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873663 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-11-16
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873667 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-11-16
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873669 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-20
Onset:2021-11-16
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873670 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-20
Onset:2021-11-16
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873674 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-20
Onset:2021-11-16
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873676 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methylphenidate ER 36mg 1 PO QD
Current Illness: none
Preexisting Conditions: ADHD
Allergies: Amoxicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pediatric dose (0.2mL) was given to a 14 year old.


VAERS ID: 1873678 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-20
Onset:2021-11-16
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / -

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

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

Write-up: Stored beyond use date. Moderna analysis revealed full strength of vaccine still present.


VAERS ID: 1873681 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Became dizzy, fainted and fell.


VAERS ID: 1873697 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Head injury, Headache, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 11:10 Pfizer COVID 19 EUA vaccine given in R deltoid. 11:30 Pt fainted, hitting L side of forehead on wall. 11:30 1st RN and 2nd RN arrived in room. Pt helped to R lateral position on mat on floor. Pt was complaining of stomach pain and head ache on L side of head. Assessed client?s head, no bump, redness or trauma noted. Client alert and oriented x 3. Cool cloth was applied to forehead and juice was given after nausea resolved. 11:42 Pt reported feeling better and was helped to sitting position, continued to sip juice. 12:00 PM Pt was alert and oriented x 3 and denied headache or stomach ache. Pt''s father pulled car to entrance and pt walked to family car. Pt and her mother were advised to contact PCP with any concerns. Pt and her mother were informed that VAERS report would be filed and information for VAERS was given to them in English and native language.


VAERS ID: 1873705 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

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

Write-up: Pt stated dizzy asked ambulance to be called. While waiting for ambulance pt continued to experience dizziness and reported feeling hot and numb in left arm. Pt asked if he had eaten and was offered water and lollipops. Paramedics arrived and took pt to hospital.


VAERS ID: 1873712 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 LA / IM

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

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

Write-up: Patient wanted J&J but was given Pfizer by mistake


VAERS ID: 1873718 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Headache, Hypoaesthesia, Nausea, Paraesthesia, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor
Current Illness: none
Preexisting Conditions: asthma,environmental allergies, high cholesterol
Allergies: Bactrim causes GI upset, asthma med as a child but cannot remember name but is no longer prescribed today.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 15 minutes after vaccine patient developed dizziness, left sided cheek numbness and tingling, headache and nausea. Felt as though he was swallowing a ball in his throat. BP elevated after vaccine at 170/102 but decreased to 140/98 15 minutes later. Symptoms did not worsen and patient was taken to health clinic onsight to be seen by NP and monitored. No SOB or chest tightness. Advised patient to contact PCP to discuss further vaccination. Advised on signs and symptoms to monitor for.


VAERS ID: 1873723 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Chest discomfort, Dysphagia, Hypoaesthesia oral, Loss of consciousness, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: EpiPen 2-Pak 0.3 MG/0.3ML Injection Solution Auto-injector For a severe reaction: Inject in outer thigh following instructions on package and go to the Emergency room. metFORMIN HCl ER 500 MG Oral Tablet Extended Release 24 Hour (Glucophage
Current Illness:
Preexisting Conditions:
Allergies: Flu Virus Vaccine, Tetanus-diphth-acell Pertussis, Adalimumab, Clarithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the Pfizer COVID vaccine at 11:15am. Lips started feeling numb a few seconds later. Hands started tingling. Felt like a mask was over her face. Going down into her neck and into her chest. Unable to swallow. Lost consciousness. Niece administered 1 auto inject Epi into right thigh. Patient awakened unable to verbalize, but did follow commands. Niece administered 2nd auto inject Epi into right thigh when she lost consciousness again. Was lowered off the chair onto the ground with 3 assisting onto her left side. 911 was called. 11:21am vitals 153 heart rate, 140/64 98% on room air. Patient reports mask on face is worse. Chest feels she was kicked by a horse. HR 96. Ambulance arrived and report given to EMT. Patient transported to ED.


VAERS ID: 1873741 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Haloperidol, Lorazepam, Acetaminophen
Current Illness: None
Preexisting Conditions: Chronic pain and abdominal hernia history
Allergies: Penicillin G Potassium
Diagnostic Lab Data: None indicated
CDC Split Type:

Write-up: No adverse event occurred- full dose given of Moderna vaccine instead of the 1/2 dose recommended. Pt received one prior dose of Janssen vaccine on 8/26/21. No symptoms/signs or treatment indicated.


VAERS ID: 1873750 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Back pain, Chills, Headache, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: escitalopram, loratadine, norethindrone, Imitrex
Current Illness: n/a
Preexisting Conditions: stage 3a chronic kidney disease resulting from post partum hemorrhage, migraines, allergic rhinitis,
Allergies: Hemabate (carboprost tromethamine) caused dermatitis
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: vomiting, headache, chills, body aches, low back pain that feels like menstrual cramps, weakness


VAERS ID: 1873757 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Nausea, Nuchal rigidity, Pallor, Paraesthesia, Unresponsive to stimuli
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: n/a
CDC Split Type:

Write-up: patient received pfizer covid19 vaccination on L deltoid. Immediately after vaccination patient stated "I am feeling like faint." Patient clenched her hands and neck became rigid and lops noted pale. Reporter called for help and health clinician was present and assisted patient to lay down to the ground in a supine position and elevated both lower extremities on a chair. Patient was unresponsive for 20 seconds. After 20 seconds, patient stated "I am coming back." Patient was since A+Ox3 and following directions well. However, patient reported feeling nauseous and slightly tingly in the fingers. After a few minutes, the tingling sensation subsided, but the nauseous persisted. Vital signs were WNL throughout. After 20 minutes, patient reported no signs of improvement. EMS was initiated.


VAERS ID: 1873762 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Client was administered half a dose (0.25 mL) for his 1st dose, instead of 0.5 mL. Client was notified, AP hotline was called to asked what proper step to take next. EMR record was submitted complete. No further dose was given to client. Client did not have any adverse reaction from the dose.


VAERS ID: 1873773 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 4 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event, Wrong product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa drugs
Diagnostic Lab Data: No adverse events happened, but patient did not receive what she was suppose to receive.
CDC Split Type:

Write-up: Patient was supposed to get Prevnar-13 and her daughter the Moderna booster 0.25mL. It was a family of 3. Two were getting Moderna Booster 0.25mL and one getting the Prevnar-13. Scanned the Prevnar-13. Had Prevnar-13 rubber banded to the box to keep them separated, but when administered, the immunizer grabbed one of the Moderna doses by mistake. Patient received 3 previous COVID-19 doses of Pfizer with the last dose being received 10/13/2021 (6 months after the 2nd dose). Now received a 4th dose of COVID-19 Moderna 0.25mL on 11/16/2021.


VAERS ID: 1873774 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 RA / IM

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

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

Write-up: numbness on the left side of her face without paralysis of the face


VAERS ID: 1873783 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 - / IM

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

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

Write-up: Patient is 12 years old and should have received the 12+ dose of the Pfizer vaccine but instead received the 5-11 dose


VAERS ID: 1873793 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 1 LA / 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pfizer lot#32030BD exp 12/9/21
Current Illness: none
Preexisting Conditions: ADHD, COMBINED PRESENTATION (Chronic) FINE MOTOR DEVELOPMENTAL DELAY
Allergies: Amoxicillin- Skin Rash and/or Hives
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Incorrect dose given to this patient


VAERS ID: 1873811 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: Patient jerked away upon administration resulting in the left arm being scratched by the needle. Patient then held arm still for proper administration. Small area, very shallow scratch, whole area (scratch and injections site) covered with adhesive bandage. Whole dose administered at once.


VAERS ID: 1873816 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 1 LA / IM

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

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

Write-up: Pt. reported dizziness and nausea approx. 5 minutes after administration. Pt. denied eating sufficiently today. BP: 141/87. HR: 70. pt. didnt know baseline BP. Pt. reported symptom improvement after 15 mins of observation. pt. was given water, food, a damp wet cloth for neck. pt. left 30 minutes after observation reported she felt better.


VAERS ID: 1873821 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Minnesota  
Vaccinated:1921-11-16
Onset:2021-11-16
   Days after vaccination:36525
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event
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:
Current Illness: No illness prior 1 month
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None necessary at time of visit
CDC Split Type:

Write-up: No adverse side effects noted during clinic visit. Patient lives with mother who is RN and she will monitor for side effects


VAERS ID: 1873838 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Flushing, Hyperhidrosis, Pruritus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Penicillin=Hives and throat swelling
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Moderna Covid-19 Vaccine Lot # 017C21A Expires: 12-19-21. First dose given at 13:15 hours 11/16/21. Patient began to feel overheated and progressed into feeling itchy on her arms and back, and complaints of dizziness. Patient was diaphoretic and flushed. No signs or symptoms of hives or rash. Patient denied breathing difficulties. History of allergic reaction to Penicillin antibiotic will hives and throat swelling presentation. Vital signs within normal limits. BP=114/72, HR=73, RR=16 and SpO2=98. Benadryl 50 mg administered orally. After 15 minutes (at approximately 13:45 hours) patient reports improvement in symptoms i.e. itching, dizziness, elevated temperature dissipated. Gave recommendation to patient to take Benedryl 50 mg at 19:30 hours and again in another 6 hours if needed for any symptom returning.


VAERS ID: 1873844 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 42M9S / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Loss of consciousness, Pallor, Seizure, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: hx of syncope after a vaccine a few years ago.
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE. hx of syncope with vaccines. hasnt happened in years.
Allergies: NONE
Diagnostic Lab Data: N/A. Paramedics called to transfer patient to hospital to get checked out.
CDC Split Type:

Write-up: patient passed out less than 5 minutes after receiving the moderna booster vaccine (0.25mL) and the influenza vaccine (flulaval quadrivalent). He had received the first two moderna shots in the past and had no issues. They were both administered in the left deltoid muscle. After I administered both vaccines a couple minutes later, the patient lost all color in face and began to seize (no history of seizures in the past). His arms began to shake, he made a loud moan, and starting moving his head around. Patient was sitting in a chair at the time and so I lowered him slowly and safely to the floor and laid him on his left side supporting his head. He lost consciousness for about 30 seconds (thats how long the seizure lasted) and afterwards regained consciousness. Was alert and able to answer questions correctly, but expressed that he didnt know what had occurred but that he felt disoriented. Two to three minutes went by and he began to seize again for the next 30 seconds. paramedics were called. no injury to the patient. trasnferred to the hospital to get checked out. documented accordingly in VAERS report and in patients chart. Patient should not receive another moderna vaccine or another flulaval vaccine in the future.


VAERS ID: 1873865 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immunisation, Underdose
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (broad)

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

Write-up: The pt came in for her first dose of moderna vaccine. I accidentally gave her a booster dose (0.25ml). I needed to give her the rest (another 0.25ml) During that time she was a little light-headed and needed to rest for a while. She did tell me that it was probably all in her head, but I kept checking in with her anyways. I gave her the rest of her dose and everything was fine. There were no rashes, hives, itching, SOB, or other issues. Water was given and rest.


VAERS ID: 1873872 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Certrizine, Famotidine, Flonase, Metformin, Propranolol, Ventolin HFA, Viagra, Methocarbamol, Vitamin D2, Amoxicillin prn, Augmentin, Ibuprofen, Lisinopril, Betamethasone, Amitriptyline
Current Illness:
Preexisting Conditions: HTN, pre-diabetes, BMI 26-26.9, anxiety about health
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse reactions during 15 minute monitoring time period. The patient''s 2nd Moderna dose was administered 5/21/21 so his booster could have been given no sooner than 11/21/21. His Moderna "booster" dose was administered 11/16/21.


VAERS ID: 1873884 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / UNK LA / IM

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

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

Write-up: Pt received the J&J vaccine at age 17 instead of the approved 18 years old.


VAERS ID: 1873889 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fall, Nervousness
SMQs:, Accidents and injuries (narrow), Hypoglycaemia (broad)

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

Write-up: arrived with her mom to get her pedi-Pfizer 5-11 dose of vaccine. RN administered the vaccine at 4:25 pm. She was nervous but held herself together. then went to give the girl a lollipop about 2 minutes later and she was sitting quietly with her mom. As soon as he returned to complete the paperwork fell off her chair to the floor and her mom then screamed for help. rushed to her side and provided support and aid. Consoled child and mom. Gave an ice pack and had her sit comfortably on the floor by their side. Mom said that this has never happened before. No fainting episodes history of seizures.


VAERS ID: 1873905 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pharyngeal swelling, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid dose 1 (itching resolved by benedryl)
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported itching at 30 minutes with dose 1 given on 10/25/21. Today itching started at 0430 where 50mg of Benadryl was given. the patient started complaining of throat swelling. The patient was brought down the hall to the attached urgent care where 2 doses of epi were given.


VAERS ID: 1873911 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Private       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: N/A
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was given to patient who was not eligible due to age.


VAERS ID: 1873929 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fall
SMQs:, Accidents and injuries (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: none
Current Illness:
Preexisting Conditions:
Allergies: amoxicillan
Diagnostic Lab Data: BP 80/50 Pulse 53 O2 sat 98% on RA
CDC Split Type:

Write-up: patient slumped to floor while waiting 15 minutes s/p vaccine


VAERS ID: 1873930 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 3 LA / IM

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

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

Write-up: PT PASSED OUT AFTER HER SHOT AND THEN REGAINED CONSCIOUSNESS QUICKLY


VAERS ID: 1873931 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient''s mother stated the patient was 11 years old and therefor was administered Pfizer pediatric dose of 0.2 ml. When paperwork was completed by patient''s mother and date of birth was verified it turns out the patient just turned 12 on 10/24/2021. Patient''s mother has been notified of incident and that is has been reported. Patient was monitored for 20 minutes and did not have any adverse reactions.


VAERS ID: 1873940 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Interchange of vaccine products, Lip swelling, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient''s first dose was the Janssen vaccine. This was her Moderna booster. She waited 20 minutes after vaccination at the pharmacy and was fine and left. She left and then shortly after started to experience lips swelling and tingling and facial flushing. She returned to pharmacy and was given 25mg of benadryl. Her facial flushing decreased. Lips still felt swollen but were no longer tingling. Lips did not appear swollen in appearance but felt that way to her. She remained at pharmacy for 30 minutes and after symptoms started to resolve, she left. She was given benadryl capsules to take at bedtime and was counseled to go to the ER if she experienced hives, shortness of breath or if she felt that throat was closing.


VAERS ID: 1873946 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-11-14
Onset:2021-11-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown for 1 month prior, not ill at the time of vaccination
Preexisting Conditions: none listed
Allergies: no known allergies
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Per patient''s mother, patient experienced some fatigue and fevers the day after the immunization. Patient started to show large welts on the upper side of his right body 2 days post vaccination (shot was administered in the left). Referred the patient''s mother to call the pediatrician''s office to follow up regarding the adverse effect of the shot.


VAERS ID: 1873955 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pain, Palpitations, Vomiting
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: adverse events: throbbing headache, entire body ache, heart palpitations, nausea & vomiting, chills treatment: acetaminophen, rest, & continue to monitor


VAERS ID: 1873959 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-14
Onset:2021-11-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Basal ganglia haemorrhage, Computerised tomogram head abnormal, Facial paralysis, Hemiparesis, Neurological symptom
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No prescription medications
Current Illness: Unknown
Preexisting Conditions:
Allergies: Penicllins and sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented to the emergency department on 11/16/21 with stroke like symptoms of left sided weakness and left sided facial droop. CT imaging revealed a intraparenchymal basal ganglia hemorrhage.


VAERS ID: 1873961 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: gave vaccine that was expired


VAERS ID: 1873963 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Lymph node pain, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit B, Centrum, Omega 3,6,9
Current Illness:
Preexisting Conditions: Hypertension
Allergies: Tramadol, Losartan
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Tiredness, Headache, Muscle pain, Chills, fatigue and pain at the injection, enlarged lymph node in the right side, pain around the lymph node, under arm and shoulder


VAERS ID: 1873969 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation 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: ethinyl estradiol-norelgestromin
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pfizer dose was not diluted received 0.3 mL dose from vial without dilution.


VAERS ID: 1873975 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: gave 1 day expired vaccine, no side effects from pt.


VAERS ID: 1874130 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5217 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The Pfizer Peds dose was given by mistake. This was identified immediately. Client and parent notified. The teen was vaccinated with the correct dose of Pfizer 12yo and up.


VAERS ID: 1874133 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5217 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / IM

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

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

Write-up: The Pfizer Peds dose was given by mistake. This was identified immediately. Client and parent notified. The teen was vaccinated with the correct dose of Pfizer 12yo and up.


VAERS ID: 1874142 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: i accidentally administered the children''s formulation instead of the adult dose. The patient was UNDER dosed.


VAERS ID: 1874152 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

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

Write-up: Patient was instructed by her allergist to receive her 2nd dose (0.5 ml) of Moderna Covid-19 vaccine. Approximately 5-10 minutes after receiving her 2nd dose, patient commented that her throat felt a little tight. She declined to have emergency services called on her behalf. Patient commented that after her 1st dose she had a similar incident that was treated by her primary care, anaphylaxis ruled out. Patient was declined by her employer for an exemption for vaccine mandate because her 1st dose was not an anaphylactic reaction. RPh again offered to call EMS, patient (accompanied by a friend) said she would just go to the emergency room herself.


VAERS ID: 1874154 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-13
Onset:2021-11-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: augmentin tacrolimus azathioprine atenolol amlodipine Norditropin aspirin loratidine flintstone vitamin atorvastatin sertraline pantoprazole albuterol pulmozyme saline calcitriol budesonide Qvar ciprodex
Current Illness: some kind of respiratory illness, she also had a low level EBV PCR a few months ago.
Preexisting Conditions: heart transplant recipient, CKD, BK viremia, growth hormone deficiency, pulmonary issues, sinusitis
Allergies: family history of malignant hyperthermia, so treated as such but we don''t know forsure.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: itchy rash on neck, trunk, feet, thighs appeared about 60 hours after covid vaccine


VAERS ID: 1874157 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

Administered by: Public       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: duloxetine, elinest, ibuprofen
Current Illness: none
Preexisting Conditions: posterior capacardia syndrome
Allergies: neosporin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of light headed and dizzy. She was giving water and laid down after 3 mins of drinking water in a seating position. The ems was called after 15 mins because the patient was still feeling dizzy when she sad down. After being checked by the ems and asked to stand when patient affirmed of feeling better, she refused to go to the hospital. She left the building walking on her own to the car. She affirmed that she felt fine.


VAERS ID: 1874163 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

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

Write-up: Fainting, loss of consciousness for 15-20 seconds. Maintained strong pulse, B/P 92/60, O2 SAT 94%.


VAERS ID: 1874166 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

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

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

Write-up: Pt requested 3rd dose of Moderna (0.5ml) and was given booster dose (0.25ml).


VAERS ID: 1874171 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event, Product preparation issue
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: It appears that only 1.3 ml of diluent was drawn up instead of 1.8 ml when diluting the vial. Patient received a stronger dose. No adverse events as of now.


VAERS ID: 1874172 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Gait disturbance, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Lost feeling in his legs and couldn''t walk well, and trouble breathing


VAERS ID: 1874175 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Diarrhoea, Dizziness, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea headache dizziness pain diarrhea crying. Patient taking tylenol and rehydrating with pedialyte


VAERS ID: 1874371 (history)  
Form: Version 2.0  
Age: 3.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 7+ LA / IM

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

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

Write-up: Patient was underage of approved age per CDC. Guidelines. Due to miscommunication pt was mistaken for older sister in same room.


VAERS ID: 1874375 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion xl 150mg, Clopidigrel 75mg, Omeprazole 20mg, Lovastatin 20mg, Lisinopril/hctz 20/25mg, atenolol 25mg, allopurinol 100mg, Lisinopril 20mg
Current Illness: None
Preexisting Conditions: High blood pressure and high cholesterol.
Allergies: No Known allergies
Diagnostic Lab Data: non
CDC Split Type:

Write-up: Patient was to be given a Infuenza vaccination and received a Pfizer Covid Vaccination.


VAERS ID: 1874379 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Herpes virus infection
SMQs:, Opportunistic infections (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: Cephalexin
Current Illness: Cellulitis knee
Preexisting Conditions: Herpes.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Herpes viral flair started 36 hours after 3rd covid dose


VAERS ID: 1874380 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-11-09
Onset:2021-11-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Kid vitamins gummy vites: 2 gummy bears Calcium + d3: 250 mg calcium and 12.5 mcg d3 Vitamin c: 188 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hive like rash spreading on torso, back, and face


VAERS ID: 1874382 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac failure congestive, Dyspnoea
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Prevnar-13.
Other Medications:
Current Illness:
Preexisting Conditions: Tricuspid and mitral valve regurg
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed SOB, atrial fibrillation and CHF.


VAERS ID: 1874383 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypotension, Syncope, Tremor, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT HAD SYNCOPE A COUPLE OF MINUTES AFTER THE INJECTION. PER HER FATHER, SHE WAS SHAKING FOR A BRIEF SECOND AND THEN FAINTED. SHE BECAME CONSCIOUS A COUPLE MINUTES LATER BUT BY 3:47PM SHE WAS GETTING CLOUDY VISION AND WAS HYPOTENSIVE PER THE PARAMEDICS. PATIENT WAS TRANSPORTED TO THE HOSPITAL VIA AMBULANCE.


VAERS ID: 1874389 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / -

Administered by: Pharmacy       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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: 5:10 PM SYSTOLIC BP 102 DIASTOLIC BP 62 PULSE 67, 5:2PM SYSTOLIC BP 110 DIASTOLIC 72 PULSE 73
CDC Split Type:

Write-up: AT APPROXIMATELY 5:10 PM PATIENT FELT DIZZINESS AND LIGHT HEADED. WE HAD THE PATIENT LAY DOWN AND BLOOD PRESSURE WAS TAKEN. AT 5:29 PM THE PATIENT''S DIZZINESS HAD RESOLVED AND ANOTHER BLOOD PRESSURE WAS TAKEN


VAERS ID: 1874390 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Pfizer-BioNTech COVID-19 Vaccine EUA? Fever of 103.6, tired.


VAERS ID: 1874399 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia oral, Pruritus
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: tingling of the lips, itching all over--about 20 minutes after the vaccine; gave 1 dose of adult epi-pen, called 911- paramedics came and took blood pressure and pulse/assessed patient, mom refused hospital visit offer and patient and mother left to go home


VAERS ID: 1874400 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 3 LA / IM

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

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

Write-up: Patient came for adult Pfizer booster. Had 3 children with him who needed the pediatric Pfizer vaccine. I administered one 0.2ML pediatric dose to Pt. I noticed the error immediately and offered him a full dose by giving him and additional 0.4ML of the pediatric product.


VAERS ID: 1874407 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. P100369129 / 1 RA / IM

Administered by: Other       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: aspirin EC 81ng PO daily; valsartan 160mg po daily; atenolol 50mg po daily; omeprazole 40mg po daily; escitalopram 10mg po daily; pravistatin 20mg po daily; vit D3 2000 IU daily; acidophilus probiotic capsule 1 po daily; melatonin 3mg 1 po
Current Illness: unknown
Preexisting Conditions: hypertension; depression; hyperlipidemia; GERD; insomnia
Allergies: none known
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: STAFF INCORRECTLY FILLED OUT CONSENT FOR BOOSTER DOSE. VACCINATION WAS 3RD DOSE (0.25ML) BECAUSE IT WAS TOO EARLY FOR BOOSTER. PER CLIENT HAD ATTENDED COVID CLINIC IN JAN 2021, BUT INCORRECT INFORMATION WAS PROVIDED


VAERS ID: 1874411 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS T93SR / 3 RA / IM

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

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

Write-up: Patient immediately passed out and turned pale upon receiving vaccination. He came back within a minute, was checked out by paramedics and went home.


VAERS ID: 1874419 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 06SFZIA / 3 LA / IM

Administered by: Other       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: CBD Oil Vit C Vit D3 Turmeric Lutein DHA Ibuprofen Baby aspirin Spironolactone 25mg Rosuvastatin 10 mg Amlodipine Besylate 10 mg
Current Illness: None
Preexisting Conditions: High Blood Pressure CAD
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: A significant lump appeared in Left armpit (injected arm). It is soft and squishy, tender to the touch.


VAERS ID: 1874420 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-14
Onset:2021-11-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Rash covering entire stomach and swollen lymph nodes two days post vaccination.


VAERS ID: 1874630 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

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

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

Write-up: A small drop of vaccine dribbled out of patients arm post- vaccination. Since = or $g the recommended dose was given, pt was not revaccinated per guidelines.


VAERS ID: 1874635 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation error
SMQs:, Medication errors (narrow)

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

Write-up: The booster dose for patient was not diluted prior to administration in right arm.


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