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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 66 out of 8,010

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VAERS ID: 1744706 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Injected limb mobility decreased, Pain in extremity, Syncope, Tremor, Urinary incontinence, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: My daughter woke up around 5:00 am crying for help. I ran to her room where she had collapsed but was conscious. She vomited and lost control of her bodily functions. She peed on herself. She was shaking and asking me to call 911. She was saying she was dying. I ran to get my phone and when I was calling 911 she said she was feeling ok after vomiting. She is better now but the only symptom is she has a sharp pain in her whole arm, not only the point of needle entry. Its hard for her to move her arm and she describes it as "excruciating pain."


VAERS ID: 1744707 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache, Injection site rash, Lethargy, Myalgia, Pyrexia, Sinus congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish Oil, Vitamins - D3, B Complex, E, Glucosamine, Zinc, Magnesium, Turmeric, antihistamine
Current Illness: None
Preexisting Conditions: Seasonal allergies
Allergies: Codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme muscle aches/pain over entire body, severe rash in area of vaccine shot, Fever, Extreme exhaustion/fatigue and lethargy, some loss of appetite, some sinus congestion, head ache [Please note that I was diagnosed with a severe "virus of (then) unknown origin" in November 2019. My doctor tested me for everything known to him at the time and could not confirm what it was. I had ALL of the symptoms of Covid 19 - Loss of taste and smell, high fever, lethargy, severe cough and respiratory congestion, etc. My doctor now confirms that there was extremely high likelihood that it was Covid, although he can not be 100% certain. I suffered lingering after effects for several weeks.]


VAERS ID: 1744710 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (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: Blood in stool and stomach upset


VAERS ID: 1744763 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glucos-Chon-MSM-Ca-C-CtCl-SeCu - Tablet Orally. Vitamin B 12 100 MCG Lozenge 1 cap(s) Orally daily. Atorvastatin Calcium 40 mg Tablet 1 tablet Orally Once a day. Losartan Potassium 50 mg Tablet 1 tablet Orally bid. Carve
Current Illness: Hypertension, Hyperlipidemia, Hypothyroidism, GERD
Preexisting Conditions: Same as above
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient had an appointment for their 3rd dose of Pfizer (booster due to age) but was given the Moderna vaccine mistakenly. Patient has not had any problems with the vaccine so far.


VAERS ID: 1744768 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 RA / IM

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

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

Write-up: Patient presented at the pharmacist window approx 5-10mins after administration and said she did not feel well and felt very hot. She then went limp against the plexiglass and passed out. She came to pretty quickly and was able to talk coherently. She said she was hot and had not eaten anything. I have her cold water, cool compress, crackers. EMS arrived and took over. Before she left patient said she was feeling much better.


VAERS ID: 1744771 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA D53C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: Swore, Chills, Dizziness and weakness


VAERS ID: 1744947 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-22
Onset:2021-09-29
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / IM

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

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

Write-up: vaccine given after expirations


VAERS ID: 1744959 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-23
Onset:2021-09-29
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, COVID-19, COVID-19 pneumonia, Headache, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (broad), Arthritis (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: presented on 9/28/2021 with headache and joint pain for 5 days. Patient is fully vaccinated in February of this year. She is mostly at home, denies recent travels. She goes to her doctor''s appointments regularly. She has underlying liver cirrhosis, Pt says she was in a funeral 10 days ago, crowded and no masks were on.Her husband and son live with her, both asymptomatic but getting tested symptoms got worse she came to the ER and the screen was positive for COVID infection with pneumonia, she denies any shortness of breath. But she noted a pulse oximetry was low while in the ED it has been within normal limits on 2 L of nasal O2.she is now admitted for further management.


VAERS ID: 1744962 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cortizone-10 1 % Ointment 1 application Externally Once a day. Vitamin K 100 MCG Tablet 1 tablet Orally Once a day. Vitamin D (Ergocalciferol) 1.25 MG (50000 UT) Capsule 1 capsule Orally Once a day. Diosmin-Hesperidin-Grape S
Current Illness: Hypertension, Hyperlipidemia, CAD, GERD, CKD stage 3, Edema, Venous Insufficiency of both lower extremities, Transient confusion.
Preexisting Conditions: Same as above
Allergies: Fish Flavor
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient had an appointment for their 3rd Pfizer (booster due to age) but was given the Moderna vaccine mistakenly. Patient had not had any problems with the vaccine so far.


VAERS ID: 1744971 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-26
Onset:2021-09-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / IM

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

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

Write-up: Swollen node in armpit


VAERS ID: 1745028 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

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

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

Write-up: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.


VAERS ID: 1745033 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Immunodeficiency, 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: 1745051 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamins and iron. Had Ydap vaccine on 8/11/21
Current Illness: None
Preexisting Conditions: Smoker- approx 8 cigarettes per day
Allergies: No known allergies
Diagnostic Lab Data: Placental pathology- hemorrhage, organized thrombosis, infarction and adjacent neutrophils intervillositisand focal Villitis, consistent with clinical history of placental abruption
CDC Split Type:

Write-up: Pt had a placental abruption on 9/4/21. She started bleeding at 6 AM. Presented to Medical Center at 649 AM. She was taken for an emergency c/s that morning and a placental abruption was noted. Placental pathology confirmed abruption. She was 33weeks 5 days at delivery.


VAERS ID: 1745067 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

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

Write-up: Light headed, dizzy. EMS attended and cleared patient.


VAERS ID: 1745074 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

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

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

Write-up: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.


VAERS ID: 1745075 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose increased, Blood pressure increased, Pain in extremity, Stress, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 mg tablet atorvastatin (LIPITOR) 10 mg tablet baclofen (GABLOFEN) 10 mg tablet butalbital-acetaminophen-caffeine (FIORICET) 50-325-40 mg per tablet clopidogreL (PLAVIX) 75 mg tablet ERGOCALCIFEROL, VITAMIN D2, (
Current Illness:
Preexisting Conditions: Nervous; Carpal tunnel syndrome Cerebrovascular accident (CVA) due to thrombosis of cerebral artery Chronic pain of right knee Left shoulder pain Stroke (From Hx)Circulatory; Diabetes mellitus with coincident hypertension; Hypertension; Hypertension, uncontrolled Digestive; Class 3 severe obesity in adult; Fatty liver; Endocrine/Metabolism; High cholesterol; Hyperlipidemia (Resolved); 12/21/2017; Pure hypercholesterolemia (Resolved); 06/29/2020; Type 2 diabetes mellitus with hyperlipidemia Immune Allergic Drug-induced lupus erythematosus (Resolved) 01/17/2019 Other Abnormal LFTs Abnormal serum protein test
Allergies: Penicillin G Rash Aspirin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: tongue swelling, arm pain, elevated blood sugar, elevated blood pressure, stress about vaccine


VAERS ID: 1745085 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 filled out an administration form and stated that this was her first COVID-19 vaccine. We talked through the options of Johnson and Johnson and Pfizer and she chose Johnson and Johnson. After her vaccination and while entering data into WIR, it showed that she received one dose of Moderna back in May. I asked her and she confirmed that she had the first dose but missed the second which is why she came in for Johnson and Johnson. I let her know that at this time, we do not have enough data to know how safe it is to mix vaccine so she should carefully monitor any side effects or adverse reactions that she experiences. I also let her know that going forward, she should always let the vaccinator know that she has had both Johnson and Johnson and one dose of Moderna.


VAERS ID: 1745129 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Inflammation on vaccinated arm
Other Medications: Thyroid Medication ( Patient does not know the name )
Current Illness: None
Preexisting Conditions: None
Allergies: Morphine, Codeine, Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 11:41 am, patient states that she is nauseas and lightheaded. Patient is A/OX3. Vitals : BP 178/119, HR 66, Spo2 98%, RR 20. Patient states that she has a headache. Patient given ice pack and water. BP retaken manually 162/74. Patient states she has no double vision , radial pulses are strong, no tingling or numbness in arms. 11: 50 patient is given orange. 11:55 patient nauseas is relieved. 12:04 vitals retaken : BP 176/78, HR 56, Spo2 96%, RR 18. 12;08 pm patient is advised to go to Hospital or Emergency Room because of her high Blood pressure. Patient states that she is ok and does not need medical attention. RN educates on the importance of going to the ER if high blood pressure persists, if patient experiences chest pain, SOB, visual disturbance. Patient understands and verbalized to seek medical assistance at nearest ER if symptoms worsen at home .


VAERS ID: 1745135 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Gait inability, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adempas.
Current Illness:
Preexisting Conditions: Type 2 diabetes, Pulmonary hypertension.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unable to walk, trembling in the hands, fatigue.


VAERS ID: 1745149 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Cough, Injection site pruritus, Injection site urticaria, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: While in observation, pt experienced local site reaction (hives and itching), taken to med eval for further evaluation at 1200, VS at 1205 - BP 120/90, HR 106, RR 26, O2 sat 100 % on room air. Started to experience chest tightness and coughing, hives on legs, given benadryl 25 mg PO at 1213. Pt has season allergies, usually uses an inhaler but did not have it. Lungs were clear, no stridor, no wheezing. Started to feel better, declined further interventions, reviewed with mom any further concerns to call 911 or PCP follow up. VS at 1230 - BP 134/95, HR 94, RR 18, O2 sat 100% on room air. EB, FNP


VAERS ID: 1745152 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

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

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

Write-up: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.


VAERS ID: 1745155 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

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

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

Write-up: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.


VAERS ID: 1745163 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Immunodeficiency, 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: 1745171 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Immunodeficiency, 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: 1745173 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

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

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

Write-up: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.


VAERS ID: 1745197 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: asprin calcium 500mg Chromium-FTF 200 mcg Magnesium 200mg Multi Vitamin Sulfamethoxazole 800mg-trimethoprim 160mg Vitamin D
Current Illness: N/a
Preexisting Conditions: prediabetes osteopenia osteoarthritis
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: At this state there have not been any adverse outcomes. We administered the vaccine incorrectly. The patient received her 3rd Pfizer vaccine without the diluent and received 0.5ml rather than the 0.3mls.


VAERS ID: 1745224 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-30
Onset:2021-09-29
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Blood creatinine increased, Blood potassium increased, Chest X-ray abnormal, Hyperkalaemia, Hypotension, Lung opacity, Pneumonia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN, Diabetes mellitus, type II;
Allergies: NKA
Diagnostic Lab Data: 9/28/2021 chest xray with left hilar opacity, potassium 5.7 and creatinine 2.9
CDC Split Type:

Write-up: Ongoing hospitalization with pneumonia, hypotensive, hyperkalemic with acute kidney injury. Treated with IV fluids


VAERS ID: 1745242 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 - / -

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

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

Write-up: Rash started at injection site, whole back within the first 15 mins of injection. Rash spread to left arm.


VAERS ID: 1745250 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium


VAERS ID: 1745251 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-01
Onset:2021-09-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None.
Preexisting Conditions: None.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started to feel lightheaded and passed out while standing in the kitchen of my home. My daughter was able to ease my fall. I had just taken my usual morning vitamin D and Iron tablet with a class of juice.


VAERS ID: 1745254 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Pharyngeal erythema, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Patient complained of dizziness, itching of throat during observation. Vital signs initiated, patient throat assessed, redness of throat observed. Patient reported slight tightness only when swallowing, no shortness of breath. Patient remained AOX3, denied any SOB, vital signs remained stable, head clinician present during Intramuscular (right Deltoid) administration and confirmed dose. Benadryl administered to patient at 12:48 pm. Observation was extended for additional 50 minutes, Vital signs assessed through out stay. Patient reported dizziness has subsided, patient reported itching of throat has subsided 4 minutes after IM Benadryl was administered. Vital signs WNL. Patient was able to stand up, ambulate on her own. Patient reported symptoms has resolved. Patient left facility at 1:43 pm, in no distress.


VAERS ID: 1745261 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 OT / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 High-


VAERS ID: 1745263 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Nausea, Throat irritation
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
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: 20 YO female presented with getting the 2nd Pfizer vaccine. Pt was identified using two patient identifiers then was administered the Pfizer vaccine in the left deltoid. Pt was told to wait 15 minutes at observation site for signs of a reaction. Pt noted she was feeling light headed, nauseous, with a itchy throat. Pt has no medical or allergy hx.


VAERS ID: 1745265 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / UNK LA / -

Administered by: Private       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: Progesterone birth control pill
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syncopal event


VAERS ID: 1745295 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026021A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure increased, Dry mouth, Hypersensitivity, Lip swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: The patient was sitting after the vaccine in the waiting area and about 15 minutes after he said he had cotton mouth. At that time I observed him and had him drink water. Another 10 minutes passed and he said he still had cotton mouth. I had him take his mask off and noticed his lower lip looked slightly swollen, I had him take a Zyrtec 10mg (he didn''t want benadryl at the time due to drowsiness). He agreed his lip was slightly swollen, he sat down again and we observed him. His blood pressure, pulse and temperature was taken. His bp was elevated 139/98, pulse 90, temp 98. He sat for a few minutes and then checked his bp on our machine it was 144/85 pulse 90. He did not complain of shortness of breath, he did not have trouble breathing, no dizziness. He said his lip seemed about the same maybe a little better. I advised him that it might be best for him to go to urgent care to be evaluated. He agreed and was taken to urgent care. He was seen at urgent care where they decided he did have an allergic reaction/anaphylactic due to swollen lip. His bp and pulse went down according to patient while at urgent care where he was given benadry. They released him with prescriptions for medrol dose pack, hydroxyzine and epipen. He saw Dr at the Urgent Care.


VAERS ID: 1745342 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: left arm pain- pain at injection site with local edema, nausea, lower R and L LQ abd pain with palpation


VAERS ID: 1745373 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Productive cough, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Urticaria, age 37, 03/27/21, Pfizer
Other Medications: Ibuprofen
Current Illness: None
Preexisting Conditions: Obesity (overweight)
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: urticaria (hives/itchiness starting in the scalp and moving down to the neck/arm over course of 1 or 2 hours). General fatigue, some phleghm


VAERS ID: 1745379 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / N/A LA / IM

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

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

Write-up: Patient was given a pfizer vaccine for COVID instead of the influenza vaccine he had wanted/ expected. Patient had previously completed a two dose series of the Moderna vaccine for COVID.


VAERS ID: 1745383 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-09-29
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 UN / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Blood creatinine increased, Blood sodium decreased, COVID-19, Fatigue, Hallucination, SARS-CoV-2 test positive, Urinary tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? 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: CHIEF COMPLAINT AKI HISTORY OF PRESENT ILLNESS Patient is an 85 y.o. female with HTN/HLD, CAD s/p DES x2 (12/2020), atrial fibrillation (not on anticoagulation due to prior GI bleed), HFrEF (EF 32%) carotid artery stenosis, PAD, polycystic kidney disease s/p renal transplant 1998 on cyclosporine/cellcept/prednisone, bilateral renal artery stenosis, cerebral aneurysm s/p repair 2003, who is transferred from a facility for worsening kidney function and potential need for dialysis. Patient was initially admitted to a facility for fatigue/weakness and reported hallucinations, and was found to have AKI and UTI. Creatinine was 0.9-1.2 at baseline, 2.23 on admission, and 2.74 today. Lytes today showed Na 129 and K 5.1. CT abdomen without contrast showed no acute abdominal pathology. US kidneys showed right iliac fossa renal transplant with suggestion of mild hydronephrosis and mild diffuse increased parenchymal echotexture suspicious for sequela of AKI. Foley catheter was placed. Patient was given iv bumex 1mg, but urine output remained poor, and patient was transferred to a different hospital for possible dialysis. Patient was also started on ceftriaxone for possible UTI, and urine culture is still pending. Patient also has increased leukocytosis to 31.7. Note patient had been on bactrim since spring 2021 for UTI prophylaxis. She denies NSAID use or herbal supplementation. Patient is somnolent with decreased attention when she arrived. She is alert and oriented x3. She uses 1L NC at night at baseline. Patient''s bumex dose had been recently increased to 2mg PO in the morning and 1mg at noon.


VAERS ID: 1745389 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 AR / IM

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

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

Write-up: Patient presented stating that he was here to receive his first dose. After being vaccinated it was discovered that he had just received a first does at another location 2 days prior. Patient counseled on the importance of following CDC recommendations for COVID-19 vaccine. He was advised to not take any more vaccines. Patient advised to call 911 if he starts experiencing chest pain, SOB, difficulty breathing or a rash develops all over his body. Patient verbalized understanding.


VAERS ID: 1745402 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown Rx for Thyroid
Current Illness: None
Preexisting Conditions: Thyroid condition (did not specify)
Allergies: Eggs, Fish, beets
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Anxiety, hyperventilating


VAERS ID: 1745411 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 2 LA / SYR

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

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

Write-up: Patient walked in to the Health Department to receive what was supposed to be their first Johnson & Johnson vaccine. They filled out the necessary paperwork, and their immunization record was supposed to be checked for previous COVID-19 vaccination but was missed. The patient then received the 2nd Johnson & Johnson vaccine, and did not report they previously received the first dose. No adverse symptoms were reported.


VAERS ID: 1745415 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Condition aggravated, Extra dose administered, Fatigue, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (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: Fever, chills, headache, fatigue experienced after dose 2 of Pfizer COVID-19 vaccine on 1/19/21. 27 years old at time of vaccine
Other Medications: Luvox, Nexplanon, Wellbutrin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe muscle aches, fever, chills, fatigue, headache


VAERS ID: 1745433 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Nodule, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: I went to bed last night around 11pm (day I received vaccine) with an extremely sore arm. When I woke up around 5am my left arm was still really sore and I have a knot that has appeared on my wrist. Its hurts to touch it. I did not bump, hit, or drop anything on my wrist or do anything that would cause a knot on my wrist. I am not saying that the knot is caused by the vaccine, but I do know that there were no signs prior to me receiving the vaccine of a knot and no visible signs of the knot before bed. I have not been to visit a doctor for evaluation.


VAERS ID: 1745453 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-20
Onset:2021-09-29
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 stated her became red, swollen, warm, and itchy approximately one week after the vaccine. It was described as about the diameter of a standard coffee cup.


VAERS ID: 1745491 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

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

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

Write-up: Pt came to our clinic for covid vaccine on 8/27/21 and filled out form indicating it was her first dose. She returned on 9/17/2021 for second dose. When entering into IRIS we noticed she had Pfizer vaccine on 4/8/21 at another facility. Our Marshallese interpreter contacted patient and she states she did not get a Covid vaccine at that facility. I contacted the facility and they have notes indicating she did indeed come for a vaccine on 4/8/21. So the administration error was that the 3rd dose given to soon but pt states it was only her second. Pt feels fine.


VAERS ID: 1745512 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever and fatigue after Covid dose 2
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Sulfa drugs, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, fatigue, body aches starting with fatigue a few hours after the dose, and fever starting 20 hours after vaccination


VAERS ID: 1745513 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 RA / IM

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

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

Write-up: administered a Pfizer covid vaccine that was outside of beyond use time, vaccine was from the day prior


VAERS ID: 1745515 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D12, lisinopril, flipiZIDE ER 2.5mg ER
Current Illness: None known
Preexisting Conditions: Uncontrolled hypertension, non-compliance with medication regimen, Stage 1 Chronic Kidney Disease, hyperparathyriodism, uncontrolled Type 2 Diabetes with hyperglycemia
Allergies: NDKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received Moderna mRNA vaccine on 6/17. She no-showed to her 2nd dose appointment on 7/15. After attempts to administer 2nd vaccine in clinic, plan developed to administer 2nd dose at her home. The writer of this incident requested a dose transfer from another Harbor site but neglected to indicate that the patient needed Moderna. Pfizer dose was dispensed to home care nurse, who gave it to the patient at 11:00am today (9/29). The patient was observed for 20 minutes by the nurse with no adverse symptoms.


VAERS ID: 1745520 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / IM

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

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

Write-up: Patient''s mother signed her up for Moderna COVID 19 vaccine. I administered Pfizer knowing that patients must be 18 to receive Moderna. In my haste I failed to notify patient''s mother that she was receiving Pfizer instead of Moderna like her consent form requested. I signed COVID card reflecting that patient received Moderna but am certain that the patient received Pfizer. The mother of patient was notified of which vaccine patient actually received and provided with Pfizer Fact Sheet.


VAERS ID: 1745537 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7319MA / 1 RA / IM

Administered by: Public       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: unknown
Current Illness: None
Preexisting Conditions: None
Allergies: mercury products, cilantro
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pfizer vaccine vial was diluted with 0.8cc NS rather than 1.8cc NS. 1 dose was given to this client.


VAERS ID: 1745541 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received booster dose of Covid-19 Pfizer vaccine. Patient was observed in exit area for 15 minutes post vaccination with no complaints. As patient was exiting vaccine clinic, patient reported feeling sweaty and sat down on bench outside. Volunteer alerted public health nurse on site and nurse assessed patient. Patient was given bottled water and granola bar. She stated she felt better after water and snack, said she felt well enough to go home. Public health nurse advised patient to follow up with primary care doctor if she has any new symptoms. Patient was able to leave with daughter who brought her to the appointment.


VAERS ID: 1745561 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 2 LA / IM

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

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

Write-up: At approximately 1200 on 09/29/21 the employee arrived to the clinic. At approximately 1205 the employee was injected with the 2nd dose of Moderna in the left arm. At approximately 1216 the employee reported feeling ?slightly woozy?. At approximately 1217 vital signs were 98.5F, 100%O2, 63 Pulse, 110/82, 12 respirations. At approximately 1220 supervisor was called. Supervisor ordered team to observe the employee longer and to request the employee go home to consult with their personal physician. Strongly encouraged employee to go home and consult with physician. The employee refused to go home stating ?I am able to walk and drive, If I go home now I will be further behind?. At approximately 1230 sitting vitals 99% O2, 54 Pulse, 12 respirations, 110/78. Standing BP 112/80, 66 pulse. No apparent rash or itching was noted, denies breathing difficulties, denies chest pain, denies any medical history. Observed employee until approximately 1235. At this time employee was released back to work. Gait was steady, no difficulties bending over and raising back up. Encouraged employee to call staff if symptoms worsen or don?t improve. Encouraged employee to call 911 immediately if symptoms of anaphylaxis develops. A follow up call will be made between 1500-1600.


VAERS ID: 1745575 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glipizide 10mg, Pioglitazone 15mg. Meloxicam 15mg, Atorvastatin 20mg. Lisinopril 10mg,
Current Illness: nothing we are aware of
Preexisting Conditions: Diabetes Hypertension
Allergies: NKA
Diagnostic Lab Data: None-there was no adverse reaction just error in manufacture used
CDC Split Type:

Write-up: Patient was previously given Moderna vaccine for 1st dose on 2/15/210and 2nd dose on 3/15/21 and was given Pfizer vaccine today in error. Patient was to be given flu vaccine today


VAERS ID: 1745591 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Erythema, Feeling hot, Limb discomfort, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pt c/o anxiouse to needle, 10minute after vaccinated c/o heavyness/shakyness of feet & feeling hot face. Minium assisted by staff to stretcher, monitored v/s were normal limit exsept SBP inceased to 234 to 182, DBP 60 TO 80''s. Tx-benadryl 225mg 1 cap, cold compress on face, offered emotional supports. out come- no more s.sx of above symptoms. Pt''s conditon improved reduced redness on face & no heavy and shaky to feet. D/C''d with daughter, recommended to further exam by PCP or urgent care.


VAERS ID: 1745592 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-22
Onset:2021-09-29
   Days after vaccination:281
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 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:
CDC Split Type:

Write-up: Tested positive for COVID-19 on 9/29/21


VAERS ID: 1745608 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye haemorrhage, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Glaucoma (broad), Retinal 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: n/a
Current Illness: n/a
Preexisting Conditions: n/.a
Allergies: n/a
Diagnostic Lab Data: n/.a
CDC Split Type:

Write-up: Red eye. broken blood vessels in eye


VAERS ID: 1745610 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-01
Onset:2021-09-29
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 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:
CDC Split Type:

Write-up: Tested positive 9/29/21


VAERS ID: 1745617 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043C21A / UNK RA / IM

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

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

Write-up: patient lied and said he wanted a first dose moderna vaccine. he was with his partner who also wanted a first dose . later after billing vaccine it was determined that this patient had already gotten the first and second dose seven months ago


VAERS ID: 1745629 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-01
Onset:2021-09-29
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 RA / IM

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

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

Write-up: Tested positive for COVID 9/29/21


VAERS ID: 1745672 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

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

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

Write-up: Patient received Moderna as first dose and Pfizer as second dose.


VAERS ID: 1745685 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, 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: N/A
Current Illness: Cancer
Preexisting Conditions: Cancer
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given an expired dose a Moderna Covid-19 vaccine. Technician drew up a dose from an expired vial from yesterday. No adverse events reported.


VAERS ID: 1745687 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia oral, Pharyngeal hypoaesthesia
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Takes Zyrtec 10 mg daily and singulair 10 mg daily. History of asthma and multiple allergies.
Current Illness: None.
Preexisting Conditions: Asthma
Allergies: Milk, eggs, apples, dairy, nuts, shell fish and many more.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient complaints of throat, tongue and lip numbness approximately 15 minutes after vaccine. After a stable assessment and stable vitals signs, Benadryl 50 mg po given with noted decreased in symptoms in 30 minutes. Patient monitored another 1 hour after issues. Husband called to pick up patient. Lungs clear, BP 120-130''s/70-80, pulse 70-80''s, res 20-24, Spo2 98-99% o room air. Patient to call Dr. in am, her PCP to updated her and her recommendations of further COVID vaccines. Patient discharged home with husband, to go home. To take additional 50 mg of Benadryl this evening and if any concerns to follow up at . Patient and husband verbalized understanding of the above instructions and treatment plan. CNP


VAERS ID: 1745689 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-21
Onset:2021-09-29
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

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

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


VAERS ID: 1745694 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ligament sprain, Pain, Pyrexia, Syncope, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine 60 mg daily, metformin 2000 mg daily, omeprazole 40 mg daily, levothyroxine 75 mcg daily, propranolol 10 mg bid, gabapentin 400 mg tid, baclofen 20 mg tid, morphine er 15 mg tid
Current Illness: None
Preexisting Conditions: Hypothyroid, PCOS, migraine, chronic low back pain
Allergies: Tramadol, robaxin, benzoyl peroxide
Diagnostic Lab Data: Xray
CDC Split Type:

Write-up: High fever 102.4 max, severe body aches started 9/28/21. Syncopal episode x2 on 9/29/21 and was seen at ER for treatment, had badly sprained ankle from the syncopal episodes.


VAERS ID: 1745707 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

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

Write-up: Severe headache, fever 101, body aches, fatigue lasting about 1 day.


VAERS ID: 1745708 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Headache, Muscular weakness, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: COVID-19 Pfizer second dose. Adverse events were the same as described above.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Gluten
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 09/29/2021 2:00 AM: Onset of fatigue, muscle weakness, general aches and pains, chills, headache, general feeling of weakness, and fever.


VAERS ID: 1745711 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312835 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Loss of consciousness, Retching, 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: torsemide, triamcinolone, sotalol, nadolol, clopidogrel, lisinopril, rosuvastatin, jantoven, metolazone
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none allergy
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received a Pfizer booster shot in his left arm then a fluad in his right arm He then went to stand up and put his sweater back on and he fell over onto the table then he slowly went down to the ground and he collapse maybe a foot and a half off the ground Someone shouted please help I ran out and realized he was unconscious then I said call 911 and checked him tried to get him to respond over realized he was out I performed maybe 2 sets of chest compressions I then saw he was breathing still not responsive The person on 911 was very helpful then patient started to gag he told me to roll him on his side and keep him there then ems came


VAERS ID: 1745720 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure like phenomena, Skin discolouration, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: While pt was sitting in waiting area about 10 minutes after vaccine, pt''s head dropped, she turned grayish, and became unresponsive. After several seconds, she lifted her head and responded to my questions and asked for cold water. I asked for someone to call 911 and an ambulance was dispatched. A technician brought her cold water. She sat for a few minutes, then expressed an urgent need to use the restroom. Her son took her to the restroom. I checked on her a moment later. She said she was doing ok. She came back to the waiting area to wait for the EMTs. The EMTs assessed her and advised her of their recommendations and her options. She was going to go home with her son as the driver. As the EMTs turned to leave, she dropped the open bottle of water, her head fell back and she became unresponsive for a short time. The EMT expressed that this looked like seizure activity. They loaded her on a gurney and headed for the emergency room.


VAERS ID: 1745725 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-27
Onset:2021-09-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FDO809 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ694AB / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood thinners, and unknown
Current Illness: none known
Preexisting Conditions: heart failure
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received a third dose of the Covid vaccine. His first two vaccines were Moderna. On 9/27 he was given a Pfizer additional dose by mistake. He was called and he is having no side effects that are out of the ordinary.


VAERS ID: 1745726 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

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

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

Write-up: PT DEVELOPED A RASH IN EACH ARMPIT. PT SAID RASH WAS BURNING. THE RASH WAS CIRCULAR WITH THE CENTER NOT INVOLVED. RASH LOOKED DRY A LITTLE SCALY. PT STATED SHE HAD NEVER HAD THIS RASH BEFORE. PT DID NOT SEEK MEDICAL TREATMENT.


VAERS ID: 1745728 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / SYR

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

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

Write-up: PATIENT CAME INTO PHARMACY TO GET A FLU SHOT, PRESENTED IMMUNIZING TECHNICIAN WITH HER COVID CARD AND TECHNICIAN GAVE HER A 3RD DOSE OF PFIZER (PATIENT HAD FIRST 2 DOSES OF MODERNA WITH LAST DOSE BEING 5/2021)


VAERS ID: 1745742 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Tinnitus in ears


VAERS ID: 1745746 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D , biotin ,probiotic, melatonin methotrexate, beta met ozone
Current Illness:
Preexisting Conditions: psoriasis asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Really bad headache and low grade fever that has lasted all day


VAERS ID: 1745757 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Injection site pain, Maternal exposure during breast feeding, Nipple pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Lipodystrophy (broad), Neonatal exposures via breast milk (narrow), Sexual dysfunction (broad)

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

Write-up: Currently breastfeeding. 45 min after dose started feeling pain in right breast/nipple. Upon returning home it?s been very painful nursing on right side. Significant pain in left arm at injection site


VAERS ID: 1745762 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-01
Onset:2021-09-29
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: I have a headache. I?m not sure if it?s from the vaccine or bc of u/dsta1997?s idiotic comments.


VAERS ID: 1745763 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-01
Onset:2021-09-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062G20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: NA


VAERS ID: 1745768 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pharyngeal paraesthesia, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient reported tingling feeling in her throat and slight swelling of tongue with similar effect from seafood allergic reaction she had ten years ago. Patient alert and oriented, vital signs 135/83, pulse 64, O2 98%, 1525 administered benadryl 50mg IM to right deltoid. Patient tolerated it well. Patient resting in gurney monitored for 30 minutes she then stated she felt better bp 129/87, pulse 54, o2 100%. No respiratory distress noted. Patient denies swelling of tongue, throat closing and any other symptoms. Advised patient if symptoms worsened contact ER or 911.


VAERS ID: 1745769 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-26
Onset:2021-09-29
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aspiration pleural cavity, Blood test, Computerised tomogram thorax, Echocardiogram, Joint swelling, Pulmonary oedema, X-ray
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omprazole Atorvastin Levothroxine Metformin
Current Illness: None
Preexisting Conditions: None
Allergies: Wellbutrin
Diagnostic Lab Data: 9/8 thru 9/10 in hospital Eco , Blood work, CT of chest, x raysf
CDC Split Type:

Write-up: This is a follow up from previous report, I was Hospitalized for 3 days due to joint swelling in both hands and wrists, both knees, and both shoulder blades, Also had fluid in left lung, fluid was removed at Hospital , I have been on prednisone since my release from hospital


VAERS ID: 1745926 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30125BA / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ702AB / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Flushing, Muscle spasms
SMQs:, Anaphylactic reaction (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine 20mg metformin 1000mg glimepiride 4mg losartan/hctz 100-25
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was administered a booster Pfizer vaccine and a FluHD both in right arm due to a mastectomy on her left breast. The doses were administered 1 inch apart in her right deltoid muscle. The patient was fine initially but when she was out sitting for her 15 minute interval she began having low back spasms, was having difficulty breathing and was feeling flush. 911 was called as well as Code White. I sat with the patient and got her a bottle of water. By the time paramedics arrived her breathing had returned to normal and the flushing in her face went down and the back spasms subsided. The paramedics took her blood pressure and oxygen level. The patient did not want to go to the hospital and left the store on her own.


VAERS ID: 1745928 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hashimooto?s thyroiditis
Allergies: Cinnamon, latex, steroids, opiates
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Systemic hives


VAERS ID: 1745935 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-30
Onset:2021-09-29
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

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


VAERS ID: 1745938 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 LA / IM

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

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

Write-up: Patient received 3rd dose Pfizer/Comirnaty dose too early. Last dose reported by patient was 6/24/2021, next dose should have been due 12/24/2021 per current guidelines. Patient aware and no current effects noted.


VAERS ID: 1745943 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / UN

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

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

Write-up: NONE


VAERS ID: 1745953 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

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

Write-up: Patient received 3rd dose too early. Last dose noted 4/16/2021, should not have been due for 3rd dose until 10/16/2021.


VAERS ID: 1745973 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-29
Onset:2021-09-29
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test normal, Chills, Erythema, Feeling abnormal, Headache, Insomnia, Mechanical urticaria, Pain of skin, Pruritus, Rash, Rash macular, Sensitive skin, Skin warm, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: daily birth control pill - sronyx vitamins- vitamin d, c, zinc, probiotic, apple cider vinegar
Current Illness: none
Preexisting Conditions: none
Allergies: oral allergy syndrome.
Diagnostic Lab Data: 9/17- blood taken at ER- nothing abnormal
CDC Split Type:

Write-up: 8/29 3rd dose of moderna vaccine 9/8 Itchy began 9/9 Hives began 9/10 Urgent Care visit (prescribed prednisone for 5 days) 9/12 Followed up with personal doctor. Said could take 4-6 weeks has seen these rashes before. (Prescribed Zyrtec and Hydroxyzine) 9/17 Emergency Room. Skin very sensitive, painful/ bruised feeling to touch plus hives and itchy. Bad headache and chills couldn?t sleep. Felt awful. They administered IV Steroid. Prescribed 5 days of additional steroid, said use Zyrtec and Hydroxyzine if needed. 9/23-24 less rash, hives and itch. Skin tenderness gone. Face puffy, red spots on body and face all day. Taking hydroxezine at night 9/25 continued progress flare ups on leg and hands. Red hot spots flare up. Some itchy some not itchy. 9/26. No tenderness of skin. Flare up in late evening on legs and arms. Hot to the touch, itchy but not too itchy. Using cortisone. Felt good all day. No tenderness on body and face less puffy. 9/27 primary care visit 9/29 continuing to take zyrtec- still have Dermatographia but no skin tenderness- feeling less inflamed.


VAERS ID: 1746143 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

Write-up: itching to face, legs, ears, arms. No hives but getting worse


VAERS ID: 1746145 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-28
Onset:2021-09-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Strange taste in mouth, slightly metallic and bitter after vaccination. Continuing into today with nausea starting just after noon on 9/29/2021. Pain at injection site.


VAERS ID: 1746149 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Loss of consciousness, 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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: BP was take 105/60, and pulse ox (96)
CDC Split Type:

Write-up: Pt was given vaccine, and about 10 minutes, pt passed out. PT was unresponsive for about 60 seconds, breathing strangely. Paramedics were called and pt taken to ER


VAERS ID: 1746152 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: unknown
Current Illness: none
Preexisting Conditions: asthma
Allergies: nkda
Diagnostic Lab Data: EMS assessed vitals
CDC Split Type:

Write-up: patient received booster dose of Pfizer around 6:50PM. Around 7:00PM he starting having chest pain and nausea. This dissipated a few minutes later. EMS was called.


VAERS ID: 1746178 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: BP 120/70, O2 SAT 100%, PULSE 90
CDC Split Type:

Write-up: APPROX 5 MINUTES AFTER RECEIVING 2ND PFIZER (COVID VACCINE) DOSE, PATIENT GOT VERY NAUSEATED, BROKE OUT INTO A SWEAT, AND FELT DIZZY. I CHECKED PATIENTS BLOOD PRESSURE WHICH WAS NORMAL. I PLACED 2 ICE PACKS ON PATIENTS NECK AND FOREHEAD. PT REQUESTED COLD WATER TO DRINK. AFTER ABOUT 15 MINUTES, PT GOT OVER THIS REACTION AND ALL VITAL SIGNS WERE NORMAL..PT LEFT--PT REFUSED ANY EXTRA CARE


VAERS ID: 1746179 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram normal, Malaise, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: BP 97/80.
CDC Split Type:

Write-up: Patient came up to the counter several minutes after receiving his vaccination and stated he was not feeling well. His face was ashen. I sat down with the patient and asked if he had vomitted. He said No, then stated he was not sure as he thinks he lost consciousness for a minute. He denied any shortness of breath, wheezing, or feelings of numbness or enlargement of his lips or tongue. He then stated he felt like he was going to vomit and did. I took his blood pressure and it was 97/80 with a pulse of 80. He said he did not eat lunch today. He said he has vomitted after having blood drawn before but never after receiving a vaccine, he said he had his seasonal flu shot last year. EMS arrived and checked BP and did an EKG. EKG was normal. Patient did not go with EMS.


VAERS ID: 1746184 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30125BA / UNK - / IM

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

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

Write-up: pt denies any symptoms and is showing no reaction to being given the pfizer vaccine in place of moderna


VAERS ID: 1746185 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Patient received an expired dose of the vaccine.


VAERS ID: 1746188 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received an expired vaccine and was offered a re-vaccination.


VAERS ID: 1746189 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Patient was given an expired vaccine and will be offered a re-vaccination.


VAERS ID: 1746191 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Patient received an expired vaccine and will be offered a re-vaccination.


VAERS ID: 1746194 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Fall, Headache, Skin abrasion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt had fell forward and fainted after 8 mins of observation, also stated "has a history of fainting after getting shots" Pt had got an abrasion on nose @ 1758 and immedialtely brought to attention. We treated her with a cold compress, 500 ml water, and cleaned, and put band-aid on abrasion. Pt said she "felt better but still had a headache" initial VS 96/52, 56 HR, and 96 O2. VS before D/C 113/75, 77 HR, 97 O2. Pt was discharged said she felt better.


VAERS ID: 1746195 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

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

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

Write-up: Pt presented for 2nd dose. She was given Pfizer as her 2nd dose and received Moderna as her 1st dose. Pt was informed. CDC and Moderna both contacted. Pt was given her vaccine card with both dose documented. Recommendation is that pt is fully vaccinated and no doses should be repeated.


VAERS ID: 1746197 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Fall, Head injury, Heart rate decreased, Hyperhidrosis, Piloerection, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE REPORTED
Current Illness: NONE REPORTED
Preexisting Conditions: NONE REPORTED
Allergies: PENICILLIN
Diagnostic Lab Data: BLOOD GLUCOSE CHECK 117MCG/DL
CDC Split Type:

Write-up: SYNCOPE OCCURED MORE THAN 5 MINUTES AFTER ADMINISTRATION WHILE PATIENT WAS WALKING, SPONTANEOUSLY RESOLVED QUICKLY. PATIENT WAS SWEATING PROFUSELY AND HAD GOOSEBUMPS, LOW PULSE RATE AT INITIAL EXAM . PATIENT FELL AND STRUCK BACK OF HEAD ON FLOOR SO EXTRA PRECAUTIONS TAKEN BEFORE RELEASING PATIENT. EMS RESPONDED AND EXAMINED PATIENT WHO WAS ABLE TO LEAVE FACILITY ON HIS OWN.


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