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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 58 out of 8,010

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VAERS ID: 1749856 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypotension, Nervousness, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Abdominal Pain-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Mild, Systemic: Shakiness-Severe, Additional Details: Patient recieved Moderna Covid vaccine and was waiting for the 15 mins, friend came over to tell me that he friend was shaking, when I went over to the patient she was unresponsive. After about 15-20 seconds she was reponsive, after further discussion with the patient she said this has happened before when she gave blood, she said she was extremely nervous and thinks that is what caused the reaction BP was 90/60 at first after it was back to normal at 120/80. She did not want to call Emergency.


VAERS ID: 1749864 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Pharmacy       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: None
Preexisting Conditions: Post stroke two years
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness and sore arm


VAERS ID: 1749865 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Immediate post-injection reaction, Lymphadenopathy, Muscular weakness, Pain, Pain in extremity, Paraesthesia, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: 09/01/2021- allergies- took Zyrtec which resolved symptoms. Took COVID test: negative
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: observation, referral to PCP, follow up in 5-7 days. Instructed to go immediately to ER if symptoms should worsen, weakness/numbness or if her symptoms increase.
CDC Split Type:

Write-up: Reports immediately after IM injection of second dose of COVID vaccine, developed shooting pain into left arm/left side of collar bone. Reports she woke up this morning - noticed left supraclavical lymph node swelling and tenderness and "tingling like pins and needles" from knees extending to feet bilaterally. Reports onset of symptoms 09/30/2021 at 0530 am treatment: follow up with PCP or seek medical attention right away (ER or 911) should symptoms worsen, weakness/numbness or worsening tingling to bilateral lower extremity, shortness of breath, chest pain, or change in neurological status. will follow up with team member health care clinic in 5-7 days or sooner as needed


VAERS ID: 1749898 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Malaise, Mobility decreased, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient felt "hot" and "not well" after receiving the vaccine. She stated that she felt her hands were swollen and she was unable to move them. EMS was called and the patient left with them to be observed.


VAERS ID: 1749911 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 212A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Loss of consciousness, Memory impairment, Muscle twitching
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), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Client passed out approximately 2 minutes after receiving J&J vaccine, client had no recollection of passing out after, rolling back of eyes and slight right arm muscle twitch upon awakening. On site EMS called to client''s side, observation provided . Client stated he did not remember passing out but he does remember feeling dizzy prior to passing out, Pt awoke within less than a minute. Client has no history of fainting.


VAERS ID: 1749912 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 RA / IM

Administered by: Other       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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient indicates that they had been vaccinated with Pfizer and arrived at the center for their second dose. When the vaccination card is asked to write down the second dose, they indicated the vaccination card has been damaged and they want a duplicate. They are asked to verify that they have a photo on their phone and when it shows we realize that your first dose was Moderna not Pfizer, as verified at the beginning.


VAERS ID: 1749931 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient reported having the following symptoms: body aches, nausea, severe chills, then fever. The symptoms began at midnight and appeared to resolve at 3:30 AM. Upon awakening this morning, he reported that felt a little sore and a little weak.


VAERS ID: 1749932 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

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

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

Write-up: over 42 days. 1st dose 08/15/2021, 2nd dose 09/20/21


VAERS ID: 1749957 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: PFIZER TEMPERATURE EXCURSION. THE VACCINE WAS IN THE FREEZER FOR 3 WEEKS THEN IT WAS MOVED TO THE FRIDGE FOR A WEEK. AFTER THAT IT WAS ADMINSTERED TO THE PATIENT


VAERS ID: 1749964 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-11
Onset:2021-09-30
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asymptomatic COVID-19
SMQs:, COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Percocet 5/325mg q6hr furosemide 60mg daily magnesium oxide 250mg daily metoprolol 150mg daily multivitamin rivaroxaban 20mg spironolactone 25mg daily zolpidem 5mg HS
Current Illness: None documented
Preexisting Conditions: Congestive heart failure, hypertension, atrial fibrillation, dilated cardiomyopathy, mitral valve regurgitation
Allergies: celebrex - acid reflux pradaxa - acid reflux tranexamic acid
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated asymptomatic - patient was being tested for rehab placement.


VAERS ID: 1749972 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR

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

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

Write-up: Medication error, wrong dose given. No adverse outcome.


VAERS ID: 1749975 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sprint tech birth control
Current Illness: none
Preexisting Conditions: sjogrens syndrome
Allergies: female hormones thermogenic
Diagnostic Lab Data:
CDC Split Type:

Write-up: NO ADVERSE EFFENTS , RECEIVED SECOND DOSE 11 DAYS SOONER EARLY


VAERS ID: 1749980 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-26
Onset:2021-09-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: pfizer vaccine temperature excursion. The vaccine was placed in the freezer for 3 weeks then removed and placed in the fridge for a week. After that the vaccine was adminstered,


VAERS ID: 1749981 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Fatigue, Pain, Pollakiuria, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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: Vyvanse, Losartan, Ibuprofen, Benadryl
Current Illness: Seasonal allergies
Preexisting Conditions: Obesity, HTN, cervical herniated disc
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 101.6, severe body aches, difficulty concentrating, fatigue, frequent urination


VAERS ID: 1750003 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-26
Onset:2021-09-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: pfizer vaccine temperature excursion. The vaccine was placed in the freezer for 3 weeks then removed and placed in the fridge for a week. After that the vaccine was adminstered,


VAERS ID: 1750018 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? Yes, 45 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Celecoxib 100 MG prn, NovoLIN N 100 units qhs, Lisinopril 20 MG 1 tab BID, metFORMIN HCl ER 500 MG 3 tabs daily, Metoprolol Tartrate 100 MG 1 tab BID, Pravastatin Sodium 20 MG 1 tab daily
Current Illness: N/A
Preexisting Conditions: DM II, HTN, chronic numbness L lateral thigh, peripheral neuropathy, chronic back pain
Allergies: Demerol, clonidine, hydrocodone, Victoza
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Given COVID Vaccine on 08/13/21, on 08/14/21 started having a hard time breathing, and a elevated heart rate, was taken to hospital on 08/14/21, pt recently moved to rehabilitation facility for continued care on 09/29/21


VAERS ID: 1750022 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-27
Onset:2021-09-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pfizer vaccine temperature excursion. The vaccine was placed in the freezer for 3 weeks then removed and placed in the fridge for a week. After that the vaccine was administered,


VAERS ID: 1750032 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Pain in extremity
SMQs:, Peripheral neuropathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient said that a few hours after receiving the vaccine, her right lower leg began burning. The pain was on/off and got worse when she would stand. She reported no swelling, redness, or excruciating pain. She will follow up with a physician or a hospital.


VAERS ID: 1750049 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pallor, Paraesthesia, Throat irritation
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (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: Zyrtec
Current Illness:
Preexisting Conditions:
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Tingling in left arm moving up to neck area. Throat felt funny. Pale appearing.


VAERS ID: 1750058 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Head discomfort
SMQs:, Anaphylactic reaction (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 meds listed
Current Illness: None listed
Preexisting Conditions: None listed
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: approximately 10 minutes after injection reported fullness in head and below eyes, as well as feeling heaviness in her chest. Response was called and as taken to Urgent Care for evaluation by MD.


VAERS ID: 1750068 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 - / -

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

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

Write-up: Pt received shot and walked to monitoring area. Pt felt lightheaded so he motioned for staff to help. Nurse arrived as pt had syncopal episode. Pt had an assisted fall out of the chair. Pt awoke within 1 minute. Vital signs at 1527 were BP 159/82 HR 90 97%O2, 18 resp. An employee was called. Pt A7O x3, no difficulty breathing, on floor with legs elevated. RRT arrived at 1529. Repeat vitals at 1529 BP185/113 HR89 98%O2 18 resp. Pt brought to ED for evaluation.


VAERS ID: 1750073 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: baby aspirin and 40 mg atorvastatin daily
Current Illness: None
Preexisting Conditions: sleep apnea
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Woke up with vertigo about 12 hours after injection, which led to nausea but not vomiting. Vertigo eventually gave way to unsteadiness, which is now moderating at 24 hours post-injection. No treatment except rest and low level of activity.


VAERS ID: 1750076 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-27
Onset:2021-09-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: Pfizer vaccine temperature excursion. The vaccine was placed in the freezer for 3 weeks then removed and placed in the fridge for a week. After that the vaccine was administered,


VAERS ID: 1750077 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-02-09
Onset:2021-09-30
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Influenza like illness, Injection site pain, Somnolence, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal; Zoloft; Kroger gummies Women''s Multivitamin; D3; Allegra; Mirena; Flonase; Ibuprofen; Tylenol; Excedrin Migraine; Fioricet
Current Illness: None
Preexisting Conditions: Cats allergy and seasonal
Allergies: Kiwi
Diagnostic Lab Data: No test or labs.
CDC Split Type: vsafe

Write-up: Immediately after had a warm chill, swelling, and soreness at injection site. On the next day after taking medicine to sleep and for pain, stayed painful and annoying. Sleepiness and tired all the time (napped multiple times during the day) Flu like symptoms started without temp. OTC treatment self care. 2-3 weeks and only small issues for a week more after that.


VAERS ID: 1750085 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-29
Onset:2021-09-30
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Pain, Pyrexia, SARS-CoV-2 test negative, Upper respiratory tract congestion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Bursitis caused from booster shots in high school limiting ROM for approximately 6 weeks
Other Medications: Cymbalta, adderall, tizanadine, lunesta, vit c, omega10, gnc women, b12, magnesium
Current Illness: None
Preexisting Conditions: Anxiety, depression, add, migraines, arthritis
Allergies: Iodine contrast, latex
Diagnostic Lab Data: Rapid covid - negative
CDC Split Type:

Write-up: Fever, headache, Upper respiratory congestion, Fatigue, bodyaches.


VAERS ID: 1750092 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest pain, Dizziness, Dyspnoea, Headache, Pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Olemsartan Medoxomil 40mg, Flueoxetine HCL 40mg
Current Illness: None
Preexisting Conditions: Blue rubber bleb nevus syndrome (BRBNS) also known as BEAN syndrome which is a rare congenital vascular anomaly in which malformed veins, or blebs, appear on the skin and surfaces of internal organs. At the time of diagnosis, there were only 200 documented cases worldwide.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness and weakness, Shortness of breath, chest pain, and mild headache. The dizziness started around 2:00 pm on September 30th and around 3 PM the same day the weakness, shortness of breath, chest pains, and mild headache started. I did take Acetaminophen at 3:30 PM for pain and the headache started to go away a little around 4 PM. The other symptoms are still present. I have called my primary care physician and am waiting on her response back.


VAERS ID: 1750093 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient inadvertently received a Pfizer COVID 19 vaccine as a single dose booster and after administering the vaccine we realized that the patient had received Moderna as a primary series


VAERS ID: 1750095 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-15
Onset:2021-09-30
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased, Diabetes mellitus, Malaise, Pollakiuria
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 09/27/2021 Glucose 701, Sodium 127
CDC Split Type:

Write-up: Developed malaise and frequent urination~10 days after second Moderna. Lab done revealed glucose 701. New onset diabetes mellitus.


VAERS ID: 1750097 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not on VARIC or oral discussion
Current Illness: denied on form, oral
Preexisting Conditions: denied on form, oral
Allergies: denied on form, oral
Diagnostic Lab Data: BP 103/82 post incident
CDC Split Type:

Write-up: Pt presented 1100 for Pfizer Covid #1. Form filled out online. RPh reviewed form online (all answers no) before orally confirming in booth prior to injection. Injection given at 1110 am, discussed possible side effects, etc with patient for couple of minutes, pt was seated in waiting area for 15 minutes prescribed period , and was visually checked by RPh every couple of minutes. At 1131 another customer waved and informed us patient had fainted in chair (no fall). 2 pharmacists responded with rescue kit and bp monitor as pt was awakening. bp was taken, pupils, skin temp, peripheral blood flow, etc. Patient reported he felt a bit nausea and dizzy but very relaxed. Was surprised but not upset. One pharmacist stayed with patient the required extra 15 minutes + and provided pt with water while repeatedly checking vitals. At 1147am pt was past the 15 minutes and felt he was ready to go. Rph verified patient stability and reflex before pt left.


VAERS ID: 1750112 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-18
Onset:2021-09-30
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Inderal, Cymbalta, Imitrex, Ativan
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Adhesives, Keflex
Diagnostic Lab Data: Positive COVID-19 RT-PCR Test
CDC Split Type:

Write-up: Positive COVID-19 Test while fully vaccinated.


VAERS ID: 1750119 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-28
Onset:2021-09-30
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 2 UN / UN

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

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

Write-up: hospitalization (non-ICU) Vaccine lot numbers / sites of injection not documented.


VAERS ID: 1750123 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-09-30
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase, Zovirax, Lotrisone, Phentermine, Cryselle
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin, Codeine
Diagnostic Lab Data: Positive RT-PCR COVID-19 Test
CDC Split Type:

Write-up: Positive COVID-19 While fully vaccinated


VAERS ID: 1750139 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-09-30
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paxil, Claritin, Melatonin, Ativan, Vistaril, Singulair, Albuterol, Advair, Prilosec, Biotin, Proventil, Vitamin D3, Fish Oil. Calcium with Vitamin D, Multivitamin
Current Illness: N/A
Preexisting Conditions: Asthma, Degenerative Joint Disease, Chronic Pain, Osteopenia, Schatzki''s Ring, GERD, Allergies
Allergies: Codeine
Diagnostic Lab Data: Positive COVID-19 RT-PCR Test
CDC Split Type:

Write-up: Positive COVID-19 while fully vaccinated


VAERS ID: 1750149 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: HPV Vaccine, Patient had passed out but it was no where near as severe as described by her mother. Unknown when the exact date w
Other Medications: Aripiprazole, Sertraline, Fluoxetine, and Hydroxyzine although I believe the mother had said she had only taken fluoxetine so far today.
Current Illness: N/A
Preexisting Conditions: Anxiety and depression.
Allergies: No known drug allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: A couple minutes after getting the vaccine the patient complained she was not feeling well. We tried giving her some orange juice to see if that would make her feel better. She started to pass out dropping the orange juice and temporarily became unresponsive. She also had a few minor convulsions. 911 was called and we called a department 50 bringing in the other pharmacist and senior team members to watch over the patient while I had 911 on the line. Patient eventually regained partial consciousness and awareness answering questions. She was able to breath throughout the episode. The EMTs eventually came and got her on a cart administering oxygen and continuing to check her awareness. She was transported out of the pharmacy.


VAERS ID: 1750159 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Angina pectoris, Dyspnoea, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Respiratory failure (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: Same as this reaction
Other Medications: None
Current Illness: Ns
Preexisting Conditions: Na
Allergies: Bees, and other vaccines
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dypsnea, tachypnea, angina


VAERS ID: 1750165 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol 100 mg Prednisone 20 mg Xarel 2.5 mg Lipitor 40 mg Wellbutrin XL 150 mg Lisinopril 10 mg. Levothyroxine 100 mcg. Prevacid 15 mg.
Current Illness:
Preexisting Conditions: Hypercholesteremia Renal cell cancer Heart disease Hypertension Thyroid disease
Allergies: No known allergies
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Medical Assistant gave this patient a booster dose of the Pfizer vaccine today. She did not realize that the vial had not been reconstituted yet, and gave him the vaccine without being reconstituted.


VAERS ID: 1750166 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

Administered by: Private       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: lisinopril, gabapentin, atorvastatin, jardiance, Januvia, metformin, humira, clobetasol
Current Illness:
Preexisting Conditions: Diabetes Mellitus, chronic inflammatory demyelinating polyneuritis, GERD, hyperlipidemia
Allergies: Sulfa antibiotics
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 9/30/21-Pt arrived for Covid booster without vaccine card. Pfizer was administered. Upon checking previous vaccines to make a new card it was noted he had previously had Moderna vaccine. Pt. Informed and Supervisor informed. Checked with Pharmacy and was informed there are no contra-indications. Pt. Asked to wait 15 minutes for observation and he was agreeable. RN


VAERS ID: 1750168 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Pallor, Seizure, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none given/listed
Current Illness: none given/listed
Preexisting Conditions: none given/listed
Allergies: none given/listed
Diagnostic Lab Data: Recommended to visit Urgent Care or Hospital to evaluate further
CDC Split Type:

Write-up: Patient left pharmacy under there own power, and interacted with staff fine. Uncle of patient stated in the car ride home, approx. 15min after vaccination, the patient threw up, convulsed, and loss conciseness. Our Pharmacist meet patient in the parking lot, approx. 20min after vaccination, patient was visibly sweeting and had a loss of color to face.


VAERS ID: 1750173 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0390D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Hypotension, Posture abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None mentioned
Preexisting Conditions: None mentioned
Allergies: No known Allergy
Diagnostic Lab Data: eCG 9/30/2021 BLOOD PRESSURE CHECKED 9/30/2021
CDC Split Type:

Write-up: Patient had said he didn''t like shots when counseled to stay around. He felt light headed after the shots and was on the floor. He sat on the floor for about 10 minutes, afterwards he got on the chair and after a couple of minutes slumped off the chair and fainted for a couple of seconds. He came to it after a couple of seconds. Emergency services was called in and they checked his blood pressure, it was low. He didn''t want to go with the service. We were advised to give him crackers and water, which was done. He was advised not to drive home and he got a ride to take him home.


VAERS ID: 1750174 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: THE PATIENT DEVELOPED RASH AND WAS GIVEN DIPHENHYDRAMINE 50MG/ML VIA IM ROUTE


VAERS ID: 1750175 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145 BA / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue
SMQs:

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

Write-up: significant fatigue


VAERS ID: 1750199 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Approximately 3 red raised areas on outer aspects of let arm in elbow area. Outer left leg red with one raised area on outer part of left leg at ankle area. Stated "It is itching". Her employer gave her 50 mg of Benadryl by mouth.. Monitored immediately. v/s 130/90 , 90 16 o2Sat 99%. at 12:55 pm. 1:10 pm 128/84, 82 o2 sat 100%. all areas that were previously red at initial assessment were no longer present.


VAERS ID: 1750251 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PfizerBioNTech dose #2
Other Medications: Estriol cream
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever, chills, muscle aches, fatigue


VAERS ID: 1750252 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

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

Write-up: Patient verbally confirmed twice that she was to receive Pfizer. I checked her card and made sure the dates of 1st and 2nd shot made her eligible for a 3rd dose. I overlooked the fact that it was Moderna on her card. I gave the vaccine and turned to fill out the card. That is when I noticed that the first two shots were another mRNA (Moderna). I told the patient that I gave her Pfizer and she was supposed to stay in the Moderna dose series. Patient was not alarmed at all. She said she was actually glad she received Pfizer. I apologized and of course will double check going forward. I check them every time. I am not sure what made my attention draw away from checking the series. Patient is not harmed or upset.


VAERS ID: 1750257 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

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

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

Write-up: No adverse reaction noted.


VAERS ID: 1750260 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Fatigue, Feeling cold, Feeling hot, Muscle spasms
SMQs:, Neuroleptic malignant syndrome (broad), Dystonia (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: CoQ-10 200mg; Zinc 30mg; D3 125 mcg (5000iu); Asprin 81mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I started off getting chills and crams around 8:30 AM, which got progressively worse. As the muscle cramps got works I started to feel hot and tired. I laid down and fell asleep. When I woke up I was starting to feel better and took my temperature, about 12:30 PM. My temperature was 100.2 at that point. I''m now feeling even better and my temperature is down to 98.9.


VAERS ID: 1750263 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Cold sweat, Dizziness
SMQs:, Anaphylactic reaction (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
Preexisting Conditions: history of bradycardia 6 months ago
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: PT c/o dizziness and waves of tightness in chest 20 minutes after receiving #2/2 Pfizer vaccine to left deltoid. Skin noted to be cold and clammy. No c/o pain, no shortness of breath, PT alert, oriented & talking. PT cooperative and answers questions. PT stated he had a history of bradycardia & seen by a doctor. PT stated that he continued to feel fine up till current time. No medication given, no long term health conditions reported. VS at start of reaction... 2:40pm HR 66, O2 sat 98%, BP 126/75, RR 20, 2:50pm HR 60, O2 sat 98%, BP 155/65, RR 24 EMT called at 2:50pm and arrived 3:10pm VS at 3:00pm HR 60, O2 sat 98%, BP 140/60, RR 20 VS at 3:05pm HR 61, O2 sat 98%, BP 135/55, RR 24 PT assessed by EMT, PT refused transport to medical facility, PT stated he felt better but stated he continued to feel light tightness in chest without dizziness. PT left vaccination room and returned to office in same building. PT encouraged to call for medical attention if further dizziness is noted.


VAERS ID: 1750271 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

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

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

Write-up: Dizziness, nausea, vomiting. EMS attended and cleared patient.


VAERS ID: 1750272 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-09-30
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21AC / 1 LA / -

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

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

Write-up: Rash and pain on upper back shoulder


VAERS ID: 1750273 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyskinesia, Erythema, Fall, Hyperhidrosis, Mydriasis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Following 1st dose administration of Pfizer vaccine patient was noted to be falling out of chair. Staff was able to catch her. Patient noted to be having involuntary "jerking" motions, diaphoretic, with pupils dilated. Patient assisted to lying position and assessed airway, breathing, and circulation. Staff contacted 911 to assess patient. This nurse spoke with patient sister who states patient does not have a history of seizures or any other medical history. Paramedics arrived and assessed patient. Patient verbal and responsive and able to verbalize name, location and year. Facial redness noted at this time. Airway patent. Patient transferred from cot to stretcher with minimal assistance. Patient transported via EMS to hospital. All patient belonging sent with her via EMS.


VAERS ID: 1750276 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: N/A
CDC Split Type:

Write-up: Upon returning from break at 11:30am, RN, went back to the mixing room and grabbed two Pfizer vials that were in a clear bin with no orange UB dot on them. I mixed the vials and drew doses of vaccine in preparation to administer them to TMs coming in for their booster doses of Pfizer vaccine. At around 1:30pm Vaccine Clinic RN team lead, RN reported to my desk and asked if I knew where the two vials of Pfizer that were in the bin had gone; I acknowledged that I took the vials to dilute them and use them to administer doses to TMs. He advised me that those doses were empty vials of used vaccine. I acknowledged the information and let RN know that practice at this vaccination site since opening of the site Feburary 2021 has been to place wasted/empty vials in a clear zip lock bag so they do not get mixed with vials to be used for dilution and to place an orange dot on the pharmacy tag once mixed with the BUB (Best Used By) time; he acknowledged same. I notified Dr., medical director occupationl medical services, and manager occupational medicine, of incident. Patient called back to clinic and inoculated with correct dilution of Pfizer vaccine with lot number EW0176


VAERS ID: 1750280 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Electrocardiogram normal, Fatigue, Full blood count, Liver function test, Metabolic function test, Pain, Pyrexia, Troponin
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: ADHD, Allergic Rhinitis
Allergies: None
Diagnostic Lab Data: EKG and Cxray Normal Pending CBC, BMP/Liver Profile, Troponin
CDC Split Type:

Write-up: Onset of fatigue, body aches, low grade fever, and chest pain


VAERS ID: 1750309 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 3 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? 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: Upon returning from break at 11:30am, I went back to the mixing room and grabbed two Pfizer vials that were in a clear bin with no orange UB dot on them. I mixed the vials and drew doses of vaccine in preperation to administer them to patient''s coming in for their booster doses of Pfizer vaccine. At around 1:30pm Vaccine Clinic RN team lead reported to my desk and asked if I knew where the two vials of Pfizer that were in the bin had gone; I acknoledged that I took the vials to dilute them and use them to administer doses to patients. He advised me that those doses were empty vials of used vaccine. I acknowledged the information and let lead nurse know that practice at this vaccination site since opening of the site Feburary 2021 has been to place wasted/empty vials in a clear ziplock bag so they do not get mixed with vials to be used for dilution and to place an orange dot on the pharmacy tag once mixed with the BUB (Best Used By) time; he acknowledged same. I notified the Dr, medical director occupationl medical services, and the manager occupational medicine, of incident. Pt called & notified of same, invited to return to clinic to receive dose of Pfizer vaccine with lot number EW0176


VAERS ID: 1750312 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Breath sounds abnormal, Cough, Dyspnoea, Hyperventilation, Tachycardia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: 2/5/2021 following 2nd dose of Pfizer had 1 episode of mild fever, respiration 24 then down back to his normal. He recovered w
Other Medications: Acetaminophen 235mg PRN, allopurinol 100mg, Carbidopa-levodopa, calmoseptine ointment, diltiazem HCL ER 180mg, Eliquis 2.5mg, eye scrub pad, finasteride 5mg, flomax capsule 0.4mg, Hiprex tablet 1mg, Ipratropium-Albuterol solution, lasix 20m
Current Illness: Resident was followed by urology. He is status discontinue of Foley Catheter. He was incontinent urine.
Preexisting Conditions: Parkinson disease, atrial fibrillation, hypertension, heart failure, hyperlipemia, peripheral neuropathy, non-insulin dependent diabetes, urinary retention, right ulnar neuropathy, chronic renal insufficiency, polycythemia, gout, begnin prostatic hyperplasia
Allergies: No Known Allergy
Diagnostic Lab Data: 9/30/2021 admitted to local Hospital
CDC Split Type:

Write-up: 9/30/2021 during morning round resident received resting in bed comfortably. AM care provided. Around 8:20am nurse entered the room to administer morning medication and noticed resident was making a gurgling sound, short of breath and hyperventilated. The resident had a wet non productive cough, tachycardia and temperature of 100.0. Oxygen administered, PRN nebulizer given, 911 activated, MD notify and POA made aware. Resident was transported to local Hospital for further evaluation and treatment. The Resident was admitted.


VAERS ID: 1750318 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 3 RA / IM

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

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

Write-up: Upon returning from break at 11:30am, I went back to the mixing room and grabbed two Pfizer vials that were in a clear bin with no orange UB dot on them. I mixed the vials and drew doses of vaccine in preperation to administer them to TMs coming in for their booster doses of Pfizer vaccine. At around 1:30pm RN team lead reported to my desk and asked if I knew where the two vials of Pfizer that were in the bin had gone; I acknoledged that I took the vials to dilute them and use them to administer doses to TMs. He advised me that those doses were empty vials of used vaccine. I acknowledged the information and let employee know that practice at this vaccination site since opening of the site Feburary 2021 has been to place wasted/empty vials in a clear ziplock bag so they do not get mixed with vials to be used for dilution and to place an orange dot on the pharmacy tag once mixed with the BUB (Best Used By) time; he acknowledged same. I notified medical director occupationl medical services, and manager occupational medicine, of incident. All TMs notified of same.


VAERS ID: 1750319 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: patient stated she had left her card with the pharmacy staff and confirmed it had been six months since last dose...and also stated she was immunocomromised. She was also getting flu vaccine. After the vaccine i went to give her card back and noticed it had only been since 5/22/21 since her last dose....she stood by her claim she is immunocompromised.


VAERS ID: 1750339 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: Within minutes of administering the dose the patient became very nauseous and vomited. Patient said he was still nauseous when they left about 30 minutes later. Dad carried him to the car because he was unstable and was having trouble keeping balance.


VAERS ID: 1750348 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-28
Onset:2021-09-30
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1750359 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypertension, Hypoaesthesia, Paraesthesia, Tachycardia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: Paresthesia, numbness, tingling from top of right shoulder extending down to right 5 fingers. Htn, Tachycardia.


VAERS ID: 1750362 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Neck pain, Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin
Current Illness: unkwnown
Preexisting Conditions: type 2 diabetes
Allergies: No allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: At approximately 1310 client received Pfizer was ready to leave. She asked her if she was feeling good. Client responded by stating that she felt numbness and tingling on her left arm as well as left side of torso, by stomach. Client denied shortness of breath, denied any itchiness, and stated she was able to swallow. Arm was assessed by nurse no redness, no swelling was observed on left arm of injection site. Client stated she had a rash on her stomach from previous days and had spoken to her provider. Vitals at 1320 HR 77 02 96% 1325 BP 116/90 HR 64 02 98%. At 1320 client stated she started feeling neck pain as well pain scale 3/10. At 1325 water was provided for client and had a few sips of water. Pt stated she had something to eat in the morning. Client stated her arm was feeling better and stated she has type 2 diabetes and took Metformin in the morning. Vitals at 1330 BP 128/84 HR 64 02 98% RR 18 Client stated she had regained feeling in her arm and neck pain was better. Pain scale 2/10.Vitals 1335 BP 124/90 HR 74 02 97 RR 16, at this time client denied having any neck pain, and stated she had less tingling and no tingling on her left side of stomach. Client was observed for 30mins for further assessment. client stated she felt comfortable going home and driving herself. Client was educated about seeking emergency care if symptoms worsen. She was also recommended to follow up with her provider to inform about symptoms. She was offered a handout for VSafe. Client verbalized understanding. Client left vaccination site walking in a steady gait and was escorted to her car by in no apparent distress.


VAERS ID: 1750366 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1750372 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

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

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

Write-up: PATIENT WAS GIVEN 0.3 ML UNDILUTED VACCINE. NO KNOWN ADVERSE EFFECTS AT THIS TIME


VAERS ID: 1750380 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Flushing, Limb discomfort, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: Vitamins
Current Illness: None
Preexisting Conditions: Celiac disease
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Flushed, heart racing, pressure on arm, anxiety. EMS attended and cleared patient.


VAERS ID: 1750385 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1750386 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

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

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

Write-up: Vaccine was administered when patient is 15 years-old. No adverse event has been reported by the patient.


VAERS ID: 1750389 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling abnormal
SMQs:, Dementia (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: Aspirin, Omega-3, HBP Rx, and Meclizine
Current Illness: High Blood Pressure
Preexisting Conditions: High Blood Pressure
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Around 1520, and while in observation, client stated feeling dizzy. EMS came to the scene, assesed, and cleared her.


VAERS ID: 1750391 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1750392 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-22
Onset:2021-09-30
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (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: Shingles rash started 8 days after vaccination.


VAERS ID: 1750396 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (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: Bently 20 mg oral tab Zofran 4 mg tablet
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data: 1525 Ambulance transported patient to ER
CDC Split Type:

Write-up: 1505 Patient complaint of dizziness, shortness of breath, and throat tightness after receiving pfizer vaccination. blood pressure taken 78/49 heart rate 56 1510 Benadryl 50 mg IV given times one. 1515 throat tightness, shortness of breath and dizziness still continues. Epipen 0.3 mg given times one in the left lateral thigh. blood pressure 71/38 heart rate 72. Placed patient in a trendelenburg position. 1515called 911 1517 blood pressure retaken 132/79 heart rate 73


VAERS ID: 1750398 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1750401 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vaccine administered at 2 weeks rather than 4 weeks, no immediate negative effects noted


VAERS ID: 1750403 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Angina pectoris, Chest discomfort
SMQs:, Anaphylactic reaction (broad), Other ischaemic heart disease (narrow)

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

Write-up: Tightness in chest, pain in heart. EMS attended and cleared patient.


VAERS ID: 1750404 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1750410 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Headache, Hyperhidrosis, Myalgia, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Attendee came to get 1st dose of vaccination, and when upon receiving a few minutes shortly, she became diaphoretic, and complained of blurred vision, light headedness, and dizzy. She was then sent to a cot to lay down and she then complained of sharp pain to her shoulders and generalized muscle pain. By the time of discharge at 11:25 she had a slight head ache and some of the ache to her shoulders remained but she stated she was ready to go home and wanted to rest.


VAERS ID: 1750413 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Headache, Hyperhidrosis, Myalgia, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Attendee came to get 1st dose of vaccination, and when upon receiving a few minutes shortly, she became diaphoretic, and complained of blurred vision, light headedness, and dizzy. She was then sent to a cot to lay down and she then complained of sharp pain to her shoulders and generalized muscle pain. By the time of discharge at 11:25 she had a slight head ache and some of the ache to her shoulders remained but she stated she was ready to go home and wanted to rest.


VAERS ID: 1750415 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

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

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

Write-up: Pfizer COVID-19 vaccine was administered to patient by pharmacist on 9/30/21. Approximately 10 minutes after the vaccine, pharmacist was alerted by the patient''s co-worker that the patient was exhibiting signs of fainting. Pharmacist called emergency services according to standard operating procedures and when patient actually fainted, ammonia inhalant was used to awaken patient. An ice pack was used while emergency services arrived, and patient was released according to EMS suggestion and patient consent to decline hospital transport.


VAERS ID: 1750417 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Asthenia, Blood alkaline phosphatase increased, Blood bilirubin increased, Blood chloride decreased, Blood lactic acid, Blood potassium decreased, Blood sodium normal, Blood urea increased, Carbon dioxide decreased, Haemoglobin decreased, Hypotension, Lactic acidosis, Leukocytosis, Liver function test increased, Lymphocyte percentage decreased, Nausea, Neutrophil percentage increased, Platelet count decreased, White blood cell count increased
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81mg PO QD Atorvastatin 80mg PO QD Epoietin 50mcg IV Q4 weeks Furosemide 80mg PO BID Gabapentin 300mg PO BID Sevelamer 1600mg PO TID Nephrovite 1 tab PO QD
Current Illness: COVID infection (Symptom onset 8/27/21)
Preexisting Conditions: HTN HLD DM2 ESRD on HD Anemia Secondary hyperparathyroidism
Allergies: None
Diagnostic Lab Data: 9/30/21 Hb: 10.8 WBC: 27.8 (10% bands, 82% neutrophils, 3% lymphocytes) Platelet: 95 Na: 138 K: 2.9 Cl: 96 CO2: 21 BUN: 55 AST: 933 ALT: 774 Alk Phos: 232 T-bili: 2.4 Lactate: 6.8
CDC Split Type:

Write-up: Adverse events: Hypotension, Lactic acidosis, Leukocytosis, Elevated LFTs Symptoms: Weakness, nausea Treatment: Vancomycin, Zosyn, Pressors


VAERS ID: 1750426 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

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

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

Write-up: Around 1520, while in observation, client stated feeling dizzy and anxious. EMS attended and cleared client.


VAERS ID: 1750450 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Vaccination site pruritus, Vaccination site rash
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Melatonin, Omega-3
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around 1540, while in observation, client notified of rash and itchy skin at vaccination site. EMS attended the client and released him.


VAERS ID: 1750454 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, Hyperhidrosis, Mydriasis, Respiration abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Vestibular disorders (broad), Respiratory failure (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient had a reaction to the vaccine. After his second dose of Pfizer was administered, patient broke a sweat, his pupils dilated, his heart was beating fast, and his breathing was altered. He also started feeling dizzy. Patient was given water and icepacks were placed on his forehead and neck. 911 were called. Upon arrival, they took his vitals. Everything was normal O2 97%, Temp: 36.1 C, BP: 121/80, HR: 73. Patient was not transferred to the hospital.


VAERS ID: 1750455 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache
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: Diflucan
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pain on left side of head. EMS attended and cleared patient.


VAERS ID: 1750464 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tamoxifen, bactrim, baby aspirin, biotin
Current Illness: None- surgical drain in place, surgery on 8/18/2021
Preexisting Conditions: Breast cancer
Allergies: Amoxicillin, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, body aches, fever 101.5


VAERS ID: 1750489 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal behaviour, Condition aggravated, Dysphonia, Skin discolouration, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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: fainting
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Patient reported history of fainting for vaccinations from fear/anticipation of needle injection
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient walk in to pharmacy to request her first dose COVID vaccine, she has a history of fainting from immunization from needle injection pain. Pfizer covid vaccine was prepared and administered per manufacturer procedures. Immunizing technician noticed patient''s change in behavior/voice and color of face, offered water and patient accepted, she fainted shortly after. Husband and technician was transitioning patient to recovery position as patient became alert and aware. She sat back down, vomited, and recovered, she left store on her own with husband.


VAERS ID: 1750493 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, 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), Vestibular disorders (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: Patient felt light headed and passed out right after vaccine administration within few minutes. Patient was conscious and had pulse and breathing. pharmacist checked blood pressure and pulse every few minutes .Oxygen saturation was at 99.Initially blood pressure seemed to drop.so called emergency.first responder arrived and checked vitals which were normal by then.so patient chose not to go to the hospital. she felt better and went home.


VAERS ID: 1750499 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (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: Kelnor Lexapro Zyrtec Melatonin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, body wide joint aches, chills


VAERS ID: 1750507 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

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

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

Write-up: Fever of 100.5, significant joint and muscle pain, headache, stabbing pains


VAERS ID: 1750508 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-24
Onset:2021-09-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Conjunctival haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Conjunctival disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin; Ibuprofen; Levothyroxine 100mcg daily; Paroxetine 30mg daily
Current Illness: N/A
Preexisting Conditions: Autoimmune disorders
Allergies: PCN; Sulfa; Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: subconjunctival hemorrhage. Seen at Eye Center. No treatment other than time.


VAERS ID: 1750509 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 LA / IM

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

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

Write-up: over 42 days. 1st dose 08/13/21, 2nd dose 09/30/21


VAERS ID: 1750510 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 - / IM

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

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

Write-up: Needle/syringe malfunction upon administering Moderna COVID-19 vaccine to patient on 09/30/2021. Administering provider noted approximately half of the vaccine dose administered, and half wasted. Doctor was consulted via telephone, and recommended 0.25ml to be administered to the patient to complete the full vaccination dose. Patient in agreement. No adverse reactions noted after the post vaccine observation period.


VAERS ID: 1750516 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-30
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Oropharyngeal pain, Vaginal haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Lisinopril, multivitamin, flaxseed oil, Vitamin D3, Calcium-Magnesium-Zinc, Vitamin C
Current Illness: None
Preexisting Conditions: Mild high blood pressure controlled with Lisinopril.
Allergies: Sulpha drugs and Tetanus, apples
Diagnostic Lab Data: Haven''t had time to consult physician yet.
CDC Split Type:

Write-up: Abdominal pains with light bleeding from the vagina. Sore throat on Wednesday afternoon, 9/29/2021, abdominal pains all day on Thursday 9/30/2021, had light bleeding from vagina after getting home from work. Haven''t had a menstruation in about 8 years.


VAERS ID: 1750518 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 LA / IM

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

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

Write-up: Patient administered 3rd dose of Moderna while not meeting eligibility requirements.


VAERS ID: 1750520 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-24
Onset:2021-09-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 LA / IM

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

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

Write-up: Patient given 3rd dose of Moderna without meeting eligibility requirements.


VAERS ID: 1750552 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event, 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: Metoprolol, ezetimibe, simvastatin, digoxin
Current Illness:
Preexisting Conditions:
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse reactions were seen at the time of administration, but the patient received the Pfizer Covid vaccine instead of a flu shot and had previously been fully vaccinated with the Moderna Covid vaccines back on 03/27/2021.


VAERS ID: 1750569 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588/ / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site rash
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: rosuvastatin 5mg, quinapril 10mg, duloxetine 30mg
Current Illness: n/a
Preexisting Conditions: hypercholesterolemia, hypertension
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: pt had bruise at injection site and rash below injection site


VAERS ID: 1750572 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dehydration, Fall, Syncope, Vertigo
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (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: "Walking Vertigo" Dehydration
Preexisting Conditions: "Walking Vertigo"
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fainted, fell to floor, no injuries, was surprised he was on floor. Stated he had walking vertigo and had no drank any liquid that day. sat patient in chair gave water and he felt much much better. Patient departed on his own after a time, said he was doing fine.


VAERS ID: 1750591 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3183 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Palpitations, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SGLT 2 inhibitor, ASA 325 mg /day, altace 10 mg/day, metformin 2500 mg divided daily. synthroid 75 mg, 5mg lexipro, benadryl 50 mg per day at night,
Current Illness: Non
Preexisting Conditions: Asthma, HTN, CVD, 60%LAD lesion not stented, Diffuse interstitial pneumonitis, Diet and medication controlled DM, Carries Epi pen
Allergies: Bee Venom, Red Dye in Salmon
Diagnostic Lab Data: 142/70 82, 97 % on RA
CDC Split Type:

Write-up: sx started approx 7 minutes after vaccine. C/o itching left hand spreading to bl arm and lower ext Wheal on left foot under chin, felt heart race. Denies shortness of breath, denies chest pain, denies palpitations.


VAERS ID: 1750594 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Headache, Malaise, Pain, Pyrexia, Rash, Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: None
Preexisting Conditions: Asthma, crohns
Allergies: Keflex, azithromycin, dilaudid
Diagnostic Lab Data: Have not sought medical attention at this time. I am a nurse myself, If condition worsens or do not improve in 24 hrs will seek medical attention
CDC Split Type:

Write-up: Full body Rash starting at 7pm 9/30/21- small reddened and slightly raised. Covering entire skin in close proximity. (Febrile to 101.2 at 0530, full body aches/generalized malaise, headache, and slept all day.)


VAERS ID: 1750830 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-17
Onset:2021-09-30
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: None
CDC Split Type:

Write-up: Dizziness and spinning suddenly while lying in bed. Woke up to feeling off severe dizziness. Mildly nauseous as well. Persisted as light headedness and mild dizziness through the day. Blood pressure routinely checked and normal. HR normal. No fever. No recent head trauma. Never had this before. No new or different foods in prior days.


VAERS ID: 1750841 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Pain, Pruritus, Skin reaction, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid Jardiance Metformin Glipizide
Current Illness: None
Preexisting Conditions: Thyroid cancer Diabetes
Allergies: Sulfa drugs Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large red, raised area. Itchy. Arm numb. Very painful.


VAERS ID: 1752829 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Abdominal discomfort, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall (40mg)
Current Illness: NO
Preexisting Conditions: NO
Allergies: NKA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: second vaccine: Severe dizziness, nausea, gastro upset first vaccine: muscle weakness, dizziness, nausea


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