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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 59 out of 8,010

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VAERS ID: 1752836 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-01
Onset:2021-09-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Extra dose administered, Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Spironolactone 25 mg Alprazolam 2MG Vitamin D3 125 mcg Atorvastatin 20 mg Venlafaxine HCl Er 37.5 Mg Omeprazole 20 mg Amlodipine Besylate 5 MG
Current Illness: none noted
Preexisting Conditions: high blood pressure high cholesterol
Allergies: none noted
Diagnostic Lab Data: none noted
CDC Split Type:

Write-up: I had my 3rd Moderna vaccination on Monday, October 27, 2021. Tonight (9/30/21) around 8 pm I noticed a smooth red patch on my vaccinated arm. It was not hot to the touch, it did not itch and it was not raised. Now at 11:30 pm if appears to be "spreading/growing" in size. It is be down from the vaccination site and is starting to circle the upper arm and has some "burning"......still not particularly warm to the touch, or raised. It has not reached the inside of the arm. At what may be the injection site (I can''t see that part of my arm) is a raised "bump". I did 1.5 hours of exercise with weights (working with a trainer).....so I have used the arm all day, without difficulty or pain. On Tue/Wed after the shot, I did experience significant "chills" which I treated with hot showers and Tylenol/Advil (alternating).


VAERS ID: 1752837 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoacusis, Nervousness, Sensation of blood flow, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 18:10- patient vaccinated and at 18:14 patient states that he got a rush feeling to the head, hearing is going out, and shaky. At this time we laid out the yoga mat and transferred patient from chair to mat and immediately elevated his legs. Vital signs at 18:15 SP02 98%, HR 55, BP 100/62, diaphoretic. He couldn''t respond for the first 20 seconds, but then said he felt much better and can see and hear fine again. Water bottle provided. At 18:20, vital signs: SP02 99%, HR 65, BP 114/60 RR 16. At this time he states he feels like he can sit on a chair, but we had him sit against the wall on the yoga mat. He stated he could use a snack and small bag of gold fish provided. He requested to sit on a chair, so we slowly stood him up and sat him on a chair. He said he felt "normal again" and we requested to stay an additional 15 minutes after to ensure he did not experience another adverse reaction. 18:30 Vital signs at 18:30, SP02 99%, HR 88, RR 18, BP 118/75. 18:35, patient requested to go home since he feels fine.


VAERS ID: 1752843 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-27
Onset:2021-09-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

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

Write-up: Redness on arm, slight itching


VAERS ID: 1752845 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 AR / 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: N/A
CDC Split Type:

Write-up: Medical Assistant accidentally gave patient a dose from a Janssen vial that was no longer viable. Vial was initially punctured on 9/29/21, and thus should not have been used today (date of service was 9/30/21). Medical director did call and speak with patient. Patient is aware that she was given a Janssen dose that was no longer viable. Patient denied adverse effects at time of this call between patient and medical director.


VAERS ID: 1752847 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site pain, Injection site swelling, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Statin, met formal, melatonin, zanax
Current Illness: None
Preexisting Conditions: Pre-diabetic, high lipids
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Developed moderate fever and whole body muscle sore as well as fatigue after about 10 hours of getting both the third (booster) dose of the Moderna Covid vaccine (left arm) and flu vaccine (right arm). Also significant red swelling and pain at the injection site of Covid vaccine, but the flu vaccine injection site has minimal redness/pain. Took 2 aspirin around 12:30 mid night and fever continued (not getting worse ) about an hour after taking aspirin pills.


VAERS ID: 1752864 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Discomfort, Eye irritation, Fatigue, Headache, Musculoskeletal pain, Nasal congestion, Pain, Pain in extremity, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Corneal 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: Probiotics
Current Illness: None that aware of
Preexisting Conditions: Heart murmur
Allergies: Not that aware of
Diagnostic Lab Data:
CDC Split Type:

Write-up: Became extremely tired a few hours after administration of the Jansen. At approximately 12am, 10/1, I was woken up w body aches, headache, stuffy nose, sore left arm & sore shoulder blade, burning eyes, inability to sleep due to overall discomfort.


VAERS ID: 1752865 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest pain, Dyspnoea, Eye pain, Fatigue, Injection site nodule, Malaise, Pain, Pain in extremity, Pyrexia, Rhinorrhoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Have not taken any
Current Illness: None
Preexisting Conditions: Back injury palliative care Covid 19 recovery ( February 2021 thru May 2021 out of work) ; still in active , treated recovery
Allergies: None
Diagnostic Lab Data: Too sick to seek treatment yet , reported to primary physician and pharmacy where shots received Had similar reaction on 1st dose which took 5 days to resolve 2nd dose problems materialized more quickly with symptoms being greater in intensity
CDC Split Type:

Write-up: Sudden onset right arm pain, runny nose, knot at injection site, body aches, fever, shortness of breath, wheezing , sore eyes / eye pain; weakness, extreme fatigue , chest pain


VAERS ID: 1752998 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cough, Dysarthria, Hot flush, Migraine, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever, chills, migraine, hot flashes, slurred speech all night after receiving dose. Next morning deep, painful cough.


VAERS ID: 1752999 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ715AB / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Incorrect dose administered, Product preparation issue
SMQs:, Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, atenolol, dulcolax, fenofibrate, lasix, PRN neurontin, glimepiride, ketoconazole cream, lisiniopril, lovastatin, metformin XR, PRN nitroglycerin, omeprazole, zofran, K-dur, flomax, kenalog cream, maxzide
Current Illness:
Preexisting Conditions: chronic DM, HTN, HLD, neuropathy, back pain
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was erroneously given undiluted vial of Pfizer COVID vaccine, equivalent to 5-6 doses. Was monitored in clinic for 1.5 hours afterward with stable q15m vitals. Patient felt clammy but otherwise no side effects.


VAERS ID: 1753000 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Chest discomfort, Chest pain, Dysphagia, Dyspnoea, Eye swelling, Injection site erythema, Injection site pruritus, Injection site swelling, Mouth swelling, Pruritus, Rash, Swelling face, Swollen tongue, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Itching at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash (specify: facial area, extremeties)-Severe, Systemic: Allergic: Rash Generalized-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Systemic: Chest Tightness / Heaviness / Pain-Severe, Additional Details: pt had vaccine rxn about 20 min after receiving moderna. itching then swelling, then hives, asked for epi I called 911, Watched pt but she went pale and said had difficulty breathing. gave epinepherine 30 mins after vaccine. ambulance came and took her to hospital.


VAERS ID: 1753002 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-23
Onset:2021-09-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products
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: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident received Moderna on 9/23 and Janssen on 9/30


VAERS ID: 1753004 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Medium, Additional Details: Patient was sitting upright then fell over to floor unconscious for 5 seconds, he slowly recovered Paramedics checked on him but he didn''t want to go. He was fine


VAERS ID: 1753007 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Crying, Dizziness, Injection site pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Abdominal Pain-Medium, Systemic: Dizziness / Lightheadness-Medium, Additional Details: Patient recieved the vaccine and said it hurt when she got the injection and was crying. Patient was with her mom. Patient requested to go to the bathroom and her mother went with her. Patient then stated she was dizzy and laid down. After a few minutes patient stated she was feeling better and sat in a chair. After a few more minutes the patient went home with her mother. Rph talked to mom and told her to have patient seen by a doctor if symptoms progess or get worse.


VAERS ID: 1753023 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium


VAERS ID: 1753026 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Incorrect Reconstitution-


VAERS ID: 1753028 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Incorrect Reconstitution-


VAERS ID: 1753031 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1753032 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 OT / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Hypertension, Lethargy, Vaccine positive rechallenge, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Hypertension (narrow), Optic nerve disorders (broad), Lens disorders (broad), Retinal 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: Systemic: Confusion-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Hypertension-Medium, Systemic: Visual Changes/Disturbances-Medium, Additional Details: PT AND HUSBAND HAD WARNED THAT PT HAD SAME ADVERSE EVENT DURING 1ST AND 2ND PFIZER DOSES AND NOTHING DONE IN ER DURING EPISODE. SAID PER DR BENEFIT OUTWAY RISK AND PT TYPICALLY RECOVER AFTER 4 HOURS OF LAYING IN THE BED. AT 4:25PM 2MINS AFTER SHOT PT BECAME VERY LETHARGIC, BUT AOX3, BP 162/107, HUSBAND SAID SIMILAR REACTION AS BEFORE. INSISTED BETTER TO TAKE PT HOME TO BED LIKE BEFORE. ASSISTED PT WALK X2 TO CAR. AT 6:24PM CALL SPOKE WITH HUSBAND SAID PT RECOVERING MUCH FASTER THAN BEFORE.


VAERS ID: 1753033 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fever-Severe, Additional Details: Husband called while driving home to report his wife called and said she is having a high fever of 105-106 degrees F. Asked if taken any acetaminophen or any other fever reducer. Reports she has taken ibuprofen and fever hasn''t been coming down. Advised to take her to urgent care or emergency room. Advised could call Urgent Care to talk to nurse triage so they can let him know where it is best for her to be seen for the fever. Advised on giving acetaminophen if possible now.


VAERS ID: 1753036 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Feeling cold, Headache, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes under left armpit. Bad headache Joint pain Muscle pain Chills but no fever Tired


VAERS ID: 1753042 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-09-30
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
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: COVID+ test on 9/30/21
CDC Split Type:

Write-up: vaccine breakthrough event


VAERS ID: 1753228 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Incomplete course of vaccination
SMQs:, Medication errors (narrow)

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

Write-up: PATIENT RECIEVED COVID (PFIZER) VACCINE FOR THE FIRST DOSE ON 12/23/2020 (LOT EJ1685)


VAERS ID: 1753232 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hypoaesthesia, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: I will my 2nd vaccine on 9/29/21 my symptoms started on 9/30/2021 around 6:30pm having Muscle pain, light headed, headache, numbness on my right side and nauseated but the nausea has gone away now. I have been eating soup and drinking a lot of fluids.


VAERS ID: 1753239 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort, Confusional state, Diarrhoea, Fatigue, Migraine, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 1000mg Black seed oil gel capsules Elderberry gummy
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/a
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Diarrhea, queasy feeling in stomach, migraine headache, body aches, tightness in chest, fatigue and feeling confused


VAERS ID: 1753240 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-05
Onset:2021-09-30
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Coronavirus 2 PCR Detect, V Asymptomatic POSITIVE
CDC Split Type:

Write-up: COVID+ found incidentally when present for an appt


VAERS ID: 1753241 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Injection site pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin Diclifenac Losartan
Current Illness: None
Preexisting Conditions: Blood pressure Cholesteral Arthritis
Allergies: None
Diagnostic Lab Data: None. Phone call to my doctor. The reaction issues faded the same day they started, after app. 12 hours.
CDC Split Type:

Write-up: Sore arm at site of injection Mild fever Difficulty breathing


VAERS ID: 1753243 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Lymph node pain, Vomiting
SMQs:, Acute pancreatitis (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: Prenatal, b6,b12, unisom
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, augmentin, promethazine, blue dye, Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache within 12 hours, Sore groin lymph nodes, throwing up 48 hours after injection


VAERS ID: 1753257 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-25
Onset:2021-09-30
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dizziness, Fatigue, Presyncope, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic, POSITIVE.
CDC Split Type:

Write-up: Dizziness, fatigue, cough, and COVID positive on 9/30/21. The patient is a 72 yo male who presents with dizziness and COVID 19 infection. Comorbidities include HTN, hyperlipidemia, prostate cancer s/p radiation (completed May 2019 followed by androgen supression therapy completed Oct 2019, last PSA <0.1 on 5/10/21), peripheral neuropathy, depression, anxiety, and prior ischemic stroke (Oct 2020, no residual deficits) with left carotid artery occlusion s/p right carotid stent placement on 11/2/20. Prior COVID 19 vaccine (Pfizer) completed on 2/24/21. Patient presented to ED due to episode of near syncope earlier today. Patient reported feeling tired, having a cough, and had planned to have a booster dose of vaccine but has not been able to do it yet. While walking to the bathroom this morning, he felt dizzy, had to lower himself to the floor, was diaphoretic, and slow to respond. During this episode patient denied any chest pain, shortness of breath, palpitations, loss of consciousness, and seizures.


VAERS ID: 1753260 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Oropharyngeal discomfort
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: prednisone, vit C, flonase, nucala
Current Illness: none
Preexisting Conditions: Churg-Strauss
Allergies: cefdinir, rituximab
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 48 yo female with PMHx Churg-Strauss and allergy to rituximab, now with vaccine reaction. Pt with remote h/o rituximab reaction p/w throat swelling, itching, wheezing. Infusion d/c''ed and pt given medication. Since then, has been treated with nucala w/o issue. Has h/o multiple food reactions, suspected sulfite sensitivity. Pt was seen by her allergist, who cleared her for the COVID vaccine as she tolerates nucala (which has polysorbate 80 as well). Today, pt was given the Pfizer vaccine at 5:30 PM, and within 15 minutes felt LH and vague throat discomfort. Denies throat closing or itching. +LH but does not feel like she will pass out. No vertigo. No face/tongue/lip swelling/itching, stridor, wheezing, SOB. No CP, palp, diaphoresis, N/V, abd pain, diarrhea. Pt given benadryl 50 at 6:05 PM with some mild improvement. Pt also on chronic daily steroids, which she took this AM. VS: T 98.2, HR 80s, R 16, BP 150s/90s, SaO2 99% RA. Gen: WDWN HEENT: NCAT, sclera anicteric and w/o injection, MMM, OP clear. Neck: supple, good ROM CV: RRR, S1, S2. No m/r/g Pulm: CTAB. No wheezes or crackles. No stridor Abd: S, NT, ND. NABS. No rebound or guarding Extr: no c/c/e Skin: no rashes Neuro: A&Ox3. No focal deficits A/P: 48 yo female with PMHx Churg-Strauss and allergy to rituximab, now with vaccine reaction, p/w vague throat discomfort and LH. No e/o anaphylaxis, however as sxs persist despite benadryl (and pt on baseline steroids), feel that pt warrants prolonged observation that cannot be done in clinic. Monitor for s/sx anaphylaxis, epipen if develops. EMS called and pt transported to the ED. While in ER, pt given dex IM, monitored for a few hours and discharged with instructions to f/u with her allergist.


VAERS ID: 1753261 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Migraine, Myalgia, Pain, 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:
Other Medications: Singular 10 MG daily, Zertec daily and flonase daily.
Current Illness: No
Preexisting Conditions: No
Allergies: NKA
Diagnostic Lab Data: N-A
CDC Split Type:

Write-up: Fever 101.1, chills, body/muscle aches and migraine.


VAERS ID: 1753268 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-09-30
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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: Patient received Pfizer vaccine with 1st dose on 03/11/2021 and 2nd dose on 04/01/2021 Per ED Note: Patient is an 83-year-old male with past medical history coronary artery disease and coronary artery bypass graft, diabetes mellitus, hyperlipidemia and hypertension presenting to emergency department chief complaint of difficulty breathing. Patient states that his symptoms began approximately 1 week ago and subsequently tested positive for COVID-19 viral illness. He denies any associated chest pain. He states that the shortness of breath has been worsening since the onset of symptoms and is constant, no significant improvement at rest. He is not normally on home oxygen. Patient denies fever, chills, headache, blurry vision, nausea, vomiting, diarrhea, chest pain, abdominal pain, numbness, weakness or tingling in his extremities.


VAERS ID: 1753274 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3188 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same soreness
Other Medications: Diabetes & Cholesterol meds
Current Illness: none
Preexisting Conditions: Diabetes & Cholesterol, Heart attack years ago
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness (slight) at injection site


VAERS ID: 1753286 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lethargy, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer #2 on 3/12/2021: Chills, body aches, severe headache, lethargy (age 70)
Other Medications: Multivitamin, Bupropion, Probiotic
Current Illness: N/A
Preexisting Conditions: HBP, PsA
Allergies: Penicillin, Tetracycline, Sulfas
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Arm pain, muscle aches, lethargy all lasting ~24 hours


VAERS ID: 1753292 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF25807 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Body aches and headache
Other Medications: Zoloft Imitrex Zofran Allegra Amovig Omeprazol
Current Illness:
Preexisting Conditions: Migraines
Allergies: Codeine Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: High Fever, body aches, headache nausea and diarrhea All symptoms lasted about 36hours


VAERS ID: 1753295 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ATORVASTATIN; ZOLPIDEM; LOW DOSE ASPIRIN
Current Illness: None
Preexisting Conditions: High Cholesterol
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Pfizer LOT FF2589, EXP: 03/31/2021, Date Given 09/30/2021, Given 6 months after expiration. Is this dose still effective.


VAERS ID: 1753296 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Fatigue, Headache, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Extreme body aches and fatigue. Headache, leg and low back pain. Nausea.


VAERS ID: 1753297 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / UNK LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: warfarin, simvistatin, metpropol, vitamin D, calcium, Bayer 81mg
Current Illness:
Preexisting Conditions: Aortic valve and ascending aorta replaced
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, chills, and headache


VAERS ID: 1753298 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-14
Onset:2021-09-30
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: positive covid test 09/30/21 in vaccinated pt w/symptoms


VAERS ID: 1753313 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor Emgality
Current Illness: None
Preexisting Conditions: Migraines Depression
Allergies: No allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever up to 102.0, extreme body aches, fatigue, nausea, vomiting---12hrs post injection that persisted for 36 hours.


VAERS ID: 1753327 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: na
Preexisting Conditions:
Allergies: At time of vaccination patient declined any allergies or history of reaction to vaccines, After the patient received her dose and stared to develop redness/itching of her chest, she stated that she might have gotten slightly itchy with her second dose of pfizer vaccine. Later she said she also sometimes gets itchy after eating eggs.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient got her pfizer vaccine and developed redness and itching on her chest 15 minutes after. She said her face felt slightly itchy as well. She was given 2 tablets of diphendydramine 25 mg. Her symptoms did not progress. She was monitored for a half hour then returned home. No addition medical intervention was given.


VAERS ID: 1753331 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Insomnia, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, headache, sleeplessness Noticed symtoms the morning following vaccine and they subsided around 36-48 hours after


VAERS ID: 1753332 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 AR / IM

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

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

Write-up: Fever began on 9/30/2021 at 0426 of 99.4. Throughout the day of 9/30/2021 continually increased to 103.0 at 2120. Given tylenol and fever has subsided. 10/1/2021 at 0823 98.1.


VAERS ID: 1753337 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 - / -

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

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

Write-up: Patient had a n episode of syncope approximately 10 minutes after injection. Evaluated and released


VAERS ID: 1753338 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Influenza like illness, Pain
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu like symptoms. Total fatigue, head felt thick or foggy, aching all over


VAERS ID: 1753339 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Differential white blood cell count, Electrocardiogram, Feeling cold, Fibrin D dimer, Full blood count, Headache, Injected limb mobility decreased, Metabolic function test, Myocardial necrosis marker, Palpitations, Red blood cell sedimentation rate
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins.
Current Illness: Covid on 09/06/2021
Preexisting Conditions: Athsma
Allergies: None
Diagnostic Lab Data: Basic Metabolic Panel. Card ENZ CBC with differential. D-Dimer Differential Erythrocyte sedimenation rate ECG DIAG-Portable Chest Doctor confirmed all results were good.
CDC Split Type:

Write-up: I had trouble all day. In the morning, my shoulder where the shot was administered, I couldn''t lift my 19 month old out of her crib. Checked my heart rate, and it was at 130 with O2 at 97%. Shoulder then got better throughout the day, but then my knees felt like they were 87 years old. I had a major headache all day and felt like I was having an asthma attack all day as my chest was tight. After I went to a doctor visit (heart rate at 115 and O2 at 96%), I came home, sat on the couch and picked up my youngest daughter and my heart started racing. I felt cold and was wanting to sleep. I put my daughter down and checked heart rate - 150 and O2 at 96%. I felt like I was working out, but was not moving at the time. This lasted for 20 or so minutes and had to call ambulance. On the way to hospital, heart rate flucuated from 120 to 95. Again, not doing anything except sitting in the ambulance. At the moment, my heart rate has been at a steady 100-110. Before, my resting heart rate was 60.


VAERS ID: 1753343 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 RA / IM

Administered by: Pharmacy       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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came into pharmacy and said he needed a covid shot. RPh and pt spoke about each one and together they decided on Janssen. No problems with administration and no side effects afterwards. Once we logged dose into the system, we saw pt had moderna 1st dose 1/15/21, 2nd dose 2/12/21 and a 3rd dose 3/5/21. Pt had no knowledge of these shots, no white card and these were not given at our pharmacy. Notified pt and daughter of extra dose. Pt has memory problems per daughter, but is still allowed to drive and appears to be cognitively intact when we spoke to him. No adrs reported. Pt more then adequately vaccinated.


VAERS ID: 1753350 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-10
Onset:2021-09-30
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Asymptomatic COVID-19, Balance disorder, Computerised tomogram head normal, Fall, Pain, Pain in extremity, SARS-CoV-2 test positive, X-ray limb normal, X-ray of pelvis and hip normal
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), 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: Hypokalemia Non-ST Elevation Myocardial Infarction
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V asymptomatic POSITIVE
CDC Split Type:

Write-up: CHIEF COMPLAINT Patient is a 77 y.o. male who presents after being found down. HISTORY OF PRESENT ILLNESS Patient is a 77-year-old male with past medical history significant for hypertension, hyperlipidemia, diabetes mellitus type 2 who suffered a fall resulting in a prolonged period down before being brought to the ED on 09/29/2021. Patient reports that he was using a weed whacker in the front lawn when he unexpectedly fell. Patient was unable to get up secondary to weakness and pain. Patient believes that he was down for approximately 8 hours before being found by son and brought to the emergency department. At presentation, patient reported profound pain in his leg. No evidence of fracture on lower extremity or pelvis x-ray. CT head unremarkable. Patient states that he has been falling more frequently over the past 6 months; approximately 2 times per month. However, he states that he fell 3 times in the 24 hour period prior to presentation. Patient denies loss of consciousness or presyncope. He states he merely loses his balance prior to each fall. This typically occurs with extended periods of exertion, such as walking long distances. Patient describes himself as healthy but deconditioned due to limited exercise over the course of the past year as result of COVID related restrictions.


VAERS ID: 1753355 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Lethargy, Photophobia, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Colace 100 mg 1 tab daily at bedtime Atorvastatin 10 mg 1 tab at bedtime Levothyroxine 75 mcg 1 tab q am MONTELUKAST 10 mg 1 tab by mouth daily Albuterol sulfate 90 mcg 2 puffs every 4 hours as needed Triamterene/hydrochl 37.5-25 m
Current Illness: NA
Preexisting Conditions: Hypertension, history of kidney stones, bronchitis/asthma, cervical spine stenosis
Allergies: : Colophony Bacitracin Chlorhexidine adhesive tape pine nuts and cinnamon
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Left upper shoulder redness, warmth, swelling and itchiness. Complains of lethargy and sensitivity to light.


VAERS ID: 1753357 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753359 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Injection site pain, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (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: Valum, Vitamin D, Contriton, Glucosimine
Current Illness: None
Preexisting Conditions: Arthritis, Osteoporosis, Brittle bone disease
Allergies: Osteo medciation, statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness at the injection site. Discomfort in the lymph node and the right arm pit. Increase in discomfort throughout the evening. When palpatated the area, could feel swelling of the lymph nodes and under right arm pit. Swelling has gone down, but not completely gone. Treated with warm compresses and one dose of Advil.


VAERS ID: 1753360 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753364 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753366 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753367 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-16
Onset:2021-09-30
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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: PMHx significant for Interstitial lung disease/pulmonary fibrosis followed outpatient by doctor, Chronic respiratory failure on 2L O2, hypothyroidism, PMR on chronic steroids who presented to the ED with complaints of increased cough, shortness of breath x2-3 days, she is positive for COVID-19.


VAERS ID: 1753368 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753371 (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: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

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: 1753372 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753374 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753377 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / UNK RA / SYR

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: 1753379 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753383 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

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: 1753384 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753385 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753386 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753388 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

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: 1753389 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Has seen allergist and was prescribed medication, because of reaction to 1st covid vaccine she had previously had
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: EE has had a previous reaction to the 1st covid vaccine she received, was told to go see her PCP or provider about getting the 2nd dose. She did so and was given instruction, she received the 2nd dose and had this reaction BP 127/90, abnormal for her she states to number is always between 101-107. had hives facial swelling, fatigue


VAERS ID: 1753390 (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: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753391 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753392 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753393 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753395 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

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: 1753396 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753399 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753401 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753402 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753405 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

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

Write-up: RECEIVER IS UNDER 18 YEARS OLD


VAERS ID: 1753406 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753408 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / UNK - / -

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1753410 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753411 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753417 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753421 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753426 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753433 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753435 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

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: 1753439 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

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: 1753443 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753446 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753450 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-12
Onset:2021-09-30
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fatigue, SARS-CoV-2 test positive, Vaccine breakthrough infection
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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ? HIT (heparin-induced thrombocytopenia) ? PAF (paroxysmal atrial fibrillation) ? History of stroke ? Primary malignant neoplasm of right lung metastatic to other site ? Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin
Allergies:
Diagnostic Lab Data: COVID PCR positive on 9/30/21
CDC Split Type:

Write-up: COVID Breakthrough. The patient presented to the hospital on 9/30/21 with fatigue and possible COVID concern "for a few days". Tested positive on 9/30/21 at the hospital. He is on 12L of Oxygen as of 10/1/21


VAERS ID: 1753452 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753457 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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: 1753466 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash, Paraesthesia, Peripheral swelling, Rash, Swelling face, Wheezing
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (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: Lythorone (thyroid)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Getting allergy test10/1/2021
CDC Split Type:

Write-up: Wheezing, red and rash by the injection site, facial swelling , arm swelling right arm, and tingling down my arm and right side and rash throughout body.


VAERS ID: 1753472 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-23
Onset:2021-09-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye pain, Eye swelling, Lacrimation increased, Ophthalmological examination, Periorbital swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Lacrimal disorders (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Eye doctor did a physical exam on 10/1/21. She feels it is a viral-response. No periorbital cellulitis noted and eye itself appears normal.
CDC Split Type:

Write-up: Right eye became sore underneath and a little puffy on Thursday morning, 9/30/21. Friday morning (10/1/21) woke up and eye was nearly swollen shut. Has increased tear production, both under and over eye are swollen. No redness around area.


VAERS ID: 1753473 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-12
Onset:2021-09-30
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

Administered by: Work       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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/30 SARS/COV-2, NAAT Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1753488 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Disorientation, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: none
Current Illness: NO
Preexisting Conditions: NO
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1:32pm - Pt became disoriented for brief moment, diaphoretic. no difficulty breathing , no pain . Transfered to cot , Vitals E/N. Pt given 2 juice boxes , power bar to eat . Initial symptoms resolved in 5 minutes. Patient remained on cot for 30 min . No facial droop , no arm drift , Neg speech . 1:40 B/ P 120/80, P58 ,RR14 spO2 98%. 2:10 Patient assymptomatic . Sat up with no symptoms . Significant other present to drive patient home . Encouraged to call 911 if symptoms return.


VAERS ID: 1753493 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-02
Onset:2021-09-30
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Pfizer on 4/11 and 5/2. Positive on 9/25


VAERS ID: 1753528 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Viva menopause support, Viva positive mental attitude
Current Illness:
Preexisting Conditions: osteoporosis
Allergies: n/a
Diagnostic Lab Data: 9/30 all vitals were noraml
CDC Split Type:

Write-up: dizzy and weak, passed out for a few seconds


VAERS ID: 1753549 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-09-30
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

Administered by: Work       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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/30 SARS/COV-2, NAAT positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1753550 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-27
Onset:2021-09-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 - / 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 in the freezer for 3 weeks, then it was removed to the fridge and administered to patients.


VAERS ID: 1753552 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-09-30
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=59&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No

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