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

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



Case Details (Reverse Sorted by Onset Date)

This is page 58 out of 4,799

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VAERS ID: 1460098 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-17
Onset:2021-06-26
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Electroencephalogram, Generalised tonic-clonic seizure, Laboratory test, Magnetic resonance imaging, Postictal state
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec as needed for seasonal allergies
Current Illness: None
Preexisting Conditions: None
Allergies: No known drug or food allergies
Diagnostic Lab Data: MRI, EEG, Visit to ER, primary care physician, and referral/visit to pediatric neurologist. Rescue medication prescribed in the event that the patient experiences another seizure.
CDC Split Type:

Write-up: Dose #1 recieved May 27th, 2021. Dose #2 recieved June 17th, 2021. 6/26/21 2:00pm Grand Mal seizure (Full body convulsions, foaming at the mouth, eyes twitching and rolled back/up. Postictal immediately following seizure activity for roughly 10-15 minutes) on June 26th, 2021, with no history of seizures or any other comorbidities. Resulted in an ER visit on 6/26/21. MRI and EEG ordered for testing. Lab worked ordered on 7/8/21. Rescue medication ordered in the event that he has another seizure. Outcomes: EEG showing absence seizure activity however that remains undetermined at this time due to the fact that the patient never displayed any physical evidence of an absence seizure during the test as he remained alert, responsive followed directions and was able to recall information, during the part of the test that displayed absence seizure activity. MRI: No acute infarct, intracranial hemorrhage or mass effect. Referral to pediatric neurologist.


VAERS ID: 1460105 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-25
Onset:2021-06-26
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Chills, Headache, Hyperhidrosis, Influenza virus test negative, Laboratory test normal, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative, Streptococcus test negative, Urine analysis normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra D, glucosamine 1000mg/twice daily,CBD tincture twice a day
Current Illness: None
Preexisting Conditions: None
Allergies: Environmental
Diagnostic Lab Data: Blood work, urinalysis,chest x-ray,rapid covid, influenza, strep along with lab tests,all negative
CDC Split Type:

Write-up: Sore throat, headache, chills, sweats, fever 101-103,


VAERS ID: 1460146 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-10
Onset:2021-06-26
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6206 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER 8734 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Coordination abnormal, Diarrhoea, Disorientation, Intensive care, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: diabetes, chronic kidney condition on dialysis, heart disease, hypertension, blind, anxiety, depression
Allergies: unknown
Diagnostic Lab Data: 6/26/2021 (+) COVID test
CDC Split Type:

Write-up: No adverse event after the vaccination in March. Case went for his Dialysis (at a separated private setting for their covid patients) on 6/29/2021. Was supposed to have dialysis tx on 6/26 but that one got cancelled due to his sxs and subsequent test. After dialysis session on 6/29, case was disoriented (more than usual after tx), hard to direct/assist in transfer, decreased coordination at home, diarrhea. Family tried to care for him but by next day 6/30 (Wed) realized it was more serious, and via ambulance went to the hospital and admitted on 6/30/2021 through 7/7/2021. Was in ICU but not ventilated. DIscharged to an extended care facility on 7/8/2021.


VAERS ID: 1460221 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Posture abnormal, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Over-the-counter antihistamines; marijuana
Current Illness: none reported
Preexisting Conditions: Anxiety, asthma
Allergies: seasonal allergies unspecified
Diagnostic Lab Data:
CDC Split Type:

Write-up: At approximately 1520, patient slumped over in observation chair. EMT supported patient in chair and observed minimal shaking. EMT activated EMS. Patient''s mother and patient''s boyfriend called out patient''s name. Patient remained slumped over in chair for approximately 6 seconds. Patient aroused via verbal stimulation. Patient opened eyes and lead nurse assessed patient. Patient refused EMS. Patient stated she "needs time to breathe". Patient alert and oriented to person, place, time and situation. Patient given water. Patient able to drink water. Patient reported aversion to needles and history of fainting with previous vaccinations. At 1528, EMT assessed patient vital signs: blood pressure 122/78 mmHg and pulse 51 beats/minute. At 1542, EMT reassessed patient vital signs: blood pressure 126/74 mmHg and pulse 53 beats/minute. At 1555, EMT reassessed patient vital signs: blood pressure 128/76 mmHg and pulse 58 beats/minute. Patient reported she was "feeling good". Lead nurse educated patient on signs/symptoms of when to seek emergency care, to sign up on v-safe and to follow up with primary care provider. At approximately 1600, patient left facility with unlabored respirations and steady gait, accompanied by mother.


VAERS ID: 1460336 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye swelling, Pain, Swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? 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: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: 06/26/2021 swelling began around eyes and face , next was extreme swelling , and then everywhere pt. had fillers done was extreme pain and swelling. eyes felt like could not be opened (swelling in filler areas)


VAERS ID: 1461656 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. T032003 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site movement impairment, Injection site pain, Injection site rash, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Methadone, Ondansetron, cetirizine, bupropion, APAP, ibuprofen
Current Illness: cold (not covid)
Preexisting Conditions: Obesity, PCOS, bile duct issues, asthma, PCOS
Allergies: Promethazine (anxiety), benadryl(anxiety), codiene(rash), naproxen (headache and stomach ache), tramadol (headache and stomach ache)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6/25/21 Received vaccine. 6/26/21 In the morning pt stated she couldn''t move left arm. In the evening redness and blotches started appearing. 6/27/21 In evening, her arm was hot, and redness was spreading, painful. It took 1 week for redness and pain to go down.


VAERS ID: 1461676 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 5032003 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Balance disorder, Erythema, Hyperhidrosis, Immune system disorder, Malaise, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 6/25/21 Received vaccine. 6/26/21 Started feeling sick, unwell. Patient stated he almost fell over. EMT''s at game stated it was because his immune system was working in overdrive trying to create immunity to pneumovax and Covid. On 6/27/21 in am, Patient went to hospital because his shoulder hurt. He was given some medication cocktail by hospital and went home same day. On 6/27/21 in pm the redness in his arm started and got worse and he started sweating really bad. On 6/28/21 He started feeling better, but went to the clinic due to the rash. They gave him cephalexin 500 mg 1tid, but he only took it once or twice a day and didn''t finish the course. MD drew a line around rash and told him if rash expands beyond line, to come back in due to possible blood clot. On 6/29/21 patient stated he felt better. 7/9/21 Patient states he has recovered.


VAERS ID: 1461865 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad)

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

Write-up: Patient complained of weakness in legs, fatigue, shoulder pain when taking deep breaths


VAERS ID: 1462108 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO186 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Muscle spasms, Pain in extremity, Vertigo
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Vestibular disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: 2nd day after final dose woke up with severe vertigo. Lasted for 5 days. Since then have had increasing chest discomfort and muscle spasms. Left shoulder and arm still hurt 2 and a half weeks after dose.


VAERS ID: 1462149 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Gastroenteritis viral, Magnetic resonance imaging abnormal
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: AMOXICILLIN
Diagnostic Lab Data: Urgent care 7/2 MRI 7/5
CDC Split Type:

Write-up: Patient said she experienced stomach discomfort a couple of days after vaccination. She said it continued so she went to an urgent care on 7/2. She then went to the hospital and on 7/5 and had an MRI. She said they found an unidentified bacteria in her stomach.


VAERS ID: 1463441 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Unknown  
Location: Nebraska  
Vaccinated:2021-06-12
Onset:2021-06-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait disturbance, Hypoaesthesia, Loss of personal independence in daily activities, Sciatica, Sleep disorder, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: There was an skin infection on her ear. She took levofloxacin for 10 days from 6/1/21 to 6/10/. She was done by the time of the vaccination
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives on face, abdomen, both arms, and both legs. Arm numbness on vaccine arm (left arm) from elbow to fingers. Numbness and pain from left hip to left knee, including sciatica pain. This prevented her from sleeping and causes pain walking and other daily activities. She went to urgent care on 6/23/21 and was given prednisone 20mg daily for 7 days and cyclobenzaprine 10mg three times daily for 5 days. These helped but not completely resolved the event. Upon finishing the medications, the pain came back. She went to urgent care on 7/9/21 and was given prednisone 20mg for 7 days and cyclobenzaprine 10mg three times daily for 7 days. She is most concerned about numbness.


VAERS ID: 1463876 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Axillary pain, Blister, Body temperature, Chills, Headache, Hypokinesia, Lymphadenopathy, Nausea, Pain in extremity, Presyncope, Pyrexia, Rectal haemorrhage, Vaginal haemorrhage
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Surgery
Allergies:
Diagnostic Lab Data: Test Date: 20210627; Test Name: Body temperature; Result Unstructured Data: 102.6
CDC Split Type: USJNJFOC20210708845

Write-up: STOMACH PAIN; BLISTERS IN MOUTH AND LIPS; SEVERE NECK PAIN LIKE SWOLLEN LYMPH NODES; FEVER; VAGINAL BLEEDING; RECTAL BLEEDING; ALMOST FAINT; COULD NOT MOVE AT ALL; UNDER ARM HURT; CHILLS; ARM AND LEG PAIN; HEADACHE; SEVERE NAUSEA; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient''s past medical history included no uterus. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A expiry: UNKNOWN) dose was not reported, frequency 1 total, administered on 26-JUN-2021 10:30 for prophylactic vaccination. No concomitant medications were reported. On 26-JUN-2021, the patient experienced severe nausea, almost fainted, experienced leg pain at the point to where she could not move at all, arm and under arm hurt her terribly bad, had uncontrollable chills and headache. On 27-JUN-2021, the patient had fever 102.6, experienced chills, nausea, leg pain, headache, vaginal bleeding, rectal bleeding and continued with all above symptoms. Laboratory data included: Body temperature (NR: not provided) 102.6. On 28-JUN-2021 and on 29-JUN-2021, the patient continued symptoms and no fever. On 30-JUN-2021, the patient had fever, blisters in mouth and lips, experienced severe neck pain like swollen lymph nodes and she could not move her neck at all. On 01-JUL-2021, the patient was feeling better but the leg pain was still very painful, had headache, nausea, and stomach pain. The patient just wanted to report her symptoms, like a dummy she went to get the shot and got sick. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from rectal bleeding, almost faint, under arm hurt, chills, fever, vaginal bleeding, blisters in mouth and lips, severe neck pain like swollen lymph nodes, and could not move at all, and had not recovered from severe nausea, arm and leg pain, headache, and stomach pain. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210708845-covid-19 vaccine ad26.cov2.s- rectal bleeding. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1464312 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-18
Onset:2021-06-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0273-10 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Echocardiogram, Intensive care, Magnetic resonance imaging, Pulmonary embolism, Thromboembolectomy, Ultrasound Doppler, Ultrasound scan
SMQs:, Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NO Prescriptions, over-the-counter medications, dietary supplements, or herbal remedies being taken at the time of vaccination.
Current Illness: No other illnesses at the time of vaccination
Preexisting Conditions: No chronic or long-standing health conditions
Allergies: No Allergies to medications, food, or other products.
Diagnostic Lab Data: Ultrasound on my right leg, Duplex on my heard, MRI, blood tests
CDC Split Type:

Write-up: Acute saddle pulmonary embolism. S/p pulmonary embolectomy. Spent 3 days in ICU + 2 days recovering at the Hospital


VAERS ID: 1465101 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-07
Onset:2021-06-26
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine; Valacyclovir; Synthroid; Leo thyroxine
Current Illness: no
Preexisting Conditions: asthma
Allergies: codeine; gluten sensitive - but not diagnosed with celiac
Diagnostic Lab Data: Visual exam at doctor.
CDC Split Type: vsafe

Write-up: I had three days of hives - significant hives - everywhere except my face and the soles of my feet. My doctor put me on Prednisone. I took that, Pepcid and Zyrtec and Singulair. It stopped the hives.


VAERS ID: 1465135 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

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

Write-up: PER PATIENT, CONSTANT ARM PAIN ON SITE OF INJECTION SINCE 6/26/21 TO 7/12/21


VAERS ID: 1465390 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-10
Onset:2021-06-26
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore muscles starting in left arm and neck. Weakness mostly left arm so far. Has been ongoing and appears to have increased in severity. I purchased deep massager to assist with muscles aches.


VAERS ID: 1466514 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-05
Onset:2021-06-26
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Disturbance in attention, Fatigue, Irritability, Total lung capacity decreased
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

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

Write-up: extreme fatigue, decreased lung capacity, irritability, difficulty concentrating


VAERS ID: 1466520 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-06-26
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Pain in extremity, Spinal pain
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: On June 26th he started having a pain in his spine and a sharp pain down his right arm . Stated that he cannot get comfortable when laying down, sleeping, or walking he feels very uncomfortable. This has been continuously going on since he got his second dose of the moderna. Was taking ibuprofen and has been trying different meds but none of them worked .


VAERS ID: 1466739 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C211A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, 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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started feeling itchy later after getting the vaccine, have been breaking out in hives every other since then


VAERS ID: 1467007 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 reported itching face and spots on face within 30 minutes of vaccination. No SOB or other symptoms. Patient felt better after resting and was released to home.


VAERS ID: 1467181 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-23
Onset:2021-06-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW198 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: No known allergies
Diagnostic Lab Data: None mentioned. Mom spoke to patient''s Dr., and her doctor just recommended her to report to the pharmacy
CDC Split Type:

Write-up: Patient''s mom called on the 20th day after patient''s covid vaccination. Per patient''s mom, patient complained about feeling "sensitive" on and around injection site started 3 to 5 days after vaccination. The pain level gradually elevated over the last 2 weeks. Today is the 20th day after vaccination and patient still feels the pain. Per mom, there are no "bumps" around or under the arm or close to injection site.


VAERS ID: 1467311 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Propranolol 10 mg 3x daily for Postural Orthostatic Tachycardia Syndrome
Current Illness: N/A
Preexisting Conditions: Postural Orthostatic Tachycardia Syndrome
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstrual bleeding that will not stop nor slow down, beginning two days after second dose of COVID-19 Pfizer vaccine, currently on day 17 of bleeding.


VAERS ID: 1469609 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Musculoskeletal stiffness, Neck pain, Sleep disorder
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METFORMIN; LISINOPRIL; TYLENOL
Current Illness: Abstains from alcohol; Arthritis (Tylenol is used for arthritis for pain as needed.); Blood pressure high (Lisinopril 40 mg daily for high blood pressure.); Diabetic (Metformin 500 mg twice daily for diabetes.); Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies, no history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210709450

Write-up: STIFFNESS IN BACK OF NECK OR STIFFNESS OF SHOULDER; PAIN IN NECK; WOKE ME UP; SHOULDERS PAIN; This spontaneous report received from a patient concerned a 74 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high blood pressure, diabetic, non smoker, non alcohol user, and arthritis, and other pre-existing medical conditions included the patient had no known allergies, no history of drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204N21A, expiry: UNKNOWN) dose was not reported, administered on 24-JUN-2021 for prophylactic vaccination. Concomitant medications included paracetamol for arthritis, metformin for diabetic, and lisinopril for high blood pressure. On 26-JUN-2021, the subject experienced stiffness in back of neck or stiffness of shoulder. On 26-JUN-2021, the subject experienced pain in neck. On 26-JUN-2021, the subject experienced woke me up. On 26-JUN-2021, the subject experienced shoulders pain. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from stiffness in back of neck or stiffness of shoulder, pain in neck, woke me up, and shoulders pain on 26-JUN-2021. This report was non-serious.


VAERS ID: 1469618 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-26
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Apnoea, Burning sensation, Dizziness, Heart rate, Heart rate decreased, Muscle spasms, Nasal oedema, Oxygen saturation, Oxygen saturation decreased, Pain in extremity, Paraesthesia, Pyrexia
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: Test Date: 20210702; Test Name: Pulse rate; Result Unstructured Data: dropped to 48; Test Date: 20210702; Test Name: Oxygen saturation; Result Unstructured Data: dropped to 89; Test Date: 20210703; Test Name: Pulse rate; Result Unstructured Data: Normal; Test Date: 20210703; Test Name: Oxygen saturation; Result Unstructured Data: Normal
CDC Split Type: USJNJFOC20210716048

Write-up: APNOEA; PULSE DROPPED TO 48; OXYGEN DROPPED TO 89; SWOLLEN NASAL PASSAGES; PAIN AT THE BOTTOM OF LEFT FOOT AND THEN MOVED TO RIGHT FOOT; SHARP STOMACH PAIN FELT LIKE CRAMPING; LEFT ARM NUMBNESS AND TINGLING; MUSCLE SPASM IN RIGHT ARM AND LEFT ARM; MILD FEVER; DIZZINESS/LIGHTHEADEDNESS; BURNING SENSATION RADIATING THROUGH THE LEFT CHEST/LEFT ARM BURNING SENSATION; This spontaneous report received from a patient concerned a patient of unspecified age, sex, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A expiry: UNKNOWN) dose was not reported, 1 total, administered on 26-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 26-JUN-2021, the patient experienced dizziness within 5 to 8 minutes along with a burning sensation radiating through the left chest. The burning subsided to a medium burning sensation within 15 minutes and continued for several hours. On 27-JUN-2021, the patient started to get muscle spasms which lasted all day and night in left arm and experienced mild fever. On 28 -JUN-2021 the patient had no symptoms. On 29-JUN-2021, the patient had muscle spasms on the right arm that lasted several hours and sharp stomach pain that felt like severe cramping. Later in the afternoon, the patient felt lightheadedness and experienced left arm numbness and tingling with a burning sensation which lasted approximately for four hours. On 30-JUN-2021, the patient had muscle spasms on right arm for about 20 minutes. On 01-JUL-2021, the patient experienced pain at the bottom of left foot which then had moved to right foot. On 02-JUL-2021, the patient had to wake up in the middle of the night unable to breathe like sleep apnea with reduced airflow and swollen nasal passages. The pulse rate of patient was dropped to 48 and oxygen saturation dropped to 89. On 03-JUL-2021, the patient again woke up in the middle of the night with apnea and not being able to breathe but the pulse rate and oxygen saturation appeared normal. On 02-JUL-2021, Laboratory data included: Oxygen saturation (NR: not provided) dropped to 89, and Pulse rate (NR: not provided) dropped to 48. On 03-JUL-2021, Laboratory data included: Oxygen saturation (NR: not provided) Normal, and Pulse rate (NR: not provided) Normal. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from burning sensation radiating through the left chest/left arm burning sensation, and left arm numbness and tingling on 29-JUN-2021, pulse dropped to 48, oxygen dropped to 89, and pain at the bottom of left foot and then moved to right foot on 03-JUL-2021, and swollen nasal passages on 02-JUL-2021, and the outcome of dizziness/lightheadedness, muscle spasm in right arm and left arm, sharp stomach pain felt like cramping, sleep apnea and mild fever was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210716048-covid-19 vaccine ad26.cov2.s-apnea, pulse dropped to 48. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1470277 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-10
Onset:2021-06-26
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Ear pain, Impaired work ability, Laboratory test normal, Mobility decreased, Neck pain, Oropharyngeal pain, Pain in extremity
SMQs:, Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram; losartan; pantoprazole; multivitamin; valacyclovir; topiramate; trazadone; Donepezil; amoxiclav; q-nasal spray; ipratropium nasal spray; allergy shot
Current Illness: Ear infection
Preexisting Conditions: High blood pressure; GERD
Allergies: No
Diagnostic Lab Data: Labs 6/30/2021 results normal.
CDC Split Type: vsafe

Write-up: The 26th, I woke up and my knee joint hurt me terribly and my elbows were hurting. Sunday, the same joints hurt, and my right shoulder joint also hurt and my wrists. Then Monday neck and throat hurt and Tuesday more joints hurt. Wed, I couldn''t lift my right arm and my fingers and hands, and wrists hurt. I went to the doctor, shot of Kenalog in my butt. I didn''t go to work. Gradually over the following days my symptoms subsided. My ear and joint in my shoulder still hurt.


VAERS ID: 1470289 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-18
Onset:2021-06-26
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Chills, Diarrhoea, Productive cough, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Infective pneumonia (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus Cardiovascular disease Chronic Liver Disease Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization Case began symptoms on 06/25/2021 consisting of productive cough, diarrhea, syncope, chest pain, and chills - reports pneumonia, diabetes mellitus, cardiovascular disease, and chronic liver disease as pre-existing medical conditions - case was transported to hospital via EMS, admitted 06/25/2021-06/28/2021


VAERS ID: 1470379 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 UN / IM

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

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

Write-up: Client received J&J on 4/12/21 and on the health screening disclosed she had not received any other Covid-19 vaccines. On the day the Pfizer vaccine was given, the VIIS system, was not working and we were not able to check record status. The client was given one dose of 0.3ml of Pfizer. No adverse reactions during 15-30 minute client observation waiting period. It was not until a random check was done 7/13/2021 that this event was noted.


VAERS ID: 1470608 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test, Chest X-ray, Dizziness, Injection site erythema, Injection site swelling, Lymphadenopathy, Neck pain, Night sweats, Pain, Pain in extremity, Palpitations, Photosensitivity reaction, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal
Current Illness: No
Preexisting Conditions: Epilepsy
Allergies: No
Diagnostic Lab Data: Blood work (7/9/2021) and chest X-ray (7/14/2021)
CDC Split Type:

Write-up: Fever 102.7, extreme night sweats, body aches, neck pain, arm pain, wrist pain, swollen lymph nodes (neck, clavicle and groin), heart palpitations, injection site swelling and redness (made worse with sun exposure) and dizziness


VAERS ID: 1470712 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 - / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown; unable to establish contact with patient. Attempted 07/01, 07/12-07/14/2021
Current Illness: Unknown; unable to establish contact with patient. Attempted 07/01, 07/12-07/14/2021
Preexisting Conditions: Unknown; unable to establish contact with patient. Attempted 07/01, 07/12-07/14/2021
Allergies: Unknown; unable to establish contact with patient. Attempted 07/01, 07/12-07/14/2021
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt attended a community event on 05/01/2021 and requested a Janssen vaccine, which was administered in his right deltoid. He then returned on Saturday, 06/26/21 and requested a 2nd dose. Pt stated he lost his vaccination card, but verbalized receiving a dose of Moderna on 05/01. During input; it was discovered that patient received two different brands of vaccine, resulting in this report. Pt''s first dose was administered on 05/01/2021, Janssen lot # 1808982


VAERS ID: 1470771 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-04-05
Onset:2021-06-26
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0031321A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pain, Erythema, Fatigue, Feeling abnormal
SMQs:, Anaphylactic reaction (broad), Dementia (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot - I think I had the flu - it lasted for two or three days (both times that I have gotten the flu shot this has occured.
Other Medications: no
Current Illness: no
Preexisting Conditions: ear problems - chronic issues since I was in middle school
Allergies: Kiwi; may have an egg allergy
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: Right after the vaccine, I felt bad for the day and the next day, I woke up and felt tired but nothing that kept me from doing anything And the next day after that everything was fine. On June 26, No fever or anything. I just had an earache and I gave it a couple of days to see if it would go away on its own. By Tuesday, I called the doctor and they got me in Thursday. It looked like my left ear was a little red - and right ear looked fine. Prescribed antibiotics for two weeks and I took those and I went back last Thursday and it looked better. She''s my ear doctor and she knows me as she has done surgery on my ears. I have had a lot of ear issues before but this was the first time I have ever had an earache.


VAERS ID: 1470786 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-23
Onset:2021-06-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea exertional
SMQs:, Pulmonary hypertension (broad)

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

Write-up: Short bouts of difficulty breathing during low to mild exertion, without chest pain, beginning about 3 days post vaccination and continuing at a frequency of about one episode per day and lasting for about 2.5 weeks. No treatment sought at the time of this reporting, and some improvement experienced over time.


VAERS ID: 1470792 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-05
Onset:2021-06-26
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity, Paraesthesia, Ultrasound Doppler
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil, multi vitamin, D, C, chlorella, probiotic, iron
Current Illness:
Preexisting Conditions: Collagenous colitis
Allergies: Keflex
Diagnostic Lab Data: Venous Doppler right leg ultrasound 7/7/2021
CDC Split Type:

Write-up: Leg pain, deep in right leg initially from hip to knee. Pain has settled into more of a ?sensation? than pain. Tingly but not numb.


VAERS ID: 1471014 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxepin, clonazepam, diazepam, levothyroxine, hydrocodone-acetaminophen
Current Illness:
Preexisting Conditions: Fibromyalgia, Crohn''s disease, hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 1 day swelling of left arm and generalized whole-body erythema that persists now 3.5 weeks later


VAERS ID: 1471842 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-09
Onset:2021-06-26
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bacterial test, Bacterial test negative, Diarrhoea, Laboratory test normal, Parasite stool test negative
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/8/21 tests C diff negative Test for parasites negative Test for other infection negative
CDC Split Type:

Write-up: Diarrhea started on 6/26/21 and has not resolved. Doctor ran stool tests and all tests were negative. This has never happened before and we think it could be a delayed adverse reaction.


VAERS ID: 1474369 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-06-26
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Illness
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: On June 26th started to feel sick and had chills for 24 hours and it went away. On July 5th found out she had covid.


VAERS ID: 1474739 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-26
Onset:2021-06-26
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW3171 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Lymphadenopathy, Pain in jaw
SMQs:, Dementia (broad), Osteonecrosis (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: vit d, promodatine 20mg, omeprazole, stool softeners, Spiriva, daliresp 500 and steroids off and on
Current Illness: COPD
Preexisting Conditions: COPD, astma, emphysema
Allergies: mephorfine, Symbicort, Newstatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Didn''t feel right felt pain in jaw, felt golf gall size in gland with to walk in clinic was prescribed some antibiotics


VAERS ID: 1429525 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Vaccine positive rechallenge
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: Risperidone, Citalopram, Omegas, Calcium, C, D, MSN, Multivitamin
Current Illness: Nothing
Preexisting Conditions: Osteo arthritis , Osteopenia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on arm with both 1st & 2nd doses First dose : rash 2 weeks after injection Second dose: rash 2 days after injection


VAERS ID: 1430166 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-25
Onset:2021-06-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Headache, Hyperhidrosis, Pain, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Na
Current Illness: Nothing
Preexisting Conditions: Nothing
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea, vomiting ,sweats,tremors, body and head ache.


VAERS ID: 1449676 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002181 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction, Heart rate, Oxygen saturation
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Fruit allergy (Peach); Fruit allergy (Apple)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210626; Test Name: heart rate; Result Unstructured Data: low 68; Test Date: 20210626; Test Name: spO2; Result Unstructured Data: normal 98%
CDC Split Type: JPTAKEDA2021TJP047998

Write-up: Anaphylaxis (Dyspnoea, Asthma); This regulatory authority case was reported by a physician and describes the occurrence of ANAPHYLACTIC REACTION (Anaphylaxis (Dyspnoea, Asthma)) in an 18-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3002181) for COVID-19 vaccination. Concurrent medical conditions included Fruit allergy (Apple) and Fruit allergy (Peach). On 26-Jun-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 26-Jun-2021, after starting mRNA-1273 (COVID 19 Vaccine Moderna), the patient experienced ANAPHYLACTIC REACTION (Anaphylaxis (Dyspnoea, Asthma)) (seriousness criteria hospitalization and medically significant). The patient was hospitalized on 26-Jun-2021 due to ANAPHYLACTIC REACTION. The patient was treated with HYDROCORTISONE SODIUM SUCCINATE (intravenous) on 26-Jun-2021 at a dose of 100 mg; SODIUM CHLORIDE (intravenous) on 26-Jun-2021 at a dose of 50 ml and ADRENALINE [EPINEPHRINE] on 26-Jun-2021 at a dose of 1 dosage form. On 26-Jun-2021, ANAPHYLACTIC REACTION (Anaphylaxis (Dyspnoea, Asthma)) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 26-Jun-2021, Heart rate: 68 (Low) low 68. On 26-Jun-2021, Oxygen saturation: 98% (normal) normal 98%. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication were reported. No treatment medications were reported. Action taken with mRNA-1273 in response to the event was not applicable. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1462680 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD5613 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Headache, Laboratory test, Maternal exposure during pregnancy, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID
Current Illness: Pregnancy (Estimated due date: 14Nov2021)
Preexisting Conditions: Medical History/Concurrent Conditions: Folic acid supplementation
Allergies:
Diagnostic Lab Data: Test Name: Lab Test; Result Unstructured Data: Test Result:All normal
CDC Split Type: GBPFIZER INC2021813351

Write-up: Maternal exposure during pregnancy; Headache; Nausea; Shoulder pain; Ache; This is a solicited report from a contactable consumer. This is the second of two reports. The first report is a report downloaded from the Regulatory Agency (RA).The regulatory authority report number is GB-MHRA-YCVM-202106171830322790-V9IV1, Safety Report Unique Identifier GB-MHRA-ADR 25494162. A 32-year-old female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: FD5613), via an unspecified route of administration on 26Jun2021 at the age of 32-year-old as single dose for COVID-19 vaccination. Medical history included ongoing pregnancy (estimated due date: 14Nov2021), folic acid supplementation. Patient did not have symptoms associated with COVID-19. Not had a COVID-19 test. Patient was not enrolled in clinical trial. Patient was not currently breastfeeding. The patient previously received first dose of BNT162B2 (Lot Number: ET8885) on 25May2021 for COVID-19 vaccination, and experienced maternal exposure during pregnancy and shoulder soreness. Concomitant medication included folic acid taken for folic acid supplementation. The patient experienced maternal exposure during pregnancy, shoulder pain (medical significant), and ache (medical significant) on 26Jun2021, headache (medical significant), and nausea (medical significant) on 27Jun2021. The patient became pregnant while taking bnt162b2. The mother was 19 weeks pregnant at the onset of the event. The mother was due to deliver on 14Nov2021. The patient underwent lab tests and procedures which included lab test: all normal on an unspecified date. The outcome of maternal exposure during pregnancy was unknown, shoulder pain was recovering, ache was recovered on 28Jun2021, headache, and nausea was recovered on 27Jun2021. The reporter''s assessment of the causal relationship of the events with the suspect product was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: A possible contributory effect of suspect BNT162B2 on reported events cannot be excluded The impact of this report on the benefit/risk profile of the Pfizer drug is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


VAERS ID: 1465231 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021786592

Write-up: Chest pain; Swollen arm; Painful L arm; This is a spontaneous report from a contactable consumer received from the Regulatory Agency.The regulatory authority report number is GB-MHRA-WEBCOVID-202106270714010160-BADFL Safety Report Unique Identifier GB-MHRA-ADR 25551207. A 18-years-old non-pregnant female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot number: unknown), via an unspecified route of administration on 26Jun2021 (at the age of 18-years) as dose 1, single for covid-19 immunization.The patient medical history and concomitant medications were not reported. Patient has not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient was not enrolled in clinical trial. Patient has not tested positive for COVID-19 since having the vaccine. On 26Jun2021, the patient experienced swollen arm and painful Left arm and on 27Jun2021, the patient experienced chest pain. The patient had not yet recovered from the events. No follow-up attempts are possible, Information about batch number cannot be obtained. No further information is expected.


VAERS ID: 1465247 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspepsia, Gastrooesophageal reflux disease, Insomnia, Maternal exposure during pregnancy, SARS-CoV-2 test
SMQs:, Gastrointestinal nonspecific dysfunction (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210625; Test Name: COVID-19 virus test; Test Result: Negative
CDC Split Type: GBPFIZER INC2021797787

Write-up: heartburn; Acid reflux (oesophageal); sleeping impossible; patient was 33 Weeks pregnant at the onset of the event; This is a spontaneous report from a contactable consumer. This is a report received from the Regulatory Agency. The regulatory authority report number is GB-MHRA-WEBCOVID-202106271212029870-PDDE4. Safety Report Unique Identifier GB-MHRA-ADR 25551580. A female patient of an unspecified age received bnt162b2 (BNT162B2), via an unspecified route of administration on 26Jun2021 (Batch/Lot number was not reported) as DOSE 1, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 26Jun2021, the patient reported acid reflux started in the evening and made sleeping impossible even with antacids. I''ve never had heartburn this severe or persistent before. The events were assessed as serious, medically significant. The mother was 33 Weeks pregnant at the onset of the event. The patient underwent lab tests and procedures which included sars-cov-2 test: negative on 25Jun2021. The outcome of the event heartburn was recovering; the event acid reflux was recovered on 27Jun2021; and the event sleeping impossible was unknown. No follow-up attempts are needed, information about batch number cannot be obtained. No further information is expected.


VAERS ID: 1468559 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Maternal exposure during pregnancy, Off label use, Pain in extremity, Product use issue
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament 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: ASPIRIN [ACETYLSALICYLIC ACID]; FOLIC ACID; OMEPRAZOLE SODIUM
Current Illness: Breast feeding; Pregnancy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021798051

Write-up: Maternal exposure during pregnancy/Patient was exposed to the medicine Second-trimester (13-28 weeks); Maternal exposure during breast feeding; Maternal exposure during breast feeding; Painful arm; Tiredness; This is a spontaneous report from a contactable consumer received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106272345072190-3VPGX. Safety Report Unique Identifier GB-MHRA-ADR 25552683. A 29-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 26Jun2021 (Batch/Lot number was not reported), at the age of 29-years-old, as dose 1, single for COVID-19 immunisation. Medical history included ongoing pregnancy and ongoing breast feeding. Patient has not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient is not enrolled in clinical trial. Concomitant medications included acetylsalicylic acid (ASPIRIN) taken for pregnancy from May2021 to an unspecified stop date; folic acid taken for folic acid supplementation, start and stop date were not reported; omeprazole sodium taken for pregnancy from May2021 to an unspecified stop date. The patient experienced maternal exposure during pregnancy/ patient was exposed to the medicine Second-trimester (13-28 weeks) on an unspecified date with outcome of unknown, painful arm and tiredness on 26Jun2021 with outcome of recovering. The events were assessed as serious and medically significant by regulatory authority. The patient also experienced maternal exposure during breast feeding on an unspecified date. Additional information: Patient has not tested positive for COVID-19 since having the vaccine. Patient was exposed to the medicine Second-trimester (13-28 weeks). No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1472937 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Dyskinesia, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Blood pressure; Result Unstructured Data: Test Result:Unknown result
CDC Split Type: GBPFIZER INC2021809118

Write-up: Eyes flickering; Body seemed to jerk; Fainting; This is a spontaneous report from a contactable consumer. This is a report received from the regulatory authority. Regulatory authority report number [GB-MHRA-WEBCOVID-202106281310113170-RUPXN], Safety Report Unique Identifier [GB-MHRA-ADR 25555022]. An 18-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection), via an unspecified route of administration on 26Jun2021 (Batch/Lot number was not reported), at the age of 18-years-old, as dose 1, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced eyes flickering and body seemed to jerk on an unspecified date; fainting on 26Jun2021. The patient underwent lab tests and procedures which included blood pressure: unknown result on an unspecified date. The outcome of the event ''eyes flickering'' was not recovered and outcome of the other events was unknown. The clinical course was reported as follows: Body seemed to jerk and eyes flickering, lasting a few seconds, did not feel faint. Patient has not tested positive for COVID-19 since having the vaccine. Additional information: Patient has not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient was not enrolled in clinical trial. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1473671 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 9001 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Lymphadenopathy, Maternal exposure during pregnancy, Nausea, Pain, Pain in jaw, SARS-CoV-2 test, Scan
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID
Current Illness: Pregnancy (Estimated due date: 21Oct2021)
Preexisting Conditions: Medical History/Concurrent Conditions: Cholestasis of pregnancy; Clinical trial participant; Folic acid supplementation; Suspected COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20200317; Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:Yes - Positive COVID-19 test; Test Name: Scan; Result Unstructured Data: Test Result:All normal
CDC Split Type: GBPFIZER INC2021808956

Write-up: Swollen glands; Generalised aching; Nausea; Headache; Jaw pain; Tiredness; Joint pain; Maternal exposure during pregnancy; This is a solicited report from the RA from a contactable other health professional. This is a report received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-YCVM-202106282134419740-X1UGG, Safety Report Unique Identifier is GB-MHRA-ADR 25558169. A 37-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot # FC 9001), dose 1 via an unspecified route of administration on 26Jun2021 at the age of 37-year-old as single dose for COVID-19 vaccination. Medical history included ongoing pregnancy (estimated due date: 21Oct2021), suspected covid-19 from 17Mar2020 to 27Mar2020, clinical trial participant, folic acid supplementation. Patient had obstetric cholestasis and covid in last pregnancy. Patient was not currently breastfeeding. Concomitant medication included folic acid taken for folic acid supplementation, start and stop date were not reported. The patient experienced maternal exposure during pregnancy on 26Jun2021; swollen glands on 28Jun2021; generalised aching, nausea, headache, jaw pain, tiredness and joint pain on 27Jun2021. The events were reported as serious (medically significant). The patient underwent lab tests and procedures which included covid-19 virus test: yes - positive covid-19 test on 17Mar2020, scan: all normal on unknown date. Outcome of swollen glands was not recovered, of nausea was recovered on 28Jun2021, of generalised aching, headache, jaw pain, tiredness and joint pain was recovering. The reporter''s assessment of the causal relationship of the events with bnt162b2 was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: The Company cannot completely exclude the possible causality between the reported events swollen glands, generalised aching, nausea, headache, jaw pain, tiredness and joint pain, and the vaccination with BNT162B2, based on a plausible drug-event temporal association and known product safety profile. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1475342 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-24
Onset:2021-06-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 30002913 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arrhythmia, Hypertension, Myocarditis
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEMODERNATX, INC.MOD20212

Write-up: ; This regulatory authority case was reported by a consumer and describes the occurrence of MYOCARDITIS, HYPERTENSION and ARRHYTHMIA in an 18-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 30002913) for COVID-19 vaccination. No Medical History information was reported. On 24-Jun-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 26-Jun-2021, the patient experienced MYOCARDITIS (seriousness criteria hospitalization and medically significant), HYPERTENSION (seriousness criterion hospitalization) and ARRHYTHMIA (seriousness criterion medically significant). At the time of the report, MYOCARDITIS and HYPERTENSION had not resolved and ARRHYTHMIA outcome was unknown. The action taken with mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1425288 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-21
Onset:2021-06-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin 0.08 obtained 6/24/21
CDC Split Type:

Write-up: Elevated troponin, syncope


VAERS ID: 1425570 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Fatigue, Immediate post-injection reaction
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PREBIOTIC AND PROBIOTIC, DIGESTIVE ENZYMES, FIBER, MULTIVITAMIN.
Current Illness: NONE
Preexisting Conditions: IBS AND RECOVERING ULCERS
Allergies: DAIRY AND GLUTEN SENSITIVITY
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA IMMEDIATELY UPON RECEIVING THE SHOT I STARTED TO FEEL DIZZY, LIGHTHEADED, AND TIRED. IT HAS BEEN 3 HOURS AND I STILL FEEL THE SAME.


VAERS ID: 1425906 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-15
Onset:2021-06-25
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin c, zinc, Nexium 20 mg fish oil vitamin d3
Current Illness: None
Preexisting Conditions: Heartburn
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I was fine till day 10 after Shot, in middle of night I woke up with crazy chills and a low fever


VAERS ID: 1425923 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Injection site pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Arm pain at injection site and severe abdominal cramping/pain


VAERS ID: 1426106 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (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:
Diagnostic Lab Data: Given diphenhydramine 50 mg and VS taken, 30 minutes later symptoms resolved
CDC Split Type:

Write-up: 15 minutes after receiving second dose of Pfizer COVID vaccine patient complained of headache, dizziness and itching.


VAERS ID: 1426117 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Disorientation, 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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: 6/25/2021 Patient was observed post Covid-19 immunization for 15 minutes . During the observation period, he experienced an adverse reaction with the following symptoms: loss of consciousness. Assessment : Time of assessment 0831am. Pallor, Clammy and disoriented. Actions taken: Vitals sign taken EMS called at 0831. VAERS form obtained and completed by RN. Hand off to EMS upon arrival at 856am. Patient refuses EMS transport. Water given 0835- BP- 67/44, P- 39, O2- 100 %, recheck- at 0839- BP- 105/66 , 0915- bp 012/82, P- 44, O2- 100% Medications administered: No medication administered. Disposition: Reports no further symptoms of adverse reaction after observation for 30 minutes. Discharged home. Instructed to call 911 for trouble breathing, rapid heart rate, dizziness, swelling of tongue or throat. EMS accessed patient, patient refuses transport. Wife with patient. Immunizations Administered Name Date Dose VIS Date Route Pfizer COVID-19 Vaccine 6/25/2021 8:27 AM 0.3 mL 2/25/2020 Intramuscular Manufacturer: Pfizer, Inc Lot: ER8736 NDC: 59267-1000-2


VAERS ID: 1426156 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Feeling abnormal, Influenza, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), 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: Morphine, oxycodon , valium, Zanaflex, vyvanse, modafinial, trazadone, arboreal inhaler , Tylenol 650mg, top-rated, triazolam
Current Illness:
Preexisting Conditions: Asthma, chronic fatigue syndrome Fibromyalgia, arthritis, ADD, there is more these shots my memory has declined since 1st vaccine the pharmacist is reporting my side effects of 1st dose of Pfizer
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My arm feels like it''s on fire feels like an incision infected but worse on fire with 1st injection put in left 2nd in right arm. Excessive pain then normal extremely then normal, horrible sore throat, fever this was with 2st injection im starting with 2nd already same. With 1st vaccine I was in bed 5 days. My memory since the 1st injection has been horrible I really have severe loss of memory. Nauseous. I know there is more since this is 1st full day of 2nd vaccine I will write down. I just feel like the flu but worse. I feel like I''m going to die it''s horrible!!!!!!


VAERS ID: 1426457 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: I gave the first dose of Pfizer Covid vaccine to patient. She was extremely nervous for the vaccine and passed out after about 5 minutes from receiving the shot. She came to within 10 seconds. She was momentarily disoriented and warm to the touch. Her face was flushed. I monitored her breathing and gave her a cool cloth and water. I kept her sitting for 30 minutes with her family and checked on her every 5 minutes. She left alert and functional.


VAERS ID: 1426463 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: DIZZINESS, ANXIETY


VAERS ID: 1426481 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Feeling abnormal, Hypoaesthesia, Malaise, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Dementia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOWN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: AMOXICILLIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT RECEIVED THE VACCINE AT 9:00AM, SAT IN STORE FOR 15 MINUTES AND LEFT THE BUILDING. AT ABOUT 9:20 SHE CAME BACK TO THE PHARMACY SAYING SHE IS NOT FEELING WELL AND FELT WEIRD. PHARMACIST ASKED HER TO DESCRIBED THE FEELING, PATIENT SAID SHE JUST FEEL WEIRD LIKE NAUSEA AND NUMBNESS AROUND HER LEGS AND HER CHEST FELT TIGHT. PHARMACIST OFFERED HER TO SIT DOWN AGAIN AND ASKED HER IF SHE HAS ANY HISTORY OF ALLERGIES OR REACTIONS TO OTHER VACCINES BEFORE. PATIENT SAID NO REACTION TO HER YEARLY FLU SHOTS AND NEVER FELT LIKE THIS BEFORE AND STATED SHE''S ALLERGIC TO AMOXICILLIN ONLY. PHARMACIST OFFERED TO CALL THE AMBULANCE FOR HER AND GAVE HER SOME WATER. AMBULANCE CAME IN AROUND 9:40AM AND ASKED PATIENT SOME QUESTIONS AND TOOK HER TO THE ER.


VAERS ID: 1426746 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Presyncope
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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient had vasovagal response to receiving the vaccine, became light-headed and briefly lost consciousness. We called Dr. in the attached office and his intern over to make sure Pt. was okay. Gave the pt water and he felt fine after sitting for ~15 minutes


VAERS ID: 1426767 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-13
Onset:2021-06-25
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Borrelia test negative, Condition aggravated, Depression, Fatigue, 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), Depression (excl suicide and self injury) (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alprazolam 1mg, Citalopram 40mg, Gabapentin 300mg, Levothyroxine 100mcg, Oxycodone 5mg MDD 6 tabs,
Current Illness: none
Preexisting Conditions: 1/2 thyroid removed, chronic back pain
Allergies: NKA
Diagnostic Lab Data: Lyme disease test completed at PCP office- negative results
CDC Split Type:

Write-up: Patient has been feeling extremely fatigue, joints sore (knees, wrists), more depressed and has passed out twice since the 2nd Moderna vaccine. The patient has been seen by his PCP and has been tested for lyme as had a tick bite last year, but the bloodwork came back negative. Pt also feels his normal pain medication (oxycodone 5mg) is not working as well for his back pain. He said he will do yard work that he normally does, like mowing the lawn, and is extremely tired. No change in medication or health status other than noticing these symptoms. The patient passed out once while raking leaves and another time on the porch and stood up and passed out. The patient feels these symptoms are getting progressively worse and not getting any better.


VAERS ID: 1426773 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-05-18
Onset:2021-06-25
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, No adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Penicillin
Diagnostic Lab Data: Screening EKG demonstrated possible pericarditis. Normal CXR.
CDC Split Type:

Write-up: Asymptomatic.


VAERS ID: 1426809 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Syncope with previous vaccines, dates/vaccines unknown
Other Medications: None
Current Illness: None Reported
Preexisting Conditions: None Reported
Allergies: None reported
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient experienced syncope about 2 minutes after administration of vaccine. Consciousness regained within 15 seconds. Patient has reported previous syncopal episodes with vaccines in the past.


VAERS ID: 1426979 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Adverse reaction, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: no reported illnesses at time of vaccine
Preexisting Conditions: no reported chronic conditions
Allergies: NKDA
Diagnostic Lab Data: only vital signs were taken at time of incident. EMS took over care once they arrived.
CDC Split Type:

Write-up: Patient was asked to wait 15 minutes in lobby. After ~5 minutes the person who was with him came and said he was having a reaction. When I reached the lobby the patient was lying supine in the floor with his feet on a chair. He had pallor in his face in arms, was diaphoretic, but alert to person and place. Upon questioning patient he said he had not eaten this morning. EMS arrived at 1059.


VAERS ID: 1427002 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: None stated.


VAERS ID: 1427016 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: patient fainted within 5 minutes of adminstering the vaccine, he looked very pale, his pulse was very high, but he came back within one minute, and was able to maintain conversation...he knew his name and current date. after 20 minutes he walked out of pharmacy with his mom


VAERS ID: 1427034 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood glucose normal, Dizziness, Hyperhidrosis, Sinus bradycardia, Syncope, Unresponsive to stimuli, Vertigo
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), Disorders of sinus node function (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies: NONE
Diagnostic Lab Data: Glucose 103 (6/25/21)
CDC Split Type:

Write-up: About 5 minutes after vaccination, patient complained of dizziness/spinning. It continued for several minutes when he became syncopal and briefly unresponsive. Heart rate 40. Glucose 103. BP 108/60. Respiratory rate 20 and sonorous. Placed on monitor which showed sinus bradycardia. 20 minutes after vaccination, patient recovering and able to talk but diaphoretic and weak. Taken to ER by paramedics.


VAERS ID: 1427045 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Swollen right eye
Other Medications: Multi vitamin, vitamin c, vitamin d, vitamin b12, b complex, omega 3
Current Illness:
Preexisting Conditions:
Allergies: Erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen right eye. Completely closed. 12 to 18 hours after vaccinated. Swelling started to come down by 12:40pm. Stayed until next day.


VAERS ID: 1427057 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Adverse event, Anxiety, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Adverse event: It was reported that patient received first dose Pfizer vaccine at 08:37. He had emesis in post-observation at 08:40. Treatment: Assessed by post-observation RN. EMT called and assessed. Patient taken by EMT to private observation area with parent. His father stated he (the patient) did not eat before vaccination. Given juice. Patient also stated he was very anxious about being vaccinated. Outcome: Patient asymptomatic. Vital signs stable (per EMT). BP 104/70, HR 82, Resp 16, Temp. 96,4 F, O2 Sat 98%). EMT discharged patient with parent to home.


VAERS ID: 1427062 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Old Rx for Prednisone in pt purse.
Current Illness:
Preexisting Conditions: Asthma
Allergies: Latex, Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Similar Rx to 1st dose w/ SOB, chest tightness, & CP that resolved after approx 1hr in medical observation. Obtained baseline VS prior to dose. Vax admin at 1115, SOB reported @ 1125. Benadryl 50mg PO admin @ 1133 for SOB w/ CP/heaviness. 1141 - VSS and symptoms reported as resolving and "much better" Lungs CTAx5 lobes, Pt AOx3 w/ intermittent smiling/talking. Symptoms resolved and VSS and released w/ family at 1207 1112 - BP 126/86, HR 68bpm, RR 16, O2 100% RA 1125 - BP 180/127, HR 87bpm, RR 20-24, O2 98% RA 1130 - BP 144/98, HR 87bpm, RR 20, O2 99% RA 1141 - BP 147/93, HR 75bpm, RR 18, O2 98% RA 1200 - BP 137/82, HR 66bpm, RR 18, O2 97% RA 1207 - BP 139/90, HR 67bpm, RR 16-18, O2 97% RA


VAERS ID: 1427064 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

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

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

Write-up: Patient reported chest pains within first 15 minutes which resolved after 30 minutes.


VAERS ID: 1427067 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 101.4 temp General achyness


VAERS ID: 1427082 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / UNK - / IM

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

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

Write-up: patient was 17 and administered the MODERNA vaccine. no symptoms occurred.


VAERS ID: 1427381 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Triumeq 1 tab Daily, hydrochlorothiazide 25 mg daily, multivitamin 1 tab daily, VItamin d2 50000 units 2 x weekly
Current Illness: HIV, Vitamin D deficiency, Syphilis, HPV, Bipolar Disorder, substance abuse
Preexisting Conditions: HIV and Bipolar Disorder
Allergies: NKDA/NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Pfizer as their 2nd dose instead as Moderna, which was their 1st dose.


VAERS ID: 1427395 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 developed redness around the site of injection.


VAERS ID: 1427399 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO180 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Burning sensation, Joint swelling
SMQs:, Peripheral neuropathy (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Left Elbow swelling & burning in left ankle.


VAERS ID: 1427400 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0271 / 1 LA / IM

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

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

Write-up: After waiting the necessary 15 minutes post vaccination, patient started to feel nauseated when she stood up to walk away. She made it a couple aisles away from the pharmacy and felt weak and she felt like she was going to throw up. So, patient dropped to her knees to avoid passing out. Patient was brought back to the pharmacy vaccine observation area and was giving a mat to lie on with a pillow and blanket. Patient was given a box of apple juice and a few minutes after patient felt much better, was no longer dizzy, weak or nauseated. Patient left area with mother after returning back to feeling normal.


VAERS ID: 1427436 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Pain in extremity, Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Occipital Neuralgia
Allergies: Most recent Ajovy injection gave rash at injection site. Codeine makes her "feel funny"
Diagnostic Lab Data:
CDC Split Type:

Write-up: RPh administered vaccine into left deltoid at 11:45am patient stated arm hurt and felt tingling in left arm/hand. Patient felt too lightheaded to move so remained seated until about 12noon was able to move patient to waiting/observation area with Dad. RPh continued to check in on patient. 12:20pm patient stated felt tired and still was having tingling in arm and soreness. 12:40pm patient presented back at Pharmacy counter stating she was having "tightness in the throat" and "getting worse". EMS contacted, then 12:45pm RPh administered EPiPen into left leg and patient taken to hospital for further evaluation/cardiac monitoring.


VAERS ID: 1427440 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Foaming at mouth, Hyperhidrosis, Malaise, Muscle spasms, Musculoskeletal stiffness, Pallor, Seizure like phenomena
SMQs:, Neuroleptic malignant syndrome (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Patient came in to receive his first Pfizer vaccination. The patient was signed up and vaccinated like normal. About 5 minutes after administering the vaccine to the patient, he stood up and came to the window to tell the technician on duty that he was not feeling well. He appeared sweaty and pale. The technician immediately advised the patient to sit down and called for the pharmacist on duty. The pharmacist went into the vaccine area and when she reached him, he went into a seizure-like state. He was foaming at the mouth, his hands were spasming, and he went stiff. The technician immediately called 911 and advised them of the situation. The employees stayed with the patient until the emergency services arrived approximately 7 minutes later.


VAERS ID: 1427447 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Cold sweat, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Niacin
Current Illness: not known
Preexisting Conditions: not known
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt reported dizziness/. BP 8548. wet & clammy. waited 30 minutes to leave, no dizziness or clammy BP 104/66 hr80


VAERS ID: 1427453 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 RA / IM

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

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

Write-up: Patient was inadvertently given a dose of Moderna 22 days after a dose of Pfizer. Patient presented to clinic to receive second dose of Pfizer but Moderna was administered through fault of human error.


VAERS ID: 1427454 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: dizziness, soar harm


VAERS ID: 1427459 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Illinois  
Vaccinated:2020-06-25
Onset:2021-06-25
   Days after vaccination:365
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK LA / IM

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

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

Write-up: pt is 15 but recived johnson and johnson covid vaccine


VAERS ID: 1427460 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

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

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

Write-up: patient reported not having felt faint before with vaccines and no problems in the past. after received vaccine said was ok and moved to waiting chair for 15 minutes. a few minutes later (while she was sitting) she passed out and hit her face on the floor. her glasses cut her cheek. 911 was called and they evaluated patient. unsure whether took her to the hospital but she said she was not going to go.


VAERS ID: 1427472 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (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: 10 ml of Benadryl Liquid 12.5mg/5ml
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After about 5 minutes of administration of the vaccine the patient began to feel tightness in her chest. She was able to breathe and speak freely so I administered benadryl. After about 5 minutes she said she felt better.


VAERS ID: 1427652 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 RA / 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: denies
Current Illness:
Preexisting Conditions: denies
Allergies: denies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt in clinic for 2nd dose of Moderna. Per dad, no medication, no PMH, NKDA. @9am-c/o of feeling dizzy post injection. No LOC. vasovagal. BP 90/p P 46 POX 100%9a-BP-99p P 46 head down; 915a 90/60 P 47 resp 16 916a 98/60 P 51 up 45 degree (head) 922a p 55; 927 106/74 p 50 resp 16, 932 108/66 p 60 resp 16 pox 100%. 934a-sympotsom resolved, bp 108/60 P 57 left with father in stable condition.


VAERS ID: 1427670 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Mild, Additional Details: Patient was sitting in chair, as she was getting up, experienced lightheadedness and thought she was going to faint.


VAERS ID: 1427673 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Choking, Headache, Injection site pain, Injection site swelling, Lymphadenopathy, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin 1.25 mg and Synthroid .05 mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Unknown
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Painful and swollen arm, both at injection site and underarm in lymph nodes. Woke up to pain in the right side of chest, under left arm. Slight fever, body aches, occasional choking, dull headache in back of neck near base of skull.


VAERS ID: 1427702 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, trazodone, adderall, clonidine, aspirin
Current Illness: none
Preexisting Conditions: asthma, diabetes
Allergies: IV dye, peanuts, celery, sulfa, cephalexin, clarithromycin, simvastatin
Diagnostic Lab Data: tryptophan
CDC Split Type:

Write-up: Cough, wheezing, shortness of breath


VAERS ID: 1427704 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

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

Write-up: Client stated he received first dose of an MRNA vaccine from the department. Checked database and database for his record and there was no record of MRNA vaccine. Notified, Nurse Manager, of the client and current situation and she recommended Moderna as he claimed he could not remember if he had received Moderna or Pfizer. Administered Moderna Vaccine as a second dose for the client and patient had no reaction after 15 min of monitoring.


VAERS ID: 1427709 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: Patient got dizziness and shaking. Patient was given gatorade, hershey kisses, and water. About 15 minutes later, he felt better and was able to walk out of the pharmacy.


VAERS ID: 1427721 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-19
Onset:2021-06-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: patient had mild arm rash develop underneath area of injection


VAERS ID: 1427728 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: anterior cervical lymphadenopathy 2 days after receiving 2nd Pfizer vaccine


VAERS ID: 1427753 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: Client stated that he received his first dose at back in May and does not recall if it was Housing for Health or the Fire Department. He only knows that he was told to come back for second dose at this location. Client information was checked both inand there was no record of him. Notified nurse manager,, and was directed to administer moderna. Client was notified of situation and client consented of moderna. Client had no reaction after 15 min of monitoring post vaccination.


VAERS ID: 1427759 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Patient received vaccine. As she walked out of the consult room she felt dizzy and described that she thought she blacked out. She fell into a plastic room divider and went to the ground. Her dad was right there and hoisted her upright. Offered to call ambulance but patient''s dad declined and reported that she had history of being squeamish and had passed out from needles before. Patient was breathing and quickly began responding verbally. Her dad picked her up and she sat upright in a chair. Took patient''s blood pressure, provided water, and had patient sit. First blood pressure reading was low (90s over 40s). Offered to call ambulance again. Patient''s dad declined. Patient drank water and juice. Retested blood pressure about 15-20 minutes later and it was 116/65 and patient reported that dizziness had subsided. Patient''s dad had left message with doctor''s office to report what had happened and to see if they wanted her to come in to be seen today. Encouraged him to do that and seek medical attention if anything worsened.


VAERS ID: 1427765 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 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: N/A


VAERS ID: 1427773 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Carpal tunnel syndrome, Chest discomfort, Dyspnoea, Headache, Myalgia, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pancreaze, Brand name Singulair, Halobetasol 0.05% cream, Metformin, Methocarbamol, eszopiclone, levothyroxine, Levalbuterol, losartan, buspirone, sertraline, theophylline, potassium chloride, Advair Diskus, Omeprazole, famotidine
Current Illness: Asthma, Heart Disease, pulmonary disease, neuromuscular disease, neurologic disorder
Preexisting Conditions: Asthma, Heart Disease, pulmonary disease, neuromuscular disease, neurologic disorder
Allergies: Iodine, penicillin, macrolides, statins, NSAIDS
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Per pt''s agent, Pt had arm pain going down her Right arm (vaccine given in Right deltoid) within 15 minutes of receiving vaccine. Pt left after 15 minutes (pt did not notify us of anything wrong, and went straight to her PCP). Pt''s agent said within 1 hour of the vaccine, pt was experiencing arm pain that radiated to neck, shaking, headache, heavy feeling of chest accompanied by shortness of breath, general muscle pain, and worsening of her carpal tunnel. pt agent said PCP gave pt benadryl shot, and prescribed pt hydroxyzine and diazepam (which were promptly picked up by pt agent to be delivered to the pt). Pt relayed all the above information to us as she was on the phone with the pt during this whole conversation. We will follow up with pt today.


VAERS ID: 1427783 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 UN / IM

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

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

Write-up: Patient had Pfizer COVID-19 vaccine for Dose # 1, and Moderna COVID-19 vaccine was adm as Dose # 2 today. Patient did not have vaccine card with her and told nurse she had received Moderna for dose #1. Verification in system showed patient had in fact received Pfizer for dose # 1 at another clinic but nurse had already adm the Moderna


VAERS ID: 1427807 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: 58 y/o male presented for his second pfizer dose. Reports no medical history but stated that he had some abdominal pain earlier and had his last meal of half egg sandwich around 12pm. He reports that he was told 1 year ago by his PCP that he had borderline diabetes. Reports that he usually passes out when he gets blood drawn. Pt reported that he felt dizzy about 5 minutes after injection at about 1:46pm that he felt lightheaded and was about to pass out when the observation staff transferred the patient to the bed stretcher. On examination, patient was alert & oriented X 3, and sweaty. Initial vital signs at 1:46pm were BP 117/67, HR 71, Temp 97, O2 sat 100%, fingerstick was 138. Repeat Vitals at 2:09pm were BP 108/83, HR 64, Temp 96.9, O2 sat 97%. Pt was escorted off the premises in stable condition at 2:09pm


VAERS ID: 1427811 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0127 / 2 LA / IM

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

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

Write-up: redness, swelling, heat at site of injection beginning hours after vaccine and still present 6 days later


VAERS ID: 1427812 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Injection site pain
SMQs:, Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Pain and a hurting sensation present at site of vaccination at 1405. Pt waited 15 minutes in the EMS room with an ice pack and then left vaccination clinic. Pt stated she was feeling better, however, pt returned with guardian and stated that burning sensation was still present. Pt was provided a second ice pack for site of vaccination. Nurse administered PO 25mg of Benadryl with guardians consent at 1430. Pt states at 1440 that she feels better. Minimal pain and burning sensation present. Pt has a history of needle phobia and anxiety.


VAERS ID: 1427814 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 RA / IM

Administered by: Private       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: Triamterene Carvedilol Simvastatin Simvastatin Allopurinol Lamotrigine Alprazolam Zolpiden tartvate
Current Illness:
Preexisting Conditions: High blood pressure Depression High cholesterol
Allergies: codeine ibuprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second dose of moderna on 6.25.21 at 11:00 a.m. at. The vial the dose was taken from was opened at 9 a.m. on 6/24/21.


VAERS ID: 1427824 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

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

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

Write-up: The patient received a dose of vaccine 6/25/21 at 9:40 am that was reconstituted 6/24/21 at 3:30 pm. No adverse events reported.


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