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From the 9/3/2021 release of VAERS data:

Found 661,087 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 7 out of 6,611

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VAERS ID: 1659276 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-08
Onset:2021-08-28
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Nasal congestion, Paranasal sinus discomfort, Pulmonary embolism, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CYTOMEL PAROXETINE SAXENDA
Current Illness:
Preexisting Conditions: DIABETES, HYPOTHYROIDISM
Allergies:
Diagnostic Lab Data: POSITIVE COVID TEST, CHEST X-RAY
CDC Split Type:

Write-up: SHORT OF BREATH,, SINUS PRESSURE, NASAL CONGESTION, DEVELOPED A PULMONARY EMBOLISM


VAERS ID: 1659453 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-27
Onset:2021-08-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Headache, Lymphadenopathy, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nodules in the neck area of the clavicle swollen. Front and back chest pain. Chikungunya-like muscle aches, headache, pain in joints fingers, wrist, hips, and feet. General pain in the body especially in the neck towards the head by the back of the neck. Pain in the left arm.


VAERS ID: 1659474 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Cough, Ear congestion, Ear pain, Fatigue, Headache, Nasal congestion, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune 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: Ibuprofen, Portia birth control
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Tested negative for COVID-19 on 8/31/21 at 1:30PM
CDC Split Type:

Write-up: Normal known side effects of vaccine for first 24 hours: fever, body aches, chills, fatigue. Then at about 48 hours I developed a bad cough, nasal congestion, ear congestion, headache. Then at 56 hours lost taste. Then at 80 hours lost smell. I have tested negative for COVID as of today, 6 days post vaccine and 3.5 days post unusual symptoms so it is not that. Lost of taste and smell continue to persist as well as cough, nasal congestion and horrible ear pain.


VAERS ID: 1659492 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: NONE MEDICATION ERROR PATIENT IS 16 YEARS OF AGE. MASS VACCINATION EVENT AND FAMILY REQUESTED JANSSEN FOR BOTH PEOPLE BEING VACCINATED. VOLUNTEER HEALTH PROVIDER ADMINISTERED JANSSEN TO BOTH INDIVIDUALS AND ONE WAS 16 YO


VAERS ID: 1662216 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-08-28
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / UNK - / -

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

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

Write-up: Hospital 8/28/21. 2nd Pfizer COVID vaccine on 4/18/21 with LOT ER8730


VAERS ID: 1662567 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-21
Onset:2021-08-28
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic conditions DM 2, HTN, A fib, hyperlipidemia, hypothyroidism.
Allergies:
Diagnostic Lab Data: Positive SARS-COV-2 test 8/31/21 $g14 days post vaccination
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria review. Presented to ED with SOB


VAERS ID: 1662625 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-24
Onset:2021-08-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Hallucination, Malaise, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lorazepam, mematine, levothyroxine, duloxetine, pantoprazole, nifedipine, hydralalzine, senna, hydrochlorothiazide, calcium
Current Illness: none
Preexisting Conditions: CHF, High BP, hypothyroidism
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient didn''t feel well after 1st dose. After second dose, on Friday she was throwing up in bed. Saturday she was hallucinating and then slept for 5 hours. When she woke up she was unresponsive. The hospice nurse feels it was a stroke.


VAERS ID: 1662736 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-08-28
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Bilevel positive airway pressure, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Lung infiltration
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), 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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: DM, gastric bypass surgery, previous CABG, Sleep apnea on nocturnal CPAP, HTN
Allergies: NKA
Diagnostic Lab Data: 8/28/2021 chest x ray: mulitfoccal pulmonary infiltrate; 8/26/2021 CT angiogram chest: moderate diffuse bilateral alveolar infiltrates consistent with COVID 19 pneumonia.
CDC Split Type:

Write-up: Ongoing hospitalization began 8/28/2021 for Pneumonia due to COVID-19 virus, acute respiratory failure with hypoxia: Vapotherm, BiPAP, MDI, Sarted baricitinib 8/30/2021


VAERS ID: 1662936 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-14
Onset:2021-08-28
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Pancreas infection, Ultrasound scan
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Cat-Scan 08/28/2021; Ultrasound 08/28/2021; Blood Work 08/28/2021
CDC Split Type:

Write-up: Pt. states that after receiving the 2nd dose of Moderna 04/14/2021, started experiencing symptoms 08/28/2021 of Pancreatic Infection. 3 days Hospitalized with Observation. Discharged 09/01/2021.


VAERS ID: 1662958 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

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

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

Write-up: 7 hours after injection- extreme fatigue and headache then fever by 10 pm. Fever gone by morning but headache and fatigue lasted 3 days.


VAERS ID: 1662987 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-30
Onset:2021-08-28
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 fully vaccinated 3/30/21; tested + 8/28/21


VAERS ID: 1663411 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-28
Onset:2021-08-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 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? 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: SYNCOPE


VAERS ID: 1663938 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-08-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Er succinate 50 mg , Lisinopril 20 mg , rosuvastatin 40 mg Warfarin 5 mg nighttime sleep aide 25mg
Current Illness: none
Preexisting Conditions: open heart surgery with Mech valve replacement .
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Multiple Fevers on Saturday and the Following Monday and Tuesday


VAERS ID: 1665977 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-18
Onset:2021-08-28
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -

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 on 8/28/21
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1666134 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-01
Onset:2021-08-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood creatinine increased, Blood fibrinogen increased, Brain natriuretic peptide increased, C-reactive protein increased, Echocardiogram abnormal, Electrocardiogram abnormal, Fibrin D dimer increased, Multisystem inflammatory syndrome in children, Ocular hyperaemia, Pyrexia, Red blood cell sedimentation rate increased, Respiratory tract congestion, Serum ferritin increased, Tachycardia, Troponin increased, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: Creatine, BNP, Troponin, ALT, AST, Ferritin, Ddimer, Fibrinogen, CRP, and ESR all elevated. EKG and ECHO abnormal. Has received solumedrol and IVIG
CDC Split Type:

Write-up: 17y / male presents 8/29/2021 with 4 days of symptoms: fever, tachycardia, vomiting, congestion, and red eyes diagnosed with MIS-C


VAERS ID: 1666282 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-08-28
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine increased, Blood potassium increased, COVID-19, Cough, Dyspnoea, Electrocardiogram, Intensive care, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: 69 year old male patient that presented to outside ED with increased SOB/cough for the last couple of days. Pt is COVID + as of tonight. Pt ha CKD and creat tis 5.0 with K+ 6.4. No acute changes on ECG. Call placed to CCOd and pt can go to MICU. Call placed to Dr. and pt was accepted


VAERS ID: 1666305 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-17
Onset:2021-08-28
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Diarrhoea, Hypoxia, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (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? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Rheumatoid arthritis, hypothyroidism, methotrexate use for RA
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/28/21: Patient arrived at the ER with generalized weakness, nausea, vomiting and diarrhea. Patient tested positive for COVID on 8/11/21 and states that her symptoms have been worsening over the past 4 days. EMS notes that the pt was hypoxic at 88% on RA.


VAERS ID: 1666434 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-16
Onset:2021-08-28
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Blood creatine phosphokinase increased, Chest X-ray normal, Electrocardiogram normal, Full blood count normal, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Melatonin 9mg qhs
Current Illness: none
Preexisting Conditions: Obstructive sleep apnea HTN Obesity
Allergies: none
Diagnostic Lab Data: Troponin maxed at 46.9 CK maxed at 1404 ekg wnl cbc wnl cxr wnl
CDC Split Type:

Write-up: On 8/28, 12 days after vaccination, patient sufferd a non STEMI.


VAERS ID: 1666452 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac imaging procedure abnormal, Echocardiogram, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: troponin trended from 9.938 -$g 14.433-$g 8.523-$g 6.5468 (8/26/21-8/27/21) An echocardiogram was completed (8/26/21). A cardiac MRI was completed and was suggestive of myocarditis (8/27/21).
CDC Split Type:

Write-up: Myocarditis Patient was started on prednisone daily with a 6 week taper Avoid rigorous physical activity for 6 months.


VAERS ID: 1666760 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-08-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Muscle spasms
SMQs:, Dystonia (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: Omega 6, Vitamina D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Since the second day of vaccination I feel a constant cramp sensation in my hands and feet, it does not go away.


VAERS ID: 1638457 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: D.C.  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 3 LA / SYR
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 202105B0933 / 1 LA / SYR
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 2021051011 / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chills, Dyspnoea, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, difficulty breathing, chills, nausea Eat 2 pieces of Tyleno


VAERS ID: 1638468 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-17
Onset:2021-08-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F54421 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Ageusia, Hypophagia, Vomiting
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Retroperitoneal fibrosis (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: My son nearly died from the vaccine, he suffered abdominal pain, and sever vomiting for 5 days, a he has only this evening had a mouthful of supper he has lost all taste, he innoculation last Tuesday, so it''s over a week he has had nothing to eat for fear of continues vomiting, we could not go to a doctor or the clinic as he was in to much pain to drive the car, so yesterday my sister brought him some medicine from the chemist, only started to feel a little bit better today, I nearly lost my son because of this bloody vaccine.


VAERS ID: 1640245 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 - / -

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

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

Write-up: Vicious shaking, almost like convulsions.


VAERS ID: 1640957 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-05
Onset:2021-08-27
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

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

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

Write-up: 2nd dose Moderna was given at day 21


VAERS ID: 1640958 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

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

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

Write-up: Administered early at day 15 rather than day 21 or later.


VAERS ID: 1640960 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)

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

Write-up: Metallic taste in mouth within one hour after the shot


VAERS ID: 1640997 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, 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? 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: Sun screen
Diagnostic Lab Data: None so far
CDC Split Type:

Write-up: Rapids heart beat. Passed out in bathroom hitting head on floor. Out 5-10 minutes


VAERS ID: 1641003 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SS2588 / 3 LA / IM

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

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

Write-up: ADMINISTRATION ERROR : Pt. received a 3rd Booster of Phizer 08/17/2021, Previously received 1st Moderna 04/15/2021 & 2nd Moderna 05/15/2021. No known symptoms at the time.


VAERS ID: 1641032 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-07-28
Onset:2021-08-27
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder, Muscle spasms, Polymenorrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (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:
Diagnostic Lab Data: Not yet
CDC Split Type:

Write-up: Menstrual events have been different. For as long as I have had my period, 13 years, I have been very consistent, same flow, same symptoms, etc. since having my first dose of the vaccine, I have had 2 periods. One was very heavy and painful with lots of clots (which I have never experienced) and this current one, I had one day of a small amount of blood and cramps. This is not normal for me at all.


VAERS ID: 1641040 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-15
Onset:2021-08-27
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: folic acid, amlodipine, atorvastatin, furosemide, hydralazine, levetiracetam, tamsulosin, ergocalciferol, carvedilol, lasartan
Current Illness: shortness of breath and black tarry stools
Preexisting Conditions: Acute pericardial effusion, Bilateral Pleural effusion, DM, Obesity, OSA on CPAP
Allergies: NKA
Diagnostic Lab Data: Rapid covid test
CDC Split Type:

Write-up: Pt tested positive for COVID 19


VAERS ID: 1641074 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Olanzapine 20mg
Current Illness: N/A
Preexisting Conditions: Schizophrenia
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt felt lightheaded and had mild stomach pain


VAERS ID: 1641082 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-17
Onset:2021-08-27
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Cough, Productive cough, Pulmonary mass, Ultrasound scan abnormal
SMQs:, Anaphylactic reaction (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Infective pneumonia (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: Simvastatin, Furosemide, Tamsulosin, Metoprolol ER, Eliquis
Current Illness: None
Preexisting Conditions: GFR of 25
Allergies: None
Diagnostic Lab Data: sonagram of lungs and then CT scan of lungs showing small nodules in lower lungs
CDC Split Type:

Write-up: developed dry cough and then developed cough with very viscus material-- subsequent CT scan of lungs indicated small nodules in lower lungs.


VAERS ID: 1641084 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Hyperhidrosis, Hypotension, Malaise, Respiratory rate decreased, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown. only took vaccine from us. spanish speaker. sister was with her but she did not know.
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: nkda per sister
Diagnostic Lab Data: none
CDC Split Type:

Write-up: After i gave the pfizer vaccine at 10.26am, within approx 15 min the sister knocked on the door saying he is not feeling well. When i saw him, his eyes were open but he was not responding. My tech , his sister and another person were there. I, immediately, called 911 and my tech and fellow rph went by the patient, and were letting me know the situation about the patient so i could tell the 911 team. He was about to vomit, but he did not. Cold sweating alot. Confused. Eyes open. Breathing less than normal, but not gasping for air. When 911 checked him, his blood pressure was low and then it was trending back up. But when they took the standing blood pressure, it started dropping, so they took him to the hospital.


VAERS ID: 1641093 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Dizziness, Heart rate decreased, Hyperhidrosis, Hypoaesthesia, Hypopnoea, Loss of consciousness, Mental impairment, Oral pruritus, Pallor, Rash, Rash erythematous, Reflexes abnormal, Respiratory arrest, Sensation of foreign body, Sensory disturbance, Slow response to stimuli, Swollen tongue, Tongue oedema, Tremor, Vertigo
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Pertussis vaccine
Other Medications: Zyrtec
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Betadine, Iodinated contrast media, honeydew, cantaloupe, kiwi, oranges, walnuts, peanuts, pertussis vaccine, shellfish
Diagnostic Lab Data: pending
CDC Split Type:

Write-up: Called to room 15 minutes after Pfizer 2nd dose. Patient c/o globus feeling and itching around mouth and inside mouth. Hx of vaccine reactions to various things. Had some itching after 1st shot, but did fine after monitoring. Had premedicated with 2 Zyrtec tabs. VSS, O2 sat 100% RA Gen: 36-year-old female appearing concerned, but in NAD Skin: warm and dry, no visible rashes HEENT: no rashes, no edema or erythema on face or in mouth/throat, Mallampatti 1 Heart: RRR Lungs: CTAB Approximately 5 min later, patient c/o dizziness described as spinning. Hx of vertigo. Laid head of exam table back with some relief. Other sx unchanged. VSS, O2sat 100% RA Gen: 36-year-old female appearing concerned, but in NAD Skin: warm and dry, no visible rashes HEENT: no rashes, no edema or erythema on face or in mouth/throat, Mallampatti 1 Heart: RRR Lungs: CTAB Five minutes later, patient c/o feeling that she was going to pass out and tongue feeling swollen. Also c/o decreased sensation in B hands and shaking. Wanting to call coworker, but unable. VSS, O2 sat 100% RA Gen: 36-year-old female, diaphoretic, rigors Skin: diaphoretic, pink rash R neck HEENT: no rashes on face, no erythema in mouth/throat, edema noted at the base of the tongue, Mallampatti 3 Heart: RRR Lungs: CTAB, breathing more shallow than before Neuro: decreased mentation, unable to tell RN how to unlock her phone to call the coworker she wanted, slow responses, decreased sensation to light touch on BUE compared to BLE, grip strength 4/5, unable to flex B elbows Code Medic activated Epipen 0.3 mg IM given in R lateral thigh at 0940. Mentation improved. Asking for coworker. Still c/o dizziness and sensation in tongue/throat. Reporting decreased sensation "from neck down" VS: HR 112, BP 161/81, O2 sat 100% RA Gen: 36-year-old female, diaphoretic, color improved Skin: diaphoretic, pink rash R neck HEENT: no rashes on face, no erythema in mouth/throat, edema noted at the base of the tongue, Mallampatti 3 Heart: RRR Lungs: CTAB, breathing remained Neuro: mentation improved, rigors resolved, moving all limbs, decreased sensation to light touch throughout House supervisor and transport arrived. Report given. Patient transferred to stretcher. Patient lost consciousness. Pulse and shallow breathing remained. Code blue activated. Patient regained consciousness spontaneously after ~1 min. 2nd Epipen 0.3 mg IM given in L lateral thigh at 0955. Patient''s color and breathing improved. Attached to Zole and non-rebreather at 100%. Code team arrived. Gave report. Patient lost consciousness again. Pulse strong, but no breathing for ~30 sec. Patient spontaneously began breathing again and regained consciousness. Code team transferred patient to ER with 3 additional Epipens in hand. Electronically signed by PA at 08/27/21 1056


VAERS ID: 1641123 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor 40mg, Cozaar 100mg, Nexium 40mg
Current Illness: covid19 diagnosed positive 8/9/2021
Preexisting Conditions: hyperlipidemia, hypertension, obesity, gerd
Allergies: codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: received vaccine 8/26/2021 - unknown time - unknown location but IM injection - started having nausea and vomiting 8/27/2021 AM and high fever of 103.2F orally


VAERS ID: 1641124 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dehydration, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: low blood pressure of systolic 64 per emt
CDC Split Type:

Write-up: patient fainted ( syncope) after standing up post vaccination about 7-10 minutes after the vaccine. we then had him lie down while calling 911. Emt came around 5 minutes later stating he was mostly dehydrated. They gave him an iv of saline and took him to the hospital.


VAERS ID: 1641134 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye pain
SMQs:, Glaucoma (broad)

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

Write-up: Pt. reported a sharp, severe pain in right eye. Vitals taken and noted


VAERS ID: 1641160 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Injection site erythema, Injection site pain, Injection site warmth, Oropharyngeal pain, Uterine dilation and curettage
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

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

Write-up: Employee received the Pfizer vaccine dose #1 on 08/27 at the campus vaccine event. The injection was in the right upper arm in deltoid. Started have symptoms after vaccination (8/27): Sore and redness at injection site and warm to touch, headache, sore throat,light head, dizziness . Has been off of work since 08/27. Advise to call back if symptoms worsen and get better if a follow up call, PCP follow up if needed. As well to put cold compress on site and take ibuprofen or Tylenol


VAERS ID: 1641176 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None Known as of the date of this report.
CDC Split Type: SC202145

Write-up: Patient was vaccinated with a Moderna injection at 16 years of age. At the time of this VAERS being submitted, Moderna is only authorized for 18 years of age and older.


VAERS ID: 1641188 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pharyngeal hypoaesthesia, Pharyngeal swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Proair, albuterol, symbicort, vitamin D, ibuprofen prn
Current Illness: none
Preexisting Conditions: asthma
Allergies: avacado - throat swelling / itchy. no history of epi pen use in the past. no hx of allergies or reactions to vaccinations in the past
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was given vaccine at 10am. Patient started having an itch and numbness feeling in her throat about 10-15 minutes after the covid-19 vaccine was given. She was given Benadryl 25mg liquid (10ml). Vitals were taken and normal. Her tongue was not swollen. She started to feel her throat swelling. an additional dose of benadryl was given (75mg in 30mL) for a max total of 100mg. EMS was called. EMS arrived about 10 minutes later. She was feeling better and declined EMS trip to the hospital. She was observed for 15 more minutes and left home. Her husband was the driver and will continue to monitor her all day. They were both educated to continue watching for any throat swelling, tongue swelling, difficulty breathing, etc. Educated to call EMS is she has any new or worsening symptoms. Educated on contacting her PCP about the 2nd covid-19 vaccine dose as she would likely need to have it at a higher level of care (hospital/dr office) and may need another type of vaccine (moderna vs J&J vs not get a second dose).


VAERS ID: 1641234 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site nodule, Injection site pain, Injection site warmth, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Employee received the Pfizer vaccine dose #2 on 08/25 at a campus vaccine event. The injection was in the left upper arm in deltoid. Started have symptoms after vaccination (8/27): Sore and redness at injection site and warm to touch a little knot and body aches. has been taking ibuprofen and drinking fluids Advise to call back if symptoms worsen and get better if a follow up call, PCP follow up if needed. As well to put cold compress on site and take ibuprofen or Tylenol. Spoken with PCP and was told to monitor due to underlying medical history


VAERS ID: 1641238 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Influenza like illness, Pain in extremity, Pulmonary pain, Pyrexia, Respiratory tract congestion
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: arm soreness (arm that was injected) that was prominent and lasted for four days.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm, pronounced body aches, extreme fatigue, severe headache, upper respiratory stuffiness, lungs ache with deep breaths, chills, slight fever. Literally feels like I have a bad case of the flu.


VAERS ID: 1641246 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Phenergan, Estrace, Amitriptyline, Propanolol, Miralax, Xanax, Prozac, Pepcid, Nasonex, Methylphenidate
Current Illness: Potts, Sjogren''s Syndrome, Pseudocholinesterase deficiency
Preexisting Conditions:
Allergies: Restasis, succinylcholine Chloride, Xiidra, Gabapentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 15 minutes of receiving a second Moderna vaccine patient reported itching of face, arms back and chest. Also experienced shortness of breath, increased heart rate and tingling in hands. Patient evaluated by EMS


VAERS ID: 1641252 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased, Chills, Dizziness, Feeling cold, Hyperhidrosis, Malaise, Tunnel vision
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Optic nerve disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: type 1 diabetes, hypertension
Allergies: iodine, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: After about 10 minutes after received the vaccine, patient experienced tunnel vision, feel like passing out, sweating, cold and chill. No shortness of breath or angioedema. Patient was alerted and oriented. We decided to go ahead and gave patient 1 dose of EpiPen + 1 dose of Benadryl and a bottle of water. After received EpiPen dose, patients reported to feel better, we asked patient to sit outside at the waiting area to continue monitoring. However, after about 10 minutes later, patient reported do not feel well, sweating on his palms and feel cold. At this point we decided to call 911 after asking the patient. Patient also called his wife to come and pick him up. While waiting for paramedic to arrive, I tested his blood sugar and his blood sugar is high (286mg/dl). Patient reported he is type 1 DM and has not have breakfast this morning. After paramedics arrived, they assisted him to go outside the store to wait for his wife


VAERS ID: 1641255 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Dysphagia, Rash macular, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: anaphylactic reaction started 15 minutes after the injection, with blotchy skin, throat irritation and cannot swallow own saliva. EpiPen administered immediately with improvement.


VAERS ID: 1641256 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, 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? 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: None, NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received first dose of Pfizer vaccine at 10:35 am. At 10:47 am, patient felt dizzy and stated that she " didnt feel well". RN assessed patient, Vitals : BP 107/60, HR 84 Spo2: 100 %. Heart and lung sounds clear. RN gave 1 orange. 10:50 am, patient still feels dizzy, patient is pale in color. RN gave another orange. Patient is starting to present initial signs of syncope, patient is layed on the floor feet are put up on a chair. Vitals : BP 92/40, HR 56 SPO2 94%. Patient is sternal rubbed to wake up. RN gives ammonia inhalant to patient. Patient is in and out. RN calls 911. 11:05 paramedics arrived, vitals 90/50, Glucose check 73. Patient still feels dizzy. Patient is taken by ambulance


VAERS ID: 1641274 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / SYR

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

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

Write-up: Patient received 0.5ml Pfizer instead of 0.3ml Pfizer for second dose of COVID19 vaccine series. (Pharmacy) and (Health Office) were contacted, Pharmacist and lead clinician instructed to do VAERS and incident report. Patient and wife were explained the situation that additional 0.2ml of the Pfizer vaccination was given ? they were willing to wait an extra 15 minutes post dose. After 30 minutes, patient felt fine. Both patient and wife are calm and understanding. Asked for a number they can contact should they need to reach someone in the next few days. Gave them phone number for an HCP, per instructions. They left the vaccination sire at 0953.


VAERS ID: 1641277 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: itchy, swollen and red


VAERS ID: 1641293 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Feeling hot
SMQs:, Taste and smell 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Levofloxacin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt described "funny taste in mouth" 2 minutes after receiving the vaccine, felt heat wave. Received 25mg of Benadryl 5 minutes after dose then another 25mg of Benadryl


VAERS ID: 1641304 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / -

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

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

Write-up: Patient received Janssen vaccine in left arm and vasovagaled about 10 minutes after receiving vaccination. Patient reports feeling diaphoretic and light headed. Denies any symptoms of Shortness of breath, throat swelling, difficulty breathing or itching


VAERS ID: 1641305 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 RA / IM

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

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

Write-up: partial dose given - part of dose leaked out of hub of syringe/needle


VAERS ID: 1641310 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Flu shot. I was 12. Had to be brought back to the doctor following illness after vaccine.
Other Medications: Hormonal Birth Control
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Have not been to the doctor.
CDC Split Type:

Write-up: Approximately 3:30 AM on the 27th, a most severe headache began. It continued in its severity until 1pm in the afternoon on the 27th. This was experienced with lethargy. I rarely get headaches and when I do, they are never this painful.


VAERS ID: 1641314 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pollakiuria
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seroquel, Wellbutrin, topamax, klonipin, Armour Thyroid, estrogen patch, progesterone, vit D, Benedryl
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Excessive urination, pain at injection site, headache, fatigue, chills


VAERS ID: 1641324 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-10
Onset:2021-08-27
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Fatigue, Myalgia, Psoriasis, Psoriatic arthropathy
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: first Covid Pfizer vaccine, same lot number
Other Medications: N/A
Current Illness:
Preexisting Conditions: Patient has psoriasis with pulmonary manifestations and asthma
Allergies: N/A
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient is having a flare up of psoriasis symptoms, including psoriatic arthritis (muscle ache and weakness, fatigue)


VAERS ID: 1641332 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-04
Onset:2021-08-27
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Fall, Hip fracture, SARS-CoV-2 test positive, Subarachnoid haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (narrow), Osteoporosis/osteopenia (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 was admitted for subarachnoid hemorrhage and right hip fracture post unwitnessed fall, found to also be COVID positive.


VAERS ID: 1641334 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid .50mg, DetrolLA4mg, VitB12 1000IU
Current Illness: NONE
Preexisting Conditions: Breast cancer
Allergies: Compazine, Demerol, Topical Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1641369 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-19
Onset:2021-08-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, low dose aspirin
Current Illness:
Preexisting Conditions: Recurrent pericarditis, several spine issues
Allergies: Cymbalta, topomax, savella
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen, red, itchy arm at injection site, fatigue


VAERS ID: 1641383 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-24
Onset:2021-08-27
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW02N / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Autoimmune thyroiditis, Blood test, Dehydration, Dizziness, Dry throat, Fatigue, Feeling cold, Hyperhidrosis, Mobility decreased, Pain, Pain in extremity, Pharyngeal swelling, Syncope, Thyroid hormones decreased, Ultrasound scan
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax .05
Current Illness: Asthma
Preexisting Conditions: Swollen throat for 5 weeks. Unable to move from exhaustion and have to lay in bed since shot. Very weak and aches. Doctors 2 weeks after my shot diagnosed me with Hashimotos disease
Allergies: Animals blood and animals saliva Asthma Soil, fertilizer , grass, dust, dirt, dairy
Diagnostic Lab Data: Ultra sound on neck twice, blood taken several times and found low thyroid levels 2 weeks after shot and then again 3 weeks after ans then again 4 weeks after and thyroid levels keep dropping. Most recently thyroid level at 8.9. Going again to doctor on September 17. Seen 5 different doctors
CDC Split Type:

Write-up: Painful arm, dry throat, dizzy, faint, dehydrated, freezing and sweating, unable to walk or move, body aches, swollen throat for 5 weeks. Diagnosed with Hashimotos and now take .50 synthroid medication daily


VAERS ID: 1641386 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3138 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood glucose, Condition aggravated, Electrocardiogram, Feeling abnormal, Feeling hot, Moaning, Movement disorder, Muscle spasms, Nausea, Paraesthesia, Presyncope, Sensory loss
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Approx 3 minutes after the patient had the shot, he stated, "Ma''am I''m starting to get hot." Pharmacist went over to patient. She then took his blood pressure (105/52) and pulse (~50 bpm). He was asked to open his mouth to ensure there was no swelling. He did not have swelling of the tongue or throat. He then stated that his hands are starting to feel tingly and he was feeling nauseas. He refused water. Eventually the patient moved from the chair to lay on the ground. At that time, he stated that "the tingling has moved to my face". His blood pressure was taken again and it was 142/94. He continued to talk and but was moaning whenever he was not talking. Patient was monitored and he reported continued tingling and now some cramping. He then said that he couldn''t move anything and became frozen in his position. His hands were in front of his body in an odd position and not moving. He continued to talk throughout and said that he can''t move. This went on for ~15 minutes. During that time, 911 was called and informed. After 15 min, patient reported that he was starting to have returned sensation to his hands and legs. He reported that he had a vagal response previously to an IV and he felt that this was similar but not as severe. Paramedics arrived about 30 minutes after the start of his symptoms. They took over care of the patient. They took his BP, blood sugar, and ekg since patient reported a heart murmur. Patient also stated that he had not eaten since early in the morning. He was now willing to try eating and drinking since he did not feel as bad. He was then helped to a chair from the floor. The paramedic commented that he was weak. Patient refused ambulance and was asked to not drive home. Paramedics left and patient stayed for an additional 15 minutes. Patient was in the store approx an hour after he received his vaccine. Patient''s daughter came and gave her father a ride home. Patient then walked out on his own accord.


VAERS ID: 1641407 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Systemic: Weakness-Medium, Additional Details: after the first pfizer covid vaccine, patient was lightheaded and seemed on the verge of fainting


VAERS ID: 1641409 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: no illnesses reported.
Preexisting Conditions: no chronic or long-standing health conditions.
Allergies: no known allergies
Diagnostic Lab Data: Called paramedics.
CDC Split Type:

Write-up: Patient started not feeling well, then started throwing up


VAERS ID: 1641410 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: experienced emesis immediately after receiving injection with dizziness


VAERS ID: 1641416 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: V/S 124/88, 76, 18, O2 stat-100% on RA, pt stated, "she feels dizzy, room spinning". Encouraged pt to push fluids, offered snacks, educated to stay til 11am to be monitored. Reassessed at 11am, pt states, ''she feels better'' Denies dizziness/room spinning, cleared for discharge. VS at time of dismissal is 120/70, 72, O2 stat-97% on RA.


VAERS ID: 1641419 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-24
Onset:2021-08-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sunburn like patch


VAERS ID: 1641423 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Peripheral coldness
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PT HAS NOT FILLED ANY PRESCRIPTION MEDICATIONS WITH US SINCE JULY 2021.
Current Illness: UNKNOWN
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PT STATED THAT THE FINGERS ON HER RIGHT HAND FELT COLD AND NUMB AFTER RECEIVING MODERNA. SHE REPORTED THIS DURING THE 15 MINUTES OBSERVATION PERIOD POST INJECTION. SHE SAID SHE HAD NO OTHER ISSUES/SYMPTOMS/SIGNS


VAERS ID: 1641440 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Malaise, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Said he felt sick after vaccination and vomited. BP 124/82, HR 87, O2 97


VAERS ID: 1641441 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

Write-up: Patient reported dizziness five min after getting shot. She turned white and lost conscience for a couple seconds. Response team was called and patient was taken to the ER


VAERS ID: 1641448 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-05
Onset:2021-08-27
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cerebral infarction, Computerised tomogram head abnormal, Intentional overdose, Mental status changes, Poisoning, Suicidal ideation, Unresponsive to stimuli
SMQs:, Suicide/self-injury (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Drug abuse and dependence (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN, Cervical spine fracture, Schizophrenia, GERD,COPD, Anxiety and Depression
Allergies: NKA
Diagnostic Lab Data: 8/26/2021 CT of head indeterminant infarcts; 6404 for suicidal ideation. Has been on room air
CDC Split Type:

Write-up: Ongoing hospitalization. Found by EMS unresponsive in hotel room when quarantining in hotel for COVID. Stated he was trying to kill himself. Intentional overdose. Altered mental status, intoxicated.


VAERS ID: 1641465 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Feeling cold, Loss of consciousness, Malaise, Seizure like phenomena
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), Convulsions (narrow), 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)

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 reported
Current Illness: None reported
Preexisting Conditions: Asthma
Allergies: Augmentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient feel down ( passed out ?) probably hit her head on the wall. Looked like she had a seizure, but lasted 30 seconds (?) then she was aware. Complained of being cold, but hot to the touch. Did not feel well. EMT was called.


VAERS ID: 1641475 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: Pt feeling lightheaded post vaccine administration. BP 88/60,HR 57, O2 99%


VAERS ID: 1641487 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-19
Onset:2021-08-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Blister, Pain in extremity, Pruritus, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: none reported
Diagnostic Lab Data: none reported
CDC Split Type: Covid 19

Write-up: Woke up today and reported to his mother that his left foot and ankle were hurting and itching. When mom looked at the left leg, she said that it had a rash with a few small blisters on it. She put anti-itch cream on it and sent him to school.


VAERS ID: 1641491 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Basophil percentage increased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium decreased, Blood sodium normal, Blood urea normal, Carbon dioxide normal, Chest X-ray normal, Coronavirus test negative, Eosinophil percentage decreased, Full blood count, Haematocrit normal, Haemoglobin normal, Metabolic function test, Pharyngeal swelling, Platelet count normal, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: 8/9/21 COVID-19 vaccine
Other Medications: Alendronate, amlodipine, aspirin, Align, Trulicity, vitamin D3, famotidine, ferrous gluconate, flax seed oil, folic acid, hydrochlorothiazide, leflunomide, linaclotide, magnesium oxide, metformin, montelukast, potassium chloride, pravastati
Current Illness: Mild allergic reaction to 1st dose of COVID-19 vaccine (Pfizer)
Preexisting Conditions: Diabetes, hypertension, hyperlipidemia, fibromyalgia, relapsing polychondritis
Allergies: Food allergies - nuts, seafood, shellfish, soybean, wheat; Medication allergies - codeine, iodine, penicillin, vancomycin; Environmental allergies
Diagnostic Lab Data: 8/27 Chest x-ray: no acute abnormalities in the chest/lungs 8/27 BMP: Na 141 / K 2.7 / Cl 106 / CO2 25 / BUN 15 / Cr 0.8 / Glucose 116 8/27 CBC: WBC 15.6 / Hgb 13.3 / Hct 40.3 / Plt 339, eos 0.2%, baso 1.4% 8/27 Coronavirus NAA: not detected
CDC Split Type:

Write-up: Approximately 15 min following 2nd dose of COVID-19 vaccine, pt began experiencing throat swelling. Administered epinephrine 0.3 mg IM x 1 (EpiPen autoinjector). Transported to Emergency Department for further evaluation; additional medications were given, including: epinephrine 0.3 mg subQ x1, methylprednisolone 125 mg IV x1, diphenhydramine 50 mg IV x1, famotidine 40 mg IV x1. Pt admitted to hospital for observation. ***Due to reaction following 1st dose of COVID-19 vaccine that resulted in Emergency Dept visit, pt had pre-medicated with prednisone 60 mg/day x 3 days (8/25-8/27) and diphenhydramine ~30-60 min prior to vaccine***


VAERS ID: 1641493 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Feeling abnormal, Headache, Joint stiffness, Muscle spasms, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Woke up with a headache, a 101.3 fever, muscles feel like Charlie Horses, all my joints are painfully stiff, my head is ?muddled,? and I have painful white dots that are sensitive to touch all over my back.


VAERS ID: 1641496 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Experiencing hives on upper R arm after vaccine. Also had headache and felt hot. BP 174/90, HR 94, Respirations 20 SaO2 99%. Pt sat in ambulance with AC to cool off then left.


VAERS ID: 1641508 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient answered yes to question having Leukemia.
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: On Friday, August 27, 2021 at 10:58am, 69 YO M was given a third dose of Moderna vaccine. The vaccine administered on 8-27 was withdrawn from a vial that had been punctured on 8-26 at 8:28am.


VAERS ID: 1641509 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-08-27
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / SYR

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

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

Write-up: Fully vaccinated tested positive for covid-19 with multiple symptoms


VAERS ID: 1641511 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Loss of consciousness, Tremor
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), Parkinson-like events (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt passed out in vehicle after vaccine. Pt had excessive sweating and trembling. Said she felt lightheaded and dizzy. 20 post vaccine pt felt "normal" again.


VAERS ID: 1641517 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NONE
CDC Split Type:

Write-up: PATIENT RECEIVED MODERNA VACCINE FOR DOSE 1 AND DOSE 2. INADVERTENTLY RECEIVED PFIZER VACCINE FOR DOSE 3.


VAERS ID: 1641520 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Expired product 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: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: An injection is given outside of the regulated time frame. Vial received 08.12.2021 and injection given 08.27.2021. Vial maintained in refrigerated condition since receiving. Receiver reporting no adverse conditions associated with the injection. The receiver was monitored for 15 minutes after injection for severe reactions with none noted. Will continue to monitor for 72 hours for any reactions that may be delayed.


VAERS ID: 1641521 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-16
Onset:2021-08-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site warmth, Pyrexia, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Delayed reaction of what I discovered is referred to as "Moderna Arm" This morning, 11 days after my 1st dose, I noticed a smaller size rash on my left arm at the injection site and as the day has progressed the rash has gotten bigger, began to itch and has heat to the touch. I also feel feverish and feel as though there is a lump in my throat.


VAERS ID: 1641524 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 LA / IM

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

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

Write-up: On Friday, August 27, 2021 at 10:54am, 34 YO F was given a second dose of Moderna vaccine. The vaccine administered on 8-27 was withdrawn from a vial that had been punctured on 8-26 at 8:28am.


VAERS ID: 1641526 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Product preparation error
SMQs:, Medication errors (narrow)

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

Write-up: Patient received undiluted dose of vaccine


VAERS ID: 1641528 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-05
Onset:2021-08-27
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Influenza like illness, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor Wellbutrin Cosentyx Fiber Benicar Omeprazole hydrochlorothiazide Januvia Metformin
Current Illness: None
Preexisting Conditions: Psoriatic arthritis
Allergies: Ace inhibitors
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Flu like tiredness, no energy--I have had and still have all of these symptoms Headache Dizziness Ringing in ears


VAERS ID: 1641534 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 LA / IM

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

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

Write-up: On Friday, August 27, 2021 at 12:10pm, 47YO F was given a second dose of Moderna vaccine. The vaccine administered on 8-27 was withdrawn from a vial that had been punctured on 8-26 at 8:28am.


VAERS ID: 1641545 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient had a syncope episode after her Janssen vaccine. She was monitored for 15 minutes and her husband came to pick her up.


VAERS ID: 1641562 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / UNK - / -

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

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

Write-up: Family came in with child that had an appointment with a birthday of 10/09/2008. When asked the child repeated this birthday. When we checked Immunization Registry we found that the child''s real birthday was 10/09/2009. Making the child 11 and not 12.


VAERS ID: 1641569 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blepharospasm, Cyanosis, Dyspnoea, Loss of consciousness, Musculoskeletal stiffness, Seizure, Seizure like phenomena, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (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: history of fainting
Other Medications: Terbinafine and Clotrimazole/betamethasone were both picked up today but not started. history of minocycline use
Current Illness: none
Preexisting Conditions: history of passing out upon vaccination
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out and also had seizure like symptoms including muscle stiffness and shaking with minor convulsions, blue lips, and eye twitching behind eyelid. Patient also had trouble breathing during episode. Seizure like symptoms lasted approximately 15 seconds. EMS was called. Patient recovered fully and walked out of store under own power. She denied further evaluation by EMS and plans to follow up with doctor.


VAERS ID: 1641572 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Dizziness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: patient has became light headed and dizzy with a drop in blood pressure in the past
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: Polyethylene Glycol (PEG), polysorbate, citric acid or ethanol,
Diagnostic Lab Data: we measured the patients blood pressure. 1st measurement: 61/42 After 10 minutes we measured again 2nd measurement: 107/64
CDC Split Type:

Write-up: Prior to receiving the vaccine the patient reported previously drops in blood pressure to vaccines in the past. 5 minutes after administering the janseen vaccine the patient began to feel lightheaded and dizzy and complained of blurred vision.


VAERS ID: 1641576 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / IM

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

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

Write-up: Tonic-clonic seizure started about 7 minutes after receiving dose. Lasted about 30 seconds. Arms and legs jerking. After about 30 seconds patient gained conciseness again.


VAERS ID: 1641583 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abnormal sensation in eye, Dizziness, Headache, Malaise, Skin warm, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Gave covid vaccine at 1312 in the left arm. Patient returned to work at appointment desk. At approx. 1400 patient went into another room and that she felt ill. Patient leaned forward in her chair stating she did not feel well and felt like she had a headache and vision was off (eye balls loose in her head). Took patient''s blood pressure and it was 123/66 with a pulse of 67. While taking patient''s blood pressure, she stated that she felt like she was going to faint. Patient felt warm to the touch so we took her temperature and it was 97.7. Patient was given a water bottle and advised to drink. A cold pack was placed on back of patient''s neck. After a few minutes patient stated that she was feeling well enough to move into another room. After sitting for a couple of minutes all feeling passed other than being cold and patient returned to work 40 minutes after symptoms onset.


VAERS ID: 1641584 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-09
Onset:2021-08-27
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LF3180 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: immediately after 2nd dose - see prior reports (there''s 2 reports) also have had a headache every day since the first dose - see
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Today I woke up with awful ringing in my left ear only. It hasn''t stopped ringing. Right ear isn''t giving any problems.


VAERS ID: 1641598 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:1983-06-18
Onset:2021-08-27
   Days after vaccination:13950
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dysphagia, Oxygen saturation, Vital signs measurement
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Possibly on BUspar, claritin and flonase
Current Illness: anxiety - new med buspar insect bites,- keflex
Preexisting Conditions: anxiety
Allergies: amoxil zoloft
Diagnostic Lab Data: Exam- pulse ox, vitals patient was given Benadryl 25mg IM , She became jittery and teeth chattering , decreased O2 saturation, monitored and all vitals returned to normal. Only abnormal vital was o2 sat and could have been from positioning was the cause of the drop.
CDC Split Type:

Write-up: Patient felt as if her it was difficult to swallow.


VAERS ID: 1641627 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Injection site pruritus, Injection site vesicles
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: Asthma.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy blister at the injection site.


VAERS ID: 1641633 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 RA / IM

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

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

Write-up: Patient came in for a visit, 8 days post vaccine administration, with a chief complaint of a rash. No rash noted but right lower leg swelling noted. Out of abundance of caution, patient advised to go to emergency room to rule out DVT.


VAERS ID: 1641636 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Fatigue, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: HISTORY OF LIGHT HEADEDNESS AND FAINTING
Other Medications:
Current Illness:
Preexisting Conditions: HISTORY OF SEIZURE, ANXIETY UPON VACCINATION
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upon receiving the 1st COVID Vaccine, patient felt dizzy and fainted within 2 minutes for receiving vaccine. Patient also experience an episode of seizure lasting roughly 1-2 minutes. Patient''s eyes were closed during this time. Patient after was extremely tired and became awake. 911 was called and paramedic did arrive. Patient was provided comfort for 15-20 minutes until paramedics arrived.


VAERS ID: 1641640 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Pain, Skin warm
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely swollen lymph node in left armpit-- painful and warm to touch Have been taking 1000mg of Tylenol every 6 hrs since 2am on August 27th.. woke up in pain


VAERS ID: 1641646 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: none


VAERS ID: 1641649 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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: no known and none listed or reported when being vaccinated
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called at 1:50 and reported numb and tingling right arm, right leg and top of left leg


VAERS ID: 1641650 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

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

Write-up: Pt felt like he was going to pass out while getting the vaccine shot. Said he has a hx of syncopal episodes when receiving shots. He was placed in ambulance and felt better after a few minutes.


VAERS ID: 1641651 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Disorientation, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum Men
Current Illness: Hypertension. Diabetes. Might be Anemic.
Preexisting Conditions: Hypertension. Diabetes. Family history of both.
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Client felt disoriented and legs weak. 2-3 minutes after his observation period, as he was walking out. His vitals at 1435, O2 -97, HR - 84, BP, 122/90. Client was cleared at 1445.


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