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From the 11/26/2021 release of VAERS data:

Found 908,208 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 7 out of 9,083

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VAERS ID: 1893693 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-19
Onset:2021-11-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 2 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest discomfort, Chills, Painful respiration, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Panadol half and hour before
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin
Diagnostic Lab Data: I do not have a medical plan and the Doctor I had for 15 years when I had a plan rejected me for being diagnosed with COVID-19 on August 2, 2021. Although I was asymptomatic.
CDC Split Type:

Write-up: After the vaccine during the day Sunday I started to feel chills, without fever. During the day a strong pressure on chest, reflecting to upper back. During Monday, 22 November of 2021 during work I continue with pressure on chest. Palpitations accelerated and pain on shoulders and upper back, I tried not to breath hard to not feel pain. I currently do not suffer from anything but these symptoms are new to my health.


VAERS ID: 1893699 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-19
Onset:2021-11-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 LA / IM

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

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

Write-up: Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild, Additional Details: Patient reported rash that covers her stomach and back. She also stated that she received the same rash after her first 2 doses as well.


VAERS ID: 1893741 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-18
Onset:2021-11-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / -

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

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

Write-up: localized pruritic papular rash around injection site, along with some scattered rash on face, legs, feet, all pruritic


VAERS ID: 1893780 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855191 / 1 LA / IM

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

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

Write-up: Patient fainted a few minutes after receiving vaccine.


VAERS ID: 1893790 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330268D / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: swelling in arm that started on sunday and spread to hands on Monday night requiring a doctor visit


VAERS ID: 1893809 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Eye pain, Fatigue, Headache, Lymph node pain, Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Very intense headache - top of head and behind the eyes and slight / low-grade fever, tiredness - Sunday evening into Monday morning, swollen and sore lymph node under left arm - Monday and Tuesday


VAERS ID: 1893830 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-11-21
   Days after vaccination:298
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 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: 11/21/21 SARS/COV-2, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1893894 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-17
Onset:2021-11-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone 100mg tablets for acne Kyleena IUD
Current Illness: No illnesses one month prior to vaccination
Preexisting Conditions: No chronic or long-standing health conditions
Allergies: No known allergies
Diagnostic Lab Data: No medical or lab tests have been done
CDC Split Type:

Write-up: I woke up Sunday morning (11/21/2021) at 6:00 AM with a red bumpy rash that was on my lower back that was itchy and painful if I did not itch it. I went ahead and drove to work where it began to spread up my back, and to my arm. Over the last two days (11/22/21-11/23/21) the red rash has spread to my upper back, hips, abdomen, chest, neck, and extremities. I was prescribed a Medrol pack by Doctor on Sunday (11/21/2021) and started as soon as I got it. I have also been taking Benadryl to reduce the amount of spreading, and will also be starting the antibiotic Dicloxacillin when the pharmacy has it in stock (its been delayed due to not being in stock).


VAERS ID: 1893899 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Diarrhoea, Pain
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Body aches, chills, diarrhea


VAERS ID: 1893902 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-15
Onset:2021-11-21
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 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: 11/22/21 SARS/COV-2, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1893904 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-11-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dry skin, Erythema, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pholic Acid, Aspirin, Calcium, Vitamin D, Octvite, Nutrafol
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Pennicillin, Sulfa, Steroids
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 1st dose of Phizer 11/18/2021, started experiencing symptoms 11/21/2021 of soreness in the (left) arm, redness in the left side of the face and neck (dryness). Allergist communications 11/21/2021 recommended over-the-counter Antihistamines and prescribed Hydrocortisone. Symptoms have subsided with dryness of the left side of face and neck.


VAERS ID: 1893934 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-19
Onset:2021-11-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Headache, Migraine
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: Migraines
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Migraine that occured Sunday and Monday. I had a headache Saturday, but this transitioned to a migraine that lasted sunday all day and monday until about 12:00pm


VAERS ID: 1893942 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-11-21
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid positive result 11/21/21
CDC Split Type:

Write-up: COVID Vaccine breakthrough case


VAERS ID: 1893951 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-19
Onset:2021-11-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Migraine
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: Propranolol 20mg twice a day, multi vitamin, benefiber
Current Illness: None
Preexisting Conditions: none
Allergies: codene
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sunday 11/21 had bad headache, Monday 11/22 had bad migraine


VAERS ID: 1894007 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-08
Onset:2021-11-21
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NA / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/21/2021- COVID 19 detected
CDC Split Type:

Write-up: Pt tested positive for COVID with surgical pre-screening, surgical procedure was performed as scheduled. Pt was asymptomatic.


VAERS ID: 1894097 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013FL1A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Fall, Heart rate increased, 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), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: dizzy spells for a few weeks after first Moderna shot (4/5/21, age 43). only normal side effects after Moderna shot #2 (5/3/21,
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: peniciliin
Diagnostic Lab Data: all blood tests came back normal
CDC Split Type:

Write-up: Heart rate double my normal rate even while sleeping, blacked out and fell when I got up. Heart rate persistently above 110 when at rest for 7+ hours, didn?t come down until an ER doctor massaged the vagal nerve, then it dropped to near normal and stayed down.


VAERS ID: 1894145 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hypoaesthesia, Hypoaesthesia oral, Muscle spasms, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

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

Write-up: Patient states that she experiencing, Muscle Spasms, Numbness/tingling sensation in limbs and tongue and face. Headaches, Dizziness.


VAERS ID: 1894146 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration, Mobility decreased, Pain
SMQs:, Parkinson-like events (broad), Drug abuse and dependence (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Zyrtec, Calcium, Vitamin C
Current Illness: none
Preexisting Conditions: none
Allergies: Tetracycline, Clindamycin, Penicillin
Diagnostic Lab Data: Evaluation by DO
CDC Split Type:

Write-up: Patient received Moderna booster on 11/21/21. The vaccine was administered too high and injected into the bursa. Patient complains of extreme pain with range of motion of left arm. No redness or swelling to vaccine site.


VAERS ID: 1894151 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3203080 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Chills, Fatigue, Lymphadenopathy, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever after Pfizer dose #2 but only for 4-6 hours
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Rapid COVID test yesterday, negative
CDC Split Type:

Write-up: High fever next morning 104 degrees, fatigue, chills, loss of taste, swollen lymph under arm lasting three days so far (fever has broken)


VAERS ID: 1894160 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ743AA / 1 RA / 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: Patient was inadvertently given a 0.5ml dose instead of a 0.25 dose


VAERS ID: 1894164 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received Pfizer Covid 19 5-11 year old vaccine (Pfizer 10mcg dose) and not the Pfizer Covid 19 30mcg dose


VAERS ID: 1894174 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 inadvertently given a 0.5ml dose instead of a 0.25 dose


VAERS ID: 1894183 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 inadvertently given a 0.5ml dose instead of a 0.25 dose


VAERS ID: 1894193 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-18
Onset:2021-11-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Haemorrhage, Packed red blood cell transfusion, Premature delivery, Premature labour, Retained products of conception, Ultrasound antenatal screen abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow), Myelodysplastic syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Ultrasounds on 11/17, 11/22
CDC Split Type:

Write-up: EDD 4/11/2022. Patient had normal US on 11/17/21 with cervix long and closed. Patient went into labor starting 11/21 and delivered at 20 weeks 1 day. She had retained products and a hemorrhage, requiring 2 units of PRBCs.


VAERS ID: 1894204 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 RA / 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: Patient was inadvertently given a 0.5ml dose instead of a 0.25 dose


VAERS ID: 1894215 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 RA / 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: Patient was inadvertently given a 0.5ml dose instead of a 0.25 dose


VAERS ID: 1894219 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-11-13
Onset:2021-11-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SC

Administered by: Unknown       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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives


VAERS ID: 1894223 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 RA / 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: Patient was inadvertently given a 0.5ml dose instead of a 0.25 dose


VAERS ID: 1894233 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 RA / 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: Patient was inadvertently given a 0.5ml dose instead of a 0.25 dose


VAERS ID: 1894245 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-01
Onset:2021-11-21
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chills, Cough, Decreased appetite, Diarrhoea, Dry mouth, Dysgeusia, Dyspnoea, Hyperhidrosis, Illness, Myalgia, Nausea, Pyrexia, Sinus congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Iodine, Clonidine, Curad Adhesive Bandages, Keflex [Cephalexin)Premarin [Conjugated Estrogens], Protonix [Pantoprazole], Pyridium [Phenazopyridine], Tramadol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 90 y.o. female with a history of A fib (not on anticoagulation d/t prior GI bleed and chronic Fe deficiency anemia), s/p PPM for tachy-brady syndrome, HFpEF, GERD, ITP and IDA who presents with weakness and cough. She was initially diagnosed with COVID-19 on 11/16 after presenting to facility after a week of coughing and head congestion. She received the monoclonal aby on 11/17. She is vaccinated. She returns today for increasing weakness, ongoing myalgias, chills, fevers, poor appetite, and some shortness of breath. She has not checked a temp at home, but says she sweat through her clothes a few times. She has a dry mouth with a salty taste, which has also been ongoing. She had some diarrhea a few days, but this has resolved. She had some nausea, but this has improved some. She has eaten only oatmeal and had 2-3 glasses of water a day since her initial diagnosis. She has taken Tylenol, but no other OTC meds. She has been taking her prescribed medications as well. She says she hasn''t worn her CPAP in the past few days due to illness.


VAERS ID: 1894246 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 RA / 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: Patient was inadvertently given a 0.5ml dose instead of a 0.25 dose


VAERS ID: 1894251 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 inadvertently given a 0.5ml dose instead of a 0.25 dose


VAERS ID: 1894261 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 RA / 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: Patient was inadvertently given a 0.5ml dose instead of a 0.25 dose


VAERS ID: 1894305 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient was given Pfizer Covid 19 vaccine for 5 to 11 year old (received 10mcg dose and not 30mcg dose)


VAERS ID: 1894475 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-20
Onset:2021-11-21
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NA / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NA / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic 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: PMH/Chronic conditions include seizure disorder, CAD, DM, COPD, trach w/GJ tube dependent.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets criteria for vaccine breakthrough review. SxS - asymptomatic for COVID, incidentally found COVID+ with admission screen for separate issue.


VAERS ID: 1894495 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood urine present, Fatigue, Headache, Incorrect dose administered, Influenza like illness, Myalgia, Product preparation issue, Pyrexia, Renal pain, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (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? Yes
Hospitalized? No
Previous Vaccinations: 4/18/21 Pfizer Vaccine Shot #2, body aches and pains, head ache, fatigue
Other Medications: None
Current Illness: None
Preexisting Conditions: NASH
Allergies: Penicillins, Ranitidine, Azithromycin
Diagnostic Lab Data: Urine test administered on 11/22.
CDC Split Type:

Write-up: Pharmacy called on 11/22 to indicate they failed to dilute the vaccine resulting in a double dose being administered. Confirmed 60mcg was administered instead of the 30mcg. Severe flu like symptoms started at 12:30am on 11/21 and lasted through 11/22 including severe head ache, fatigue, muscle and joint pain, side (kidney pain), low grade fever (99.9), and blood in urine.


VAERS ID: 1894500 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Gait disturbance, Pain in extremity, Pyrexia, Weight bearing difficulty
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Intense pain in left foot. Started around the same time I got a fever, but lasted longer. Had difficulty putting weight on the foot and walking. Three days later and it is still not totally gone.


VAERS ID: 1894554 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-11-21
   Days after vaccination:299
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 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: 11/22 Covid Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1894584 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 182281 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt. states that after receiving the 1st dose of J&J 11/20/2021, started experiencing symptoms 11/21/2021 of fever (101.0), "flash" in the right eye, and pain throughout the left leg (lasting 2 days). No noted Primary visit/communications.


VAERS ID: 1894603 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-19
Onset:2021-11-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Laboratory test, Thrombosis, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: amoxicillin, hydromorphone
Diagnostic Lab Data: U/S LLL, routine lab work
CDC Split Type:

Write-up: Was boosted with J&J on Friday and developed a LLL blood clot


VAERS ID: 1894613 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-13
Onset:2021-11-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac discomfort, Chest discomfort, Chest pain, Dyspnoea, Electrocardiogram normal, Headache, Inflammation, Musculoskeletal pain, Nasopharyngitis, Oropharyngeal pain, Paranasal sinus discomfort, Secretion discharge
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Covid-19 Vaccine (dose 1 and 2)--Age 29, 2/5/21 and 3/5/21
Other Medications: Xophenex (inhaler) Trazadone (for sleep) Metformin (for PCOS) Singular (for allergies)
Current Illness: None
Preexisting Conditions: Asthma
Allergies: codeine morphine oxycodone Lortab Lactose Intolerant
Diagnostic Lab Data: EKG came out normal 11/17/2021
CDC Split Type:

Write-up: Heart felt like it was being squeezed for 7 days (beginning 11/14 in evening) Chest Pain (centered in heart area) for 9 days (beginning 11/14) Pain in left shoulder blade for 9 days (still happening) (beginning 11/14) Tightness in chest to the point I couldn''t breathe 9 days (beginning 11/17 at 4am) Additional Headache for 8 days (still happening) (beginning 11/15) Sinus Pressure began 11/22 Treatment: I nebulize each day now. I take my inhaler each day. Take Ibuprofen (800 mg) from the Doctor for the next 2 weeks to help with inflammation Heating Pad on Chest and Back areas Rest and no stress Outcome: Tight Chest, but heart doesn''t feel like it''s being squeezed anymore Feel Cold Symptoms coming (tight chest--with the asthma acting up, sinus pressure, excess mucus in throat, sore throat)


VAERS ID: 1894722 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 1 LA / IM

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

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

Write-up: Patient was administered 0.3ml Covid 19 Immunization (pfizer) instead of 0.2ml peds Covid19 (pfizer) vaccination. We tried notifying mom as quickly as we could when the error was detected. Patient had no know reaction. We have attempted to reach family to f/u.


VAERS ID: 1894724 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Illness, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Temperature checks. Never had a fever.
CDC Split Type:

Write-up: On Sunday around 8pm patient got extremely tired before bed. This was unusual for him. He was falling asleep on the couch. He complained of a headache which he maybe only ever had once in his life. He wasn''t running a fever. He woke up at 5:30am throwing up. It was almost all yellow bile. He slept on the couch the entire day waking up briefly and threw up probably 7 or 8 times throughout the day. He couldn''t even watch TV he felt so exhausted and sick. He never ran a fever the whole time. He was able to urinate and take a couple ounces of fluid around 6pm Sunday. So Sunday at 5pm was the last time he threw up. He threw up when we tried to give him Motrin. We did have a call with a Dr and we''re told to go to emergency room if he gets better or can''t keep fluids down. The next day (today that I''m writing this) he still spent most of the on the couch but was drinking and able to keep small food down. We have 2 adults and 2 other kids in the house and no one has been sick but him.


VAERS ID: 1894749 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-17
Onset:2021-11-21
   Days after vaccination:277
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray normal, Confusional state, Decreased appetite, Fall, Inflammatory marker increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, CVA, bradycardia, dementia
Allergies: No known drug allergies
Diagnostic Lab Data: Chest x-ray is negative for pneumonia, mildly elevated inflammatory markers.
CDC Split Type:

Write-up: Patient admitted with worsening weakness and confusion. Patient has poor appetite, also. Patient fell prior to admission. No hypoxia.


VAERS ID: 1894778 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Haemorrhage, Headache, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: pain in back/body/legs, stomach pain, headaches, prominent diarrhea with bleeding, fever (102.7 F).


VAERS ID: 1894858 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-15
Onset:2021-11-21
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / UNK - / IM

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

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

Write-up: Pt states Left Arm is extremely sore and unable to twist it without considerable pain.


VAERS ID: 1894887 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Loss of consciousness, Malaise, Refusal of treatment by patient
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), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came to pharmacy for her booster shot. Patient filled out Vaccination Assessment Record (VAR) Form and indicated no adverse reactions from previous two Pfizer doses. Patient was evaluated based on the response on the VAR form before vaccine was given. Patient was asked to stay for 15 mins after vaccination. About 8 minutes post-administration, patient complained "not feeling well" and she was holding her head as she seems to have headaches or lightheaded. Pharmacist went and checked with patient, about 3 minutes later, patient lost consciousness and passed out. Pharmacist spontaneously called 911 and also asked help from front store. Patient was out for about 5 seconds and then restored consciousness. When Policy and Paramedic team arrived, the patient was awake and restored consciousness. Paramedic team checked patient and make sure the patient was stable and no signs for immediate attention needed. Paramedic offers to take patient to ER for further examination. Patient refused at the beginning but her family member insisted to have her taken to the ER.


VAERS ID: 1894891 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Dizziness, Nausea, Pain, Pain in extremity, Pyrexia, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Menstruation two weeks before coinciding with cold symptoms at beginning (normal)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Achy around 3 am, nausea, almost passing out/nodding off, extensive nausea/vomiting from 8 am to 5 pm (inability to eat without vomiting), 101-102f fever, arm/shoulder/upper back pain pain on left side (still have arm pain 72 hours later)


VAERS ID: 1894902 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

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

Write-up: PFIZER BOOSTER VACCINE GIVINE TO 17 YRS OLD. PT''S MOM DIDN''T KNOW THE AGE LIMIT AND ASKED HIM TO GET BOOSTER VACCINE. ACCORDING TO MOM, PT DOESN''T HAVE ANY SERIOUR SIDE EFFECT FROM VACCINE BESIDE MILD TIRENESS AND TENDERNESS ON INJECTION SITE


VAERS ID: 1894930 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pain, Rash erythematous
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: Lisinopril, Rosuvastatin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Moderate fatigue and fairly significant body aches 24 hours after vaccine. Lasted about 24 hours. Red rash about 6" in diameter appeared 48-72 hours after infection.


VAERS ID: 1894936 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Insomnia, Vaccination site pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Chills and fever after second dose of Moderna COVID-19 vaccine, on March 29, 2021. The second-dose adverse reaction was stronger
Other Medications: Lisinopril 10 mg Vitamin D 1000 mg
Current Illness: N/A
Preexisting Conditions: hypertension
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I had chills and difficulty controlling my body temperature, and thus difficulty sleeping. Also achiness at vaccine site.


VAERS ID: 1895086 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Malaise, Myalgia, Nausea, Oropharyngeal pain, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament 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: tuberculosis vaccine at age 5- swollen shoulder
Other Medications: multivitamin vitamin D melatonin L-theanine
Current Illness: N/A
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: symptoms: chills, muscle aches, headache, sore throat, nausea and vomiting, malaise starting from 2.00 AM on 11/20/2021 until 8.0 PM on 11/21/2021; chills and fatigue continuing until 11/22/2021. I could only relate these symptoms to prior influenza infections. treatment: acetaminophen 500 mg .


VAERS ID: 1895325 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same reactionphfizer
Other Medications: Vitamin d.50,000.
Current Illness: Hx sle 40 yrs
Preexisting Conditions: Osteoporosis. Sle.fibromylgia.hypertension gastroparesis
Allergies: Neomycin.colymycin.penicillin. milk.tape.vibramycin Keflex ampicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itching after1hr continues days using benadryl alternate Atarax face legs chest head Pain injection site and multi joint achiness On going day3


VAERS ID: 1895565 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer dose 2
Other Medications: Sertraline; vitamins D & C; iron
Current Illness: None
Preexisting Conditions: Anemia; anxiety/depression
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, body aches, radiating pain in extremities: 24 hours; headache, occasional shooting pain throughout body, fatigue: ongoing since evening of 21st


VAERS ID: 1895722 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-19
Onset:2021-11-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

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

Write-up: Delayed, cutaneous hypersensitivity


VAERS ID: 1896323 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-11-21
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling of body temperature change, Headache, Malaise, Pain in extremity, SARS-CoV-2 test
SMQs:, Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211121; Test Name: COVID-19 virus test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20211149699

Write-up: FEELS HOT/COLD; ARM SORENESS; NOT FEELING 100 PERCENT; HEADACHE; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1855194 and expiry: UNKNOWN) dose was not reported, administered on 20-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-NOV-2021, the patient experienced feels hot/cold. On 21-NOV-2021, the patient experienced arm soreness. On 21-NOV-2021, the patient experienced not feeling 100 percent. On 21-NOV-2021, the patient experienced headache. Laboratory data included: COVID-19 virus test (NR: not provided) Negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, feels hot/cold, and arm soreness, and the outcome of not feeling 100 percent was not reported. This report was non-serious.


VAERS ID: 1896534 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Vaccine positive rechallenge
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm at injection site 3 days and heavy datigue 2 days. Age 62. Vaccination date 11/20/2021. Pfizer booster.
Other Medications: Hydrochlorothiazide 25 mg/day and Sertraline 100 mg/day.
Current Illness: None.
Preexisting Conditions: None
Allergies: Vicodin.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm at injection site for 3 days. Heavy fatigue for 2 days after injection.


VAERS ID: 1896537 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-21
Onset:2021-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ 1620 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Body temperature increased, Chills, Fatigue, Feeling hot, Headache, Pyrexia, Sleep disorder
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: Pfizer Covid shot 2 (age 25); meningitis B (age 17)
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Began feeling warm with headache at 6pm on 11/21/21 and temp was 99 F. Tried to sleep around 12am and then awoke around 5am on 11/22/21 with fever of 102 F. Took 2 (200mg each) ibuprofen and went back to sleep and awoke around 10am still with fever. Took 2 more ibuprofen and continued checking temp. By 12pm fever had ceased but headache, chills, and fatigue remained. Awoke next day 11/23/21. With headache and extremely sore armpit in left side (side of injection). As of this report headache and armpit pain remained.


VAERS ID: 1896550 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain, Headache, Pain, Pain of skin, Pyrexia, Toothache
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin for Women, Ligaplex supplements, glutamine supplement, Amino Acid Supplements, vitamin C.
Current Illness: Had allergy shots on 11/16/21. Had prolotherapy and platelet rich plasma therapy on 11/11/21.
Preexisting Conditions: IBS, chronic back pain.
Allergies: MSG, various outdoor allergies, various indoor allergies.
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 1:50am woke up with aches all over body, skin hurt, teeth hurt, fever, headache. Mid afternoon the stabbing chest pain that I could feel in my upper middle back started. Had last chest pain around 11pm, went to bed. Woke up with just a headache the next morning.


VAERS ID: 1896759 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-18
Onset:2021-11-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Herpes zoster, Injection site erythema, Lymphadenopathy, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Site: Redness at Injection Site-Mild, Additional Details: Patient recieved pfizer covid vaccine on thursday 11/18/2021, pt stated experiencing painful rash around armpit area and swelling of armpit lymphnodes. Pt was in an excruciating pain by sunday 11/21, and seeked medical care, saw dermatolist and got diagnosed with shingles on tuesday 11/23, pt is indicating that this is relating to the vaccine.


VAERS ID: 1896806 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-24
Onset:2021-11-21
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Exposure during pregnancy, Oropharyngeal pain, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient is a 26 y.o. female, with PMH asthma, pregnant at 32 weeks, seen today for COVID 19. She has received one Pfizer vaccine approximately 8 weeks ago. She began having symptoms with cough, and sore throat, tested positive for COVID. She was monitoring her oxygen saturations at home but she dropped into low 90''s, contacted her OB/GYM and was told to come to the ED


VAERS ID: 1896809 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-12
Onset:2021-11-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: Redness, swelling, warm to the touch two inch diameter at injection site.


VAERS ID: 1899545 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Musculoskeletal chest pain
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: SPIRONOLACTONE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Acne; Sulfonamide allergy (Known allergies: Sulfa)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101628836

Write-up: Extreme Tenderness in my ribs. It''s hurts to bend or touch, lay down.; This is a spontaneous report from a contactable other healthcare professional, the patient. A 33-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FH8030) via an unspecified route of administration in the left arm on 20Nov2021 at 17:15 (at the age of 33-years-old) as a single dose for COVID-19 immunisation. Medical history included acne and sulfa allergy. Prior to vaccination, the patient was not diagnosed with COVID-19. Concomitant medications included spironolactone (MANUFACTURER UNKNOWN) for an unknown indication, from an unknown date and unknown if ongoing. The patient did not receive any other vaccine within four weeks prior to the COVID-19 vaccine. The patient previously received paracetamol; oxycodone hydrochloride; oxycodone terephthalate (PERCOCET) and experienced drug allergy. On 21Nov2021 at 08:00, the patient experienced extreme tenderness in her ribs; it hurt to bend, touch or lay down. No therapeutic measures were taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event extreme tenderness in ribs; it hurt to bend, touch or lay down was resolving at the time of this report.


VAERS ID: 1887457 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Nevada  
Vaccinated:0000-00-00
Onset:2021-11-20
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin Flovent Restasis Nexium Instaflex Centrum Vitamin D Xyzal
Current Illness:
Preexisting Conditions: Allergy induced asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm and lot of muscle soreness and weakness throughout my body! Also extreme tiredness. This is different than what I experienced after my 2nd shot.


VAERS ID: 1887789 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Vomiting.


VAERS ID: 1887867 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Injection site erythema, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: diabetes, asthma, chondrosarcoma
Allergies: Toradol MRI Contrast
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever of 102.5 nausea headache redness at injection site


VAERS ID: 1887872 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-10
Onset:2021-11-20
   Days after vaccination:255
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Atelectasis, Bacterial test, Blood creatinine increased, Blood gases abnormal, Blood pH increased, Blood potassium decreased, Blood sodium increased, Blood test abnormal, Blood urea increased, Breath sounds abnormal, COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Hypokalaemia, Hyponatraemia, Hypoxia, Laboratory test, Lung infiltration, Mucosal dryness, Oxygen saturation decreased, PCO2 decreased, Positive airway pressure therapy, SARS-CoV-2 test positive, Urine analysis abnormal, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Current Medications 1. amlodipine-benazepril 10 mg-20 mg oral capsule : 1 cap(s) orally once a day 2. apixaban 5 mg oral tablet : 1 tab(s) orally 2 times a day 3. atorvastatin 20 mg oral tablet : 1 tab(s) orally once a day 4. calcium carbon
Current Illness: unknown
Preexisting Conditions: Anxiety, colitis, acute kidney injury, hydrocephalus, hypokalemia,, DVT/ hyperlipidemia/ hypertension/ brain aneurism july 2021, VP shunt
Allergies: none known
Diagnostic Lab Data: This patient is brought to the emergency department with complaint of cough, shortness of breath, and hypoxia. On exam patient has diminished lung sounds and dry mucous membranes. ABG reveals hypoxia with a PaO2 of 70.5 on 100% nonrebreather. Patient''s pH is 7.456, PCO2 is 23.1. IV access established labs are drawn. Patient is given a 1 L fluid bolus. IV access established baseline labs are drawn. Patient is placed on BiPAP for respiratory support secondary to hypoxia. Patient is a DO NOT RESUSCITATE with no intubation. Patient''s Covid swab is positive. Patient''s blood work does reveal a slightly elevated white blood cell count of 14.8, hyponatremia with a sodium of 158 and hypokalemia with potassium of 3.3. Patient has acute renal failure with a BUN of 9 0 and a creatinine of 3.7, in January 2021 patient''s renal function was normal. Urinalysis is 4+ bacteria. Chest x-ray does show streaky infiltrate or atelectasis in the right and left lower lung base as well as the lingula. Patient is started on Rocephin. Case is discussed with on-call hospitalist Dr. who accepts the admission. Patient is given 10 mEq potassium in the emergency department.
CDC Split Type:

Write-up: Patient arrives via EMS with complaint of shortness of breath. Patient is at nursing home and staff noticed her pulse ox was low. Patient is unable to provide history. All history is obtained from nursing home records as well as husband who meets the patient in the emergency department. Husband states the patient has been recently discharged home from the hospital and was placed in rehab for treatment. States he saw her couple days ago and she was eating and was able to carry on a conversation. States he was called today and told she was short of breath. He states she appears more weak and is coughing more than she had been. Patient does have a previous diagnosis of Covid.


VAERS ID: 1887885 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-05
Onset:2021-11-20
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Lethargy, Pain, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D; Vitamin C; Elderberry; Hctz-Li
Current Illness: N/A
Preexisting Conditions: Controlled HTN
Allergies: N/A
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Fever; chills; whole body achiness; transient tingling down bilateral UE/LE; lethargy; lightheaded.


VAERS ID: 1887946 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, Hyperhidrosis, Hypoaesthesia oral, Pharyngeal hypoaesthesia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: 1 minute after injection, noted acute diaphoresis, lightheadedness, and throat/tongue numbness. HR at rest increased to 160. Offered water by pharmacy staff, sx resolved after 25 minutes


VAERS ID: 1887959 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Vomiting
SMQs:, Acute pancreatitis (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: Whey protein
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache, vomiting


VAERS ID: 1887960 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Lip swelling, Rash macular
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: Allegra, Vitamin D
Current Illness: none
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Woke up on the Saturday following a Thursday dose with a swollen bottom lip and red splotches around my neck and collar bone area.


VAERS ID: 1887962 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Injection site pain, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control, hydrochlorothiazide, sertraline, vitamin D, prenatal vitamins, fish oil.
Current Illness: No illnesses. Just a LOT of stress that manifested in some physical symptoms.
Preexisting Conditions: Anxiety, depression, obesity, knee osteoarthritis, high blood pressure
Allergies: Shrimp.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up at 4 am the day after with severe headache, low-grade fever of 100?, moderate injection site pain. (I am still glad I got the vaccine and would do so again if a 4th is ever needed. I feel icky but I know that means my body is making antibodies to protect me.)


VAERS ID: 1887971 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysmenorrhoea, Injection site pain, Injection site swelling, Mobility decreased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 8am: Bupropion XL 300mg, Vitamin D3 (1,000 iu), Garden of Life Once a Day Female Probiotics, Zyxal (generic) 25mg. 5pm: 2 Tylenol extra strength Arm implant Nexplanon 2 years in.
Current Illness: High Cholesterol
Preexisting Conditions: Asthma
Allergies: Pineapple, fungus/mold, chocolate, shellfish, Aspirin and NSAIDS
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Low fever (101F?), pain in the injection site with swelling and limited mobility. Severe period cramps even though I had a period 2 weeks ago.


VAERS ID: 1887981 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Headache, severe body aches, fever, chills, nausea


VAERS ID: 1887989 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever, sore arm, Age 43, Moderna COVID shot, 02/18/2021
Other Medications: Metformin
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: Penicillin Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen right arm Arm pain radiating from shoulder to wrist Fever 101.0


VAERS ID: 1887998 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 16 year old was given a pediatric dose. Second dose of .1ml was administered per medical authorization, Doctor to complete a full adult dose of Pediatric vaccine. Patient has no adverse effects. Pt mother is present and consented to Medical control authorization of second dose.


VAERS ID: 1888019 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Photosensitivity reaction, Vision blurred
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 800 mg Synthroid 10 mg
Current Illness: none
Preexisting Conditions: PCOS
Allergies: Allergic to eggs, wheat, yeast, soy, casin, cod, coffee, and corn
Diagnostic Lab Data: None yet. This just started and I don''t have medical insurance so I won''t be running to the doctor unless I have to.
CDC Split Type:

Write-up: Within 30 min. of shot I noticed my eyes were extremely sensitive to sunlight. To the point I had to cover my face and look down at the ground, to get to my car. This has never been an issue for me. Today, 48 hours later, I am seeing zig zag, blurry lines, in my right eye anytime I go in outside, in sunlight. This happened today, while I was driving, within minutes of going outside. Happens only in right eye. I had to immediately go into a store and buy sunglasses, wear them indoors, for 15 minutes before the blurry lines will disappear.


VAERS ID: 1888030 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 LA / IM

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

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

Write-up: Medication error - patient not eligible for booster, but was given booster dose (0.25mL Moderna) after age was missed by forms verification staff. A medication error form was documented with the health department and family was notified of the error. No adverse effect symptoms noted at time of this report.


VAERS ID: 1888039 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-11-20
Onset:2021-11-20
   Days after vaccination:365
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Immediate post-injection reaction, Joint swelling, Mobility decreased, Nervousness
SMQs:, Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient has leukemia, most recent cycle 2 weeks prior per mother
Current Illness: See above
Preexisting Conditions: See above
Allergies: None
Diagnostic Lab Data: See above
CDC Split Type:

Write-up: Per nurse patient was gripping her right wrist with her left hand when the vaccine was administered into the left arm. Immediately after the vaccine she began complaining of right wrist pain. Mild appreciable swelling noted of right wrist, no color change. Patient continued to complain, normal radial pulses. Ice pack applied to right wrist. Patient was observed for an additional 15 minutes and during that time vitals checked (Temp 37.1, BP 109/74, HR 113). Tylenol was administered by mom after. Patient was interactive with child life during this time but also appeared nervous and shivering in the chair. Child stated that was because she was nervous. No other signs or symptoms. At end of 30 minutes child still with limited ROM of right wrist and hand compared to left. No previous injury per family. Discussed with family that if pain or swelling increases or fails to resolve within 2 hours mom is to seek immediate medical care. Also discussed seeking immediate medical care for appearance of any other symptoms. Patient remained A/O, smiling intermittently when distracted by staff throughout visit.


VAERS ID: 1888043 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lymphadenopathy, Pain
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: Escitalopram 20mg, Vitamin D 5000iu
Current Illness: N/A
Preexisting Conditions: Depression, GAD
Allergies: N/A
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Swollen lymph nodes in left arm pit with pain


VAERS ID: 1888049 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site rash, Pain, Pruritus, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same- covid arm with 1st dose
Other Medications: HRT - bijuva Allegra 1/day
Current Illness: None known
Preexisting Conditions: None
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid arm - rash traveling down from injection down arm. Itchy and painful. Had same reaction after 1st dose, but rash appeared sooner this time.


VAERS ID: 1888058 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308454 / 1 RA / IM

Administered by: Private       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: Patient reported feeling dizzy about 10 mins after vaccine administration. She lied down on exam table for about 30 mins and felt better. VS stable. Her spouse came to pick her up.


VAERS ID: 1888073 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / IM

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

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

Write-up: Patient was administered the booster dose before the 6 month time period was up given 23 days early


VAERS ID: 1888094 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 25mg
Current Illness: None
Preexisting Conditions: No known
Allergies: No known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was nervous to get vaccine. She tolerated well. She moved locations to a chair and began feeling like she was going to pass out. She was bradycardic, diaphoretic and pale. She did pass out and came to a couple of seconds later. She did not fall. She was placed in a recovery position. Ice pack place on her neck. 11:45 Pulse 44, O2 Sat 99%, Resp 12 . She was on floor for 2nd assessment in recovery position. Color was better. She was talking. Pulse 60, O2 Sat 98%, BP 88/52, Resp 12. Reassessed at 11:56 Pulse 68, O2Sat 100%, BP 95/58, Resp 12. Asked how she feels on a scale of 0-10. 0 is horrible and 10 is feels great. She states she is an 8. Had a sucker and some water. Sat up on Floor. Later sat in a chair. was feeling good. Instructed to seek medical attention if she worsens.


VAERS ID: 1888096 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Feeling hot, Injection site erythema, Injection site warmth
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin 10mg, lovaza 1gm, aspirin adult, multi vitamin, lisinopril hydrochlorothiazide
Current Illness: NA
Preexisting Conditions: HX of obesity, skin rash, pneumonia, mixed hyperlipidemia, hypertension, impaired fasting glucose, hypercalcemia
Allergies: NONE
Diagnostic Lab Data: Pt given 1% hydrocortisone cream and Benadryl 25 mg, Advised pt that drowsiness may occur due to administration of Benadryl. Pt also advised that if sx worsen, return, or she has any difficulty with SOB to go to the ER. Pt verbalized understanding and thanked the office.
CDC Split Type:

Write-up: her arm felt weird and hot and that this did not occur w/ the first 2 vaccines she received, skin above & below injection site was warm to the touch w/ slight erythema present. Pt denied any shortness of breath, palpitations, throat itching/feeling swollen or any tongue complaints. This nurse applied 1% hydrocortisone cream to site and reset the 15 minute timer at 11:05. This nurse checked on patient to reassess after 5 minutes, with the patient in complete eye view the entire time. At this time patient states she is feeling minimally better. Injection site rechecked and erythema not present, with the arm now cool and dry. Benadryl 25mg given PO to patient at 11:12. Pts second timer completed at 11:20. At this time pt is feeling much better.


VAERS ID: 1888097 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: hydrocortisone 2.5% topical twice daily for 5 days ergocalciferol 1250mcg (50,000) capsule 1 per week for 8 weeks
Current Illness: none/NA
Preexisting Conditions: obesity, contact dermatitis, eczema
Allergies: eggs
Diagnostic Lab Data: none/N.A
CDC Split Type:

Write-up: patient stated he was 11 when he is really 13. RN gave him a pediatric 0.2 mL dose when he should have received a 0.3 mL adult dose instead.


VAERS ID: 1888098 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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: Lisinopril 10mg once daily. Escitalopram 5 mg once daily.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No tests. Called the nurse line and received advice over the phone.
CDC Split Type:

Write-up: Severe vertigo and dizziness the morning after the shot. Could not move my head or get out of bed without the room spinning. Lasted about 30 minutes. Eventually got up very, very slowly and it is getting better as the day goes on.


VAERS ID: 1888100 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Exposure during pregnancy, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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: No known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s estimated date of delivery is January 2022. Patient received Pfizer vaccine that had been mixed approximately 25.5 hours before administration. No other adverse effects to report. Patient will wait to repeat dose upon delivery.


VAERS ID: 1888112 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No, none was given to patient
Current Illness: No known illnesses
Preexisting Conditions: No known illnesses
Allergies: No known allergies
Diagnostic Lab Data: None done.
CDC Split Type:

Write-up: Patient fainted then immediately regained consciousness, became pale and was sweating. Called 911. They examined the patient and offered to take him the emergency department. Patient refused. He was slowly improving. He waited a few hours then left the pharmacy on his own.


VAERS ID: 1888116 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Vitals pre/post BP 120/70 HR 66 RR14 Sat 98% ----- BP 124/74 HR 71 RR14 Sat 98%
CDC Split Type:

Write-up: PT recvd JJ booster vaccine to Left arm. PT began to feel nausea about 5mins post vaccine. PT confirms no previous advised vrs reaction to first dose. PT confirms not eating today. PT given Famotadine 40mg and improved noted in 5mins. Symptoms resolved PT observed a total of 30mins.


VAERS ID: 1888117 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

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

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

Write-up: PT and dad approached registration and asked for moderna first shot. PT appeared to be an adult per registration staff but only 16yrs of age. PT given first dose 0.5mls of Moderna to left deltoid. While in observation discovered PT is a minor. Pts parents confirmed pts age as a minor and RN informed parents of error in vaccine given. Vaers report initiated and medical chain of command notified. While waiting further instructions pt observation time increased to 30min and reemphasized what to expect and education. PT without any signs and symptoms if adverse reaction. States she felt fine. Encouraged parents to take PT to ED or urgent care center of choice for additional concerns or monitoring. Pt and mother voiced understanding. Mom asked questions and answers provided. Mom also provided contact number for Director of Clinical solutions and encouraged to reach out. At pts time of discharge from the vax site PT stated they felt fine and both mom and parent reiterated what to do if adverse or signs or symptoms if a reaction occurred. Called mom @130 pm and mom stated the patient was fine and did not feel that emergency medical attention was necessary at the time.


VAERS ID: 1888118 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5NF7J / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Erythema, Loss of consciousness, Orthostatic hypotension
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: patient reported this after both vaccines had been administered that this has happened to him 5-6 times prior
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no
Diagnostic Lab Data: 911 was called and he was transported to the hospital
CDC Split Type:

Write-up: Patient presented today requesting COVID-19 booster dose. The immunization screening questions were reviewed. Booster dose given in accordance with Health Officer guidance at 8:28am. Patient requested flu vaccine. Administered at 8:27am. Shortly after at about 8:29am patient stood up still in nurse vaccine station and stated he felt dizzy, and he needed to lie down. PHN gently helped guide patient to the floor, into the supine position. Patient went unconscious immediately and PHN began to hear a gurgling noise, PHN took off his face mask, checked his airway nothing was found, rolled him onto his right side, PHN helped and lifted his legs. Patient was out for about 15 seconds. PHN then placed him back onto his back and he began to talk. He then went out again and made the gurgling noise, his face turned red. PHN assessed airway, nothing found rolled patient onto his right side. PHN continued to hold his legs up, he was out for approximately 15 seconds again. Patient returned to conscious level and was placed back onto his back, he began talking to the nurses and stated he has a history of vasovagal episodes, patient was encouraged to take a few deep breaths. PHN asked if he had eaten before coming in today, he stated he had not. He was given a cookie and a juice, he had two sips of the juice. The ambulance was called at 8:30am by site lead. PHN notified patient that the ambulance was on the way, vital signs were taken B/P 120/70, P86, O2 Sat 99% RA, he remained lying on the floor until the ambulance arrived at 8:50m. He continued to have trouble with orthostatic hypotension, the ambulance crew took him to the hospital.


VAERS ID: 1888121 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Heart rate increased, Hypertension, Interchange of vaccine products, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar but less dramatic and severe symptoms from my initial Jansen vaccination in April 2021.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Heart rate, blood pressure, temperature taken.
CDC Split Type:

Write-up: I received my Moderna booster shoot Friday afternoon and woke up a 4 AM on Saturday with a fast heart rate. It was so fast that I thought I could die and I called 911. I was breathing fairly normally and able to walk around and converse. Upon arrival of the paramedics, I had my vitals checked. My pulse rate felt quite a bit lower when checked than when I called 911 but it was still 155 BPM and very steady when breathing in and out and trying to calm down. The paramedics said my blood pressure was high and left it up to me whether I wanted to be admitted. I decided against given that my family had gotten back to me and were on their way. I took my temperature and it was 100.2. I took ibuprofen and my pulse rate and fever slowly went down. I had the Jansen vaccine in early April and experienced similar symptoms, but not as dramatically or serious, so I didn''t report or call 911 then.


VAERS ID: 1888122 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient is 16 years old but received a Pfizer booster dose
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient is 16 years but received Pfizer booster dose


VAERS ID: 1888129 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK127 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Incorrect dose administered, Muscle rigidity
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Medication errors (narrow)

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

Write-up: Patient became very tense with rigid muscle upon needle insertion. After some vaccine was instilled there was too much resistance to instill further. Very small (difficult to measure <0.1mL) in syringe after needle removed therefore less than full volume administered to patient.


VAERS ID: 1888130 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

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

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

Write-up: Patient received vaccination earlier than recommended date. Patient 1st dose administered 11/07/2021. Parent scheduled child for 11/20/2021 and received second dose. Patient was supposed to receive second dose on 11/28/2021. Father accompanied child. was advised for 15 minute observation. Child feels fine, no signs or symptoms of adverse reaction. All questions and concerns addressed. Fathers telephone number. Parent and child left facility after 30 minute observation (extra 15 minutes as precaution). Thanks.


VAERS ID: 1888141 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 2 LA / IM

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

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

Write-up: Patient received the second dose 21 days after the first dose at 9:40 am. A 4-day grace period allowed, however 21 days is fewer than 23 days; therefore required to report as an administration error. Patient informed at 11:40 am (immediately after it was discovered), the dose should be repeated at least 28 days after today''s dose. Patient understood.


VAERS ID: 1888143 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / IM

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

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

Write-up: Patient received vaccine, was leaving pharmacy and fainted near front register. Pt immediately said she was fine. I asked patient if she had eaten or drank anything today and she said yes. I asked them to sit back at the pharmacy but they left.


VAERS ID: 1888146 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 AR / IM

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

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

Write-up: Vaccine administered three weeks too soon


VAERS ID: 1888148 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-11-20
Onset:2021-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: no
Preexisting Conditions: no
Allergies: Not reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mother said that patients lips were swelling after coming home approx. 2 hours after shot given


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