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From the 7/23/2021 release of VAERS data:

Found 506,830 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 71 out of 5,069

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VAERS ID: 1437728 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-22
Onset:2021-06-30
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Paraesthesia, Rash pruritic, Skin warm
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), 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: Levothyroxine 125 mcg daily Melatonin 3 mg PRN bedtime
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfonamides
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Large circular rash at injection site 8 days after first injection. Rash is itchy and slightly warm. There is some slight tingling in the hand/fingers on that side of body (left).


VAERS ID: 1437732 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

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

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

Write-up: Patient fainted at the front of the store approximately 15 minutes after receiving her vaccine. I did not witness the faint but was told that she fell to the ground and within seconds was awake. When I reached the front she was sitting upright and stated that she felt ok. She had been given something to drink and was given an ice pack. Patient''s mother stated that she is prone to fainting and has fainted before after having blood drawn.


VAERS ID: 1437751 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-28
Onset:2021-06-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: na
CDC Split Type:

Write-up: infraclavicular lymphadenopathy on the left - same side as vaccination 2 days prior


VAERS ID: 1437772 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Nausea, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirizine 10 Mg
Current Illness: Patient''s mother stated that one week prior Patient had just recovered as she had experienced a sore throat that lasted 2-3 days.
Preexisting Conditions: N/A
Allergies: Almond
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient began to experience dizziness, nausea, vomiting, and tremors 3 minutes after vaccine was administered. A code blue was immediately called and patient was examined by provider. Vitals were take and paramedics were called immediately. Patient was transported to Hospital for further evaluation.


VAERS ID: 1437777 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

Write-up: Dose was given about 1 hour after BUD had passed. Patient was monitored closely for at least 30 minutes, had no reactions. Manufacturer was called.


VAERS ID: 1437782 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Dry mouth, Feeling jittery, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (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: MACROBID 100MG , ARMOUR THYROID 45MG, VALACYCLOVIR 500MG, FLONASE 50MCG/INH, LORATADINE 10MG, BI-EST PUMP 5MG/GM CREAM, PROGESTERONE PUMP 20MG/GM CREAM.
Current Illness: NONE
Preexisting Conditions: ANXIETY, CHRONIC UTI, DEPRESSION, HERPES OCULAR, HYPERLIPIDEMIA, HYPOTHYROIDISM, PERIMENOPAUSAL, SEASONAL ALLERGIES
Allergies: LATEX, NEOSPORIN, SULFA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt was on 15 min observation following injection. After approximately 10 min pt began to complain of feeling like her heart was racing, dry mouth and feeling "Jittery", dizzy and weak


VAERS ID: 1437783 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Pt''s mother described an injection site reaction that was swollen and hard to the touch, as well as red and raised above the skin. Did not describe any other pain outside of regular arm soreness nor any itching. Diphenhydramine oral or topical was recommended by the pharmacist on duty whom she described the reaction to.


VAERS ID: 1437797 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Patient fainted, she regained consciousness within 5 seconds, she vomited & she was lethargic. Paramedics arrived at the scene within 10 minutes and treated the patient off site.


VAERS ID: 1437807 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

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

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

Write-up: Pt received Pfizer vaccine though patient was previously vaccinated with Moderna, Moderna was given about a month ago


VAERS ID: 1437817 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Nausea, Seizure
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: UPON MY TECHNICIAN GIVING THE VACCINE, PATIENT FELT WEAK AND MY TECHNICIAN DESCRIBED HER AS HAVING A SEIZURE TYPE REACTION FOR A FEW SECONDS. THE PATIENT THEN FELT NAUSEOUS AND NEEDED TO LIE ON THE GROUND. UPON ARRIVAL OF THE PARAMEDICS, THEY EVALUATED PATIENT AND STATED THAT SHE WAS FINE AND DID NOT THINK THAT IT WAS A TRUE SEIZURE. PATIENT AND HER MOTHER LEFT THE PHARMACY AFTER FURTHER OBSERVATION WITH NO OTHER ISSUES THUS FAR.


VAERS ID: 1437855 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Vitals: Pulse: 100 SPO2: 98% B/P: 108/68 Physical Exam: Normal
CDC Split Type:

Write-up: AE: patient felt dizziness and was lightheaded 1 minute after the dose administration. Treatment: patient was offered water and rested for 30 minutes. water and rest helped resolve the symptoms. Outcome: patient was discharged to POV/Home.


VAERS ID: 1437856 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, Loss of consciousness, Skin abrasion
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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: none
Preexisting Conditions: not known
Allergies: none
Diagnostic Lab Data: ambulance called , he refused
CDC Split Type:

Write-up: passed out , hit head on ground has abrasion above eye


VAERS ID: 1437874 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

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

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

Write-up: Mixed series. First dose Pfizer on 6/9/21 lot #EW0180


VAERS ID: 1437876 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-28
Onset:2021-06-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Pt received shot on 6/28/21. Pt''s grandmother contacted pharmacy on 6/30/21 stating patient had broken out in hives over her face and hands. Pharmacy advised to start taking Benadryl for the hives and to not get the second shot due to concern the allergic reaction could escalate. Grandma will follow up with pharmacy in 24 hours to update on pt''s condition.


VAERS ID: 1437877 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypertension, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (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: not known
Current Illness: no
Preexisting Conditions: hypertension
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient claims after the 15 minute observation time that she had tingling in both arms. She claims never to have felt this before. She was asked if she felt short of breath, itchy, or dizzy to which she responded "no". She was asked to sit down for observation, rescue was called and arrived on scene. Patient was fine at the time rescue came, her blood pressure was high and she refused to be taken to the hospital.


VAERS ID: 1437885 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature decreased, Hypotension, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Nausea, vomiting, hypotension and drop in body temperature


VAERS ID: 1437894 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       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: None known
Current Illness: None according to vaccination record
Preexisting Conditions: None according to vaccination record
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient fainted after she received Pfizer 1st dose.


VAERS ID: 1437915 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Reported lightheadedness, brought via wheelchair to medical screening for evaluation by medics. Pale, diaphoretic. Initial : Pulse: 40 B.P. 70/35 Repeat: Pulse: 60 B.P. 104/66 Left in stable condition at 16:35 p.m. Recorded by medical proffesional


VAERS ID: 1437938 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-03-25
Onset:2021-06-30
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Allergy test negative, Blood test normal, Computerised tomogram normal, Diarrhoea, Laboratory test normal, Presyncope
SMQs:, Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: I have some prescriptions that I take every day as part of normal routine.
Current Illness: No
Preexisting Conditions: No
Allergies: I have allergies to medications except antibiotics.
Diagnostic Lab Data: I had to get a CT Scan, food allergies tests, blood test (potassium was way down and I was really sick), and other tests were performed as well.
CDC Split Type: vsafe

Write-up: I am experiencing a bad case of diarrhea since the end of April and have been into the Doctor several times and all the tests run came back negative. I''m on anti-diarrhea medication (Lomotil) which is helping somewhat but I don''t like taking medicine because I have to rely on the medication to perform my daily routine plus having to wear pads all the time is an inconvenience for me. I had to go to the ER because I had a episode of near fainting.


VAERS ID: 1437944 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-23
Onset:2021-06-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

Write-up: Vial expires 6 hours after the first puncture. Patient was administered one dose of the vaccine 48 hours after the vial was punctured. Patient was observed at the clinic for 15 minutes after the vaccine was given and he did not experience any adverse reactions. Patient was then discharged home. No new events have been reported by the patient at this time.


VAERS ID: 1437948 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO177 / UNK - / IM

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

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

Write-up: Patient complaint of generalized itching w/o hives 15 minutes after vaccination.


VAERS ID: 1437950 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

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

Write-up: Patient (13 years old) came with his mother at 10:36AM for second dose of the Pfizer vaccination the Covid-19 clinics that are celebrated Wednesdays and the patient is not allergic to medications only seafood and the first dose there was no adverse reaction. When he was asked to wait for 15 minutes assistant that was in the Clinic informed me Pharmacist on duty that the boy felt dizzy and was vomiting. I went to their location with alcohol to inhale. We allocated the head between the legs. At 10:47AM blood pressure reading was taken BP= 112/70 P=101. Mother indicated he only had a juice for breakfast. At 10:52AM he was given liquid BENARDYL 10ml as anti-hemetic to vomiting. In this course we closed the treatment. As the patient was feeling better. We took another reading at 11:07AM BP=113/90 P=94. When the patient felt better 55 minutes he left with his mother. I called the mother of the patient at 4:18PM to know how patient continued and she told me after they left the patient went out to eat and was good and was sleeping. Assistant helped me.


VAERS ID: 1437953 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity, Product administered to patient of inappropriate age
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: At the current time as stated by dad with the assistance of an interpreter There was no known medical or allergies noted
Current Illness: None
Preexisting Conditions: None
Allergies: No allergies to any medication as stated by dad via interpreter
Diagnostic Lab Data: No Medical test were done
CDC Split Type:

Write-up: Patient returned to receive her second injection for COVID vaccine. as stated in first report Dad identified patient as his daughter with interpreter inadvertently was give the Moderna vaccine requested by the dad. According to the dad with interpreter assistance she had no adverse reaction. Dad stated with the assistance of (interpreter) the only thing she complained of was a sore arm.


VAERS ID: 1437955 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Incorrect product formulation 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: Received PFIZER DOSE on 6/30/21, but his first dose was Moderna Given on 6/2/21. Client remain asymptomatic and stayed 15 minutes for observation.


VAERS ID: 1437962 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: passed out 5 min after receiving the vaccine


VAERS ID: 1437967 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW162 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA;VENTOLIN HFA) 90 mcg/actuation inhaler Dosage: Inhale 2 puffs 4 (four) times a day as needed for wheezing or shortness of breath. alpha tocopherol (VITAMIN E) 200 unit capsule Dosage: Take 200 Units by mouth dai
Current Illness: none
Preexisting Conditions: Problem List Date Reviewed: 6/30/2021 Endocrine Type 2 diabetes mellitus without complication, without long-term current use of insulin Respiratory Moderate persistent asthma without complication Reactive airway disease Cardiovascular and Mediastinum Essential hypertension Chronic migraine without aura without status migrainosus, not intractable Chronic combined systolic and diastolic congestive heart failure Nervous and Auditory H/O traumatic brain injury Partial complex seizure disorder without intractable epilepsy Peripheral polyneuropathy Bilateral leg weakness Other Generalized anxiety disorder Klonopin use disorder, moderate Blindness of left eye Elevated troponin Altered mental status Monocytosis Current tobacco use Influenza vaccine refused Pneumococcal vaccine refused Adverse effect of other drug primarily affecting the autonomic nervous system, initial encounter History of drug overdose Opioid dependence Chronic midline low back pain without sciatica Hypokalemia Drug overdose, accidental or unintentional, initial encounter Narcotic overdose Obesity (BMI 35.0-39.9 without comorbidity) Flu vaccine need Encounter for Medicare annual wellness exam Depression screening negative Colon cancer screening Cervical cancer screening Need for vaccination against Streptococcus pneumoniae using pneumococcal conjugate vaccine 13 Diabetic eye exam Encounter for colorectal cancer screening
Allergies: Office Visit Open 6/30/2021 Internal Medicine Type 2 diabetes mellitus without complication, without long-term current use of insulin +3 more Dx Follow-up Reason for Visit Progress Notes Internal Medicine Unsigned Expand All Collapse All Date: 06/30/21 Patient ID: is a 54 y.o. female Chief Complaint Patient presents with ? Follow-up HPI: Patient presents to clinic today for routine follow-up and medication refills. Was seen in the ED on 6/15/2021 for somnolence and possible seizure breakthrough. Is taking Depakote and Topamax as prescribed for seizures. Had labs at that time with a hemoglobin A1c at 8.1%. States is taking besides, Lantus and Xigduo XR prescribed for diabetes. States she does try to limit her carbohydrate intake but does drink 1-2 large sodas daily. ROS: Denies recent illnesses, no fever chills. Patient was offered the Covid vaccine and agreed to have this begin in the Pfizer Covid vaccine. Denies dizziness or blurred vision. Denies chest pain or shortness of breath. No abdominal pain or n/v. Appetite good and no changes in bowel and bladder habits. Sleeping well nightly with medication. Continues to have chronic pain from traumatic injury in the past Wt Readings from Last 3 Encounters: 06/30/21 238 lb (108 kg) 06/17/21 232 lb 14.4 oz (106 kg) 05/02/21 (!) 234 lb (106 kg) Past History Reviewed at Today''s Visit: Medical History Past Medical History: Diagnosis Date ? Anxiety ? Asthma ? CHF (congestive heart failure) following MVC injury ? COPD (chronic obstructive pulmonary disease) ? Diabetes mellitus ? Headache ? Hypertension ? Obesity (BMI 35.0-39.9 without comorbidity) 10/6/2020 ? Peripheral polyneuropathy 2/17/2021 ? Seizures ? Shortness of breath ? Substance abuse ? Traumatic brain injury ? Visual impairment Surgical History Past Surgical History: Procedure Laterality Date ? CRANIOTOMY related to trauma, has plate to top of head ? MANDIBLE SURGERY ? PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD N/A 3/10/2021 Procedure: COLONOSCOPY; Service: Endoscopy ? REPLACEMENT TOTAL KNEE Right ? REPLACEMENT TOTAL KNEE Left Family History Family History Problem Relation Name Age of Onset ? Cancer Mother ? Diabetes Mother ? Alcohol abuse Mother Current Outpatient Medications: ? albuterol HFA (PROVENTIL HFA;VENTOLIN HFA) 90 mcg/actuation inhaler, Inhale 2 puffs 4 (four) times a day as needed for wheezing or shortness of breath. (Patient not taking: Reported on 6/30/2021 ), Disp: 1 Inhaler, Rfl: 1 ? alpha tocopherol (VITAMIN E) 200 unit capsule, Take 200 Units by mouth daily. (Patient not taking: Reported on 6/17/2021 ), Disp: , Rfl: ? amLODIPine (NORVASC) 10 mg tablet, Take 1 tablet (10 mg total) by mouth daily. HTN, Disp: 90 tablet, Rfl: 1 ? budesonide-formoterol 160-4.5 mcg/actuation inhaler, Inhale 2 puffs every 12 (twelve) hours., Disp: , Rfl: ? busPIRone (BUSPAR) 15 mg tablet, Take 15 mg by mouth 2 (two) times a day. 1 tablet by mouth twice daily, Disp: , Rfl: ? carvediloL (COREG) 25 mg tablet, Take 1 tablet (25 mg total) by mouth 2 (two) times a day with meals. Heart and b/p, Disp: 180 tablet, Rfl: 1 ? dapagliflozin-metformin (Xigduo XR) 10-1,000 mg TBph, Take 1 tablet by mouth daily. Diabetes, Disp: 90 each, Rfl: 1 ? divalproex (DEPAKOTE) 250 mg extended release tablet, TAKE 1 TABLET BY MOUTH DAILY FOR seizures, Disp: 90 tablet, Rfl: 0 ? exenatide (Bydureon BCise) 2 mg/0.85 mL atIn, Inject 0.85 mL (2 mg total) under the skin once a week Indications: type 2 diabetes mellitus., Disp: 3.4 mL, Rfl: 3 ? gabapentin (Neurontin) 300 mg capsule, Take 1 capsule (300 mg total) by mouth 3 (three) times a day. Nerve pain (Patient taking differently: Take 600 mg by mouth 3 (three) times a day. Nerve pain ), Disp: 270 capsule, Rfl: 0 ? insulin glargine (Lantus Solostar U-100 Insulin) 100 unit/mL (3 mL) inpn injection, Inject 0.32 mL (32 Units total) under the skin nightly. Diabetes, Disp: 15 mL, Rfl: 1 ? lidocaine-prilocaine (EMLA) cream, Apply 2 to 3 grams (1 gram = 1 inch) to the affected area 4 times daily, Disp: , Rfl: ? losartan (COZAAR) 100 mg tablet, Take 1 tablet (100 mg total) by mouth daily. HTN, Disp: 90 tablet, Rfl: 1 ? nitroglycerin (NITROSTAT) 0.4 mg SL tablet, Place 0.4 mg under the tongue every 5 (five) minutes as needed for chest pain., Disp: , Rfl: ? pravastatin (PRAVACHOL) 40 mg tablet, TAKE 1 TABLET BY MOUTH ONCE DAILY AT BEDTIME FOR cholesterol, Disp: 90 tablet, Rfl: 0 ? prazosin (MINIPRESS) 1 mg capsule, Take 1 mg by mouth nightly Indications: high blood pressure. , Disp: , Rfl: ? promethazine 25 mg tablet, Take 25 mg by mouth every 6 (six) hours as needed for nausea or vomiting. , Disp: , Rfl: ? sennosides-docusate sodium (PERICOLACE) 8.6-50 mg per tablet, Take 1 tablet by mouth daily., Disp: , Rfl: ? topiramate (TopaMAX) 50 mg tablet, TAKE 1 TABLET(50 MG) BY MOUTH TWICE DAILY FOR MIGRAINE PREVENTION, Disp: 180 tablet, Rfl: 1 ? traZODone (DESYREL) 100 mg tablet, Take 200 mg by mouth nightly. Take two (2) 100 mg tabs by mouth daily at bedtime , Disp: , Rfl: ? UltiCare Pen Needle 31 gauge x 5/16" ndle, USE with victoza injection daily, Disp: 100 each, Rfl: 11 ? Viibryd 20 mg tab, Take 1 tablet (20 mg) by mouth daily with big meal, Disp: , Rfl: Allergies Allergen Reactions ? Opioids - Morphine Analogues Other (See Comments) Patient has a history of opiate dependence. ? Celecoxib Other (See Comments) ? Crab "Burning in mouth" ? Sulfa (Sulfonamide Antibiotics)
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient states she had never received a Covid Vaccine. Patient was offered vaccine. After injection was given patient stated she had received her first vaccine but was told it was not valid. After retrieving her card she had had the Moderna vaccine. Second dose given today was Pfizer.


VAERS ID: 1437969 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyskinesia, Eye movement disorder, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent HFA 44 mcg inhaler
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: Singulair
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately three minutes after administering the vaccine we heard the patient''s mother speaking her name several times with no response. One of the technicians was in the area and observed her with her arms tucked in front of her and her feet were moving back and forth in a repetitive motion with her eyes rolled back. After a few seconds she ceased that and said "I was sleeping" We called 911 and EMS came to check her out


VAERS ID: 1437974 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Feeling hot, Headache
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Synthroid, Gabapentin, Carbamazepine, oxycodone, Topiramate,
Current Illness: NONE NOTED
Preexisting Conditions: MULTIPLE SCLEROSIS
Allergies: NKDA
Diagnostic Lab Data: 1330 BP 160/100 P95 RR18 O2 SAT 95% RA 1340 BP 160/100 P97 RR 18 P97 O2 SAT 96 % RA
CDC Split Type:

Write-up: PATIENT DEVELOPED HOTNESS ALL OVER AND A HEADACHE AND AN INCHREASE IN BP. PATIENT DID NOT WANT EMS CALLED AND HAD HER HUSBAND DRIVE HER HOME I ADVIZED HER HUSBAND TO KEEP AN EYE ON HER AND IF HER SYMPTOMS CONTINUED TO CONTACT HER PRIMARY DOCTOR OR AND IF THEY GET WORSE TO CALL EMS.


VAERS ID: 1437975 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Dizziness, numbness on both arms. Evaluated by EMS-Cleared


VAERS ID: 1437983 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation 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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received Moderna for first vaccination, then received Pfizer for second dose.


VAERS ID: 1437995 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect product formulation 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Client presented at the vaccination clinic and reported that he had never received any doses of Covid vaccine. He received a first dose of Pfizer vaccine today without any obvious incident. In checking through our state database this afternoon, it was noted that the client had actually had a dose of Johnson and Johnson vaccine on 3/6/21, about which he had neglected to mention.


VAERS ID: 1438003 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

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

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

Write-up: Patient received Janssen vaccine previously in March per Pharmacy.


VAERS ID: 1438004 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821287 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: pt indicated on covid form
Other Medications: N/A
Current Illness: none
Preexisting Conditions: no
Allergies: not known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt felt dizzy and light headed, looked pale, sweating, nausea


VAERS ID: 1438006 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VYVANSE, ADDERRAL, CLONIDINE, VISTARIL, PROZAC
Current Illness: NONE KNOWN
Preexisting Conditions: ANXIETY, ADHD
Allergies: NONE KNOWN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: ADVERSE EVENT IS ONLY RELATED TO A DELAY IN THE INTERVAL OF ADMINISTRATION. PATIENT RECEIVED DOSE #1 ON 5/7/21. PT CANCELLED MULTIPLE TIMES FOR SECOND INJECTION. DOSE #2 GIVEN 6/30/21 ON DAY 54 POST INJECTION OF DOSE #1. SPOKE WITH MODERNA CUSTOMER CARE PRIOR TO ADMINISTRATION AND DISCUSSED LACK OF DATA SUPPORTING EXTENDED INTERVAL DOSING. DISCUSSED WITH PATIENT AND MOTHER PRIOR TO ADMINISTRATION. PATIENT AND MOTHER VERBALIZED UNDERSTANDING OF INFORMATION AND AGREED TO TODAY''S INJECTION.


VAERS ID: 1438007 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 OT / IM

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

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

Write-up: Swelling /tingling of the tongue. Evaluated by EMS-Cleared


VAERS ID: 1438009 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear congestion, Musculoskeletal stiffness, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient experienced rigid fingers, nausea, fever, and stuffy ears about 8 minutes after the vaccine was administered. Patient was given a cold water bottle, an ice pack to place on her forehead, and bucket in case she needed to vomit. EMS was called right away. They arrived and checked her out. She was not transported to the hospital. She waited approximately for 30 more minutes and then felt well and left.


VAERS ID: 1438010 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Patient stated she previously received the Moderna COVID-19 vaccine and had a severe reaction consisting of tinnitus. She also stated she discussed the side effect with her PCP, and would like to receive the Pfizer COVID-19 vaccine to complete her vaccine series.


VAERS ID: 1438020 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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: Unknown, none on profile.
Current Illness:
Preexisting Conditions: Asthma; ADHD
Allergies: None listed on profile.
Diagnostic Lab Data: None as of this date.
CDC Split Type:

Write-up: Patient received a second dose of COVID vaccine that was different from her first dose. She received Moderna for her first dose and Pfizer for her second dose. The manufacturer of the first dose was not known at the time second dose was given.


VAERS ID: 1438022 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Electrocardiogram, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: History of Brugada Syndrome per NP''s account. Information from the patient and his mother.
Preexisting Conditions: History of Brugada Syndrome. Heart condition per patient.
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 23 y/o complained of heart palpitations, heart pounding after 1st dose of Pfizer vaccine. Service was rendered to patient by EMT and Nurse Practitioner on site. According to notes on report, after examination, pt was breathing adequately, 3 lead EKG was normal sinus rythim, Pt. feels better and is observed for another 30 minutes. He refused transport to hospital. He was advised to follow up w/PCP.


VAERS ID: 1438028 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / IM

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

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

Write-up: Patient felt woozy(dizzy) within minutes after vaccine administration. patient sat down in chair and was given water and an icee and placed an ice pack on neck for observation. She was observed for 30 minutes and had no further complications


VAERS ID: 1438031 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol sulfate (PRO AIR) Xyzal Nasacort Junel Fe
Current Illness: No
Preexisting Conditions: Asthma
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on hand going up arm, burning feeling 3 hours after vaccine


VAERS ID: 1438036 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: No known recent illnesses
Preexisting Conditions: No known health conditions
Allergies: No Known Allergies
Diagnostic Lab Data: No medical tests were performed related to the adverse event.
CDC Split Type:

Write-up: Patient completed the COVID-19 Vaccine Screening and Consent Form and reported that he had not previously received a dose of any COVID-19 vaccine. The dose of Janssen vaccine was administered 6/30/21 at 11:46am without incident. At A Health office, we searched the Department of State Health Services data base and found a record that the patient had received a dose of the Pfizer vaccine on 5/25/2021. The patient did not report this previous dose.


VAERS ID: 1438042 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Pharmacy       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: Given Moderna 1st dose on 6/1/21 at 17yrs old. Moderna currently approved for 18 yrs and older. Gave 2nd dose 6/30/21 to complete series per recommendations.


VAERS ID: 1438049 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (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: Patient stated a history of fainting during immunizations from his teenage years.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After patient received first Pfizer Covid 19 vaccine approximately 5 minutes after, the patient fainted, he was dazed for about 2 to 3 minutes and then awoke. He completely recovered after approximately 10 minutes. Refused care of EMS and stated he was fine.


VAERS ID: 1438059 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (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: ASTHMA
Preexisting Conditions: ASTHMA
Allergies: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient said he is feeling nauseous and he said he cannot see after some seconds and also felt dizzy. we called 911 meanwhile the patient said after 5-10 minutes he can see and he still feel nauseous. He didn''t go to the hospital with the paramedics. After paramedics left he said he felt fine.


VAERS ID: 1438066 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fear of injection, 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: topical lidocaine was applied by patient prior to vaccination
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: As I was administering vaccine, during the push, the patient abruptly pulled her body away. Some vaccine leaked out onto her arm. I pushed some into her left arm, but the rest leaked out. The patient had advised me up front that she had a phobia of needles. She sat still for the initial injection, but as I pushed the vaccine she pulled away sharply. I advised her that she seemed to only have received about half of the vaccine before she moved and that she should follow up with her primary physician and to continue to protect herself and wear her mask until advised by md.


VAERS ID: 1438068 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008A21A / 1 LA / IM

Administered by: Military       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: Patient given vaccine not 18 y/o


VAERS ID: 1438069 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Epistaxis, Face injury, Fall, Hyperhidrosis, Pallor
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Accidents and injuries (narrow), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient walked to th chair for observation, within a minute patient leans forward then fell over chair to his right and landed on face. I(pharmacist) ran to his side, I though he was having a seizure ,yelled to my technician to call 911 , but with further assesment I knew he didnt have a seizure, he fell on his face and his arms tucked under his abdomen, so he couldn''t lift himself up properly. I sat him up,he was responsive to my questions, pulse was very faint and he started to sweat,pale,clammy . His nose was bleeding from the fall. Within 9 minutes paramedic showed up , took blood pressure and glucose check. After assesment they didn''t feel it was necessary to go to emergency room. Patient didn''t eat breakfast,got him apple juice and chocolate. This never happened to him before. His friend came to meet him and make sure he was ok, he left voluntarily ,and back to himself.


VAERS ID: 1438073 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / IM

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

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

Write-up: Vaccine Administration Error: 15 y/o individual given Moderna COVID-19 vaccine. No adverse events during 15 minute observation period.


VAERS ID: 1438235 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine Administration Error: 12 y/o individual was administered with Moderna COVID-19 vaccine. No adverse event during 15 minute observation period.


VAERS ID: 1438248 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Hyperhidrosis, Hypertension, Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: Blood pressure measure was 175/115 at 1:04PM.
CDC Split Type:

Write-up: Patient appeared to be pale and started sweating with complaint of nausea and expressed to use bathroom to vomit. Patient was escorted to the bathroom where he vomited a multiple times. Water was provided to the patient, and blood pressure was measured after 10 minutes. Blood pressure measure was 175/115; however, patient stated that it is always high, and he is feeling much better. Patient was monitored for 30 minutes, and he confirmed to feel safe to leave. Patient also reported his symptoms to V-Safe. He does not have an established PCP to follow up. Pharmacy information was provided to report any additional symptoms or complaints.


VAERS ID: 1438256 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-11
Onset:2021-06-30
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Other       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: unknown. Client was in rehab when he was vaccinated on 5/11. Unable to give me info re meds, etc.
Current Illness: unknown
Preexisting Conditions: Client has a history of going to rehab facilities. At time of Covid testing on 6/30, he had slipped and fell in his bathroom at home and was taken by ambulance to Hospital. He was tested at the emergency room and was positive for Covid with PCR and not admitted because no injuries. Client not a good historian and was vague about alot of his history. Has no Covid symptoms. Date of vaccination obtained in data base as May 11 with J&J vaccine.
Allergies: unknown
Diagnostic Lab Data: PCR for Covid done on 6/30 at Hospital. Health Department requested that positive spec be sent to Lab for sequencing.
CDC Split Type:

Write-up: client in emergency room s/p fall in his home. Covid test done routinely. No symptoms per client report. Covid PCR test was positive. Client not admitted but sent home. Instructed to isolate x 10 days. Client tested positive for Covid with PCR after having received vaccine 7 weeks prior.


VAERS ID: 1438257 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

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

Write-up: Patient received Moderna as their first covid dose. The patient scheduled their second dose online and selected Pfizer incorrectly. Pfizer was administered at the pharmacy.


VAERS ID: 1438258 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Hyperhidrosis, Hypotension, Loss of consciousness, Malaise, Muscle twitching, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Pt passed out (slumped over in chair) was unconscious for maybe less than 10 seconds and twitching. He came to and was conscious and seemed to know what had happened. was pale, sweaty, weak, upset stomach and low blood pressure. was not feeling well for a good 15 to 20 minutes. felt better, was assessed by EMTs and declined hospital visit.. went home with 2 friends. did not drive.


VAERS ID: 1438263 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, 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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 10mg, Ramipril 2.5mg
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was fanning herself and then passed out, about 5 minutes after vacinnation


VAERS ID: 1438276 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Not to our knowledge
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None to my knowledge
CDC Split Type:

Write-up: Patient fainted within 2 minutes of receiving vaccination. Father was holding patient in her chair and she regained her conscience within 10 seconds. Patient felt nauseas and vomited about 5 minutes later. We provided patient some water and monitored her for 30 minutes. She was calm and felt fine when she was leaving the pharmacy.


VAERS ID: 1438280 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (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: unknown
Allergies: unknown
Diagnostic Lab Data: none at time of reported side effect
CDC Split Type:

Write-up: nose bleed


VAERS ID: 1438287 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-03
Onset:2021-06-30
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion Escitalopram Lisinopril B Complex One a Day women?s formula Potassium
Current Illness: None
Preexisting Conditions: Depression Anxiety
Allergies: None
Diagnostic Lab Data: Skin biopsy June 8, 2021
CDC Split Type:

Write-up: Severe rash throughout body, very itchy, brown spots throughout the body still exist after three (3) months. Possibly Lichen Planus.


VAERS ID: 1438431 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 3 RA / IM

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

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

Write-up: PT RECEIVED A THIRD DOSE BY MISTAKE WANTED TO REPORT THE 3RD DOSE


VAERS ID: 1438434 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate decreased, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient came in for her first dose of vaccine. I verbally asked if she had any health conditions, allergies, andy reactions to previous vaccines. The mother answered for her and declined all. Once the patient filled out the paperwork and received the vaccine she stated she felt light headed. I noticed quickly she was about to faint. We put a chair under her and sat her down. She became unresponsive, but was breathing fine. She began to sweat and her pulse decreased. I asked for someone to call 911 and find her mom. I attempted to check her blood pressure but was unable because of her positioning. She was breathing fine and was answering short sentences but was speaking slow. Right after we called the ambulance she asked what happened and said she was feeling better. Shortly after the ambulance arrived and checked her out. Her mother declined transport to the hospital.


VAERS ID: 1438436 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

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

Write-up: Pt was ok during vaccination. Pt fainted in chair while sitting after during observation.


VAERS ID: 1438449 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: tingling in the neck and side of face (cheek) that began around 20 minutes after vaccination.


VAERS ID: 1438454 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       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: norethindrone 5mg
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given the J&J vaccine but she was not yet 18 years old (DOB 10/6/03)


VAERS ID: 1438455 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Dizziness, Feeling hot, Presyncope, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: patient felt faint after 1st Pfizer vaccine, but did not pass out
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became light headed and nearly passed out. Patient also vomitted twice. Patient was weak and feeling warm and clammy for about 15 minutes.


VAERS ID: 1438457 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hypertension, Injection site hypoaesthesia, Injection site pain, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, levothyroxine and metformin
Current Illness:
Preexisting Conditions: diabetes, hypertension, unspecified thyroid condition
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 1327 client reported to EMT he was feeling nausea for 30 mins. EMT did first vitals at 1329: blood pressure 160/100, pulse 65, oxygen sat 99%. EMT did first assessment. Client reported medical history of diabetes, hypertension and unspecified thyroid condition. Current medications: Lisinopril, Metformin, and Levothyroxine. Client reported no known allergies. PHN arrived at 1335. Client sitting upright in chair, alert and oriented x4. Client aware blood pressure is high and reported he took his medication today. Client reported only reaction to 1st Pfizer Covid vaccine was muscle pain, numbness to arm where vaccine was given and has followed up with provider. Vitals at 1339: blood pressure 160/98, pulse 68, oxygen sat 99%. Client reports nausea same and stated "I can tolerate it, I will not throw up". Client denies chest pain, shortness of breath, headache, or blurry vision. Vitals at 1349: blood pressure: 150/92, pulse 68, oxygen sat 97%. Client reports new onset of lightheadedness and nausea same. Client informed staff he wanted to leave. PHN asked client if someone could pick him up as symptoms had not resolved. Client stated " I can drive, if not I will contact someone when I am in my car". PHN advised client to follow up with provider and gave ER precautions. Client left facility with steady gait at 1358.


VAERS ID: 1438461 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01748 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: SHELLFISH
Diagnostic Lab Data:
CDC Split Type:

Write-up: Customer received first dose Pfizer COVID vaccine and experienced some dizziness/lightheadedness and fast heartbeat after vaccination. He reported feeling dizzy about 5-10 minutes after vaccination . He also said he felt like his heart was beating faster. We called emergency services and while we were monitoring him and waiting for emergency services he said he was feeling better. Emergency services came and took him for evaluation.


VAERS ID: 1438558 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fall, Generalised tonic-clonic seizure, Hangover, Head injury
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Preexisting Conditions: None given prior Vaccination; 10:33 observed ''scissoring'', seizure activity, falls out of chair, hits head, generalized tonic clonic x 30secs Post Vaccination and seizure, Attendee reports he is hung over, didn''t rehydrate, nor eaten breakfast. No Seizure history prior to this event. Left with EMS to ER


VAERS ID: 1438559 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Hypopnoea, Pallor, Speech disorder
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: Pt pale and diaphoretic, unable to speak for a few seconds, with shallow resp. 911 called Laid down on cot bed, obtained vs, and monitored pt. until paramedics arrived on scene. Pt evaluated returned to baseline with VSS on RA, released to mother, who took pt to urgent care for further evaluation via private vehicle


VAERS ID: 1438560 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Skin irritation
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: unknown
Current Illness: none listed
Preexisting Conditions: none listed
Allergies: none listed
Diagnostic Lab Data: none ran at the time of report
CDC Split Type:

Write-up: patient called pharmacy to advise the injection site of her vaccine (2nd dose) was itching. She stated it was irritated from her scratching , was red and felt like it had a small bump at the injection site. Patient was informed to watch for swelling, redness area growing, and to seek medical attention if it got worse.


VAERS ID: 1438561 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown-not mentioned on screening form
Current Illness: No
Preexisting Conditions: No
Allergies: NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: NO ADVERSE EVENT, MINOR RECEIVED JANSEN WHEN SHOULD HAVE RECEIVED PFIZER


VAERS ID: 1438566 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: Thyroxine
Current Illness:
Preexisting Conditions: Absent thyroid and spleen
Allergies: Codeine, and "some foods"
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received the 1st dose of the COVID vaccine (Pfizer Lot #EW0187 expiration date 07/10/2021) at 1534. At 1552, the client''s friend walked up to the EMT station and asked, "she''s feeling dizzy, can we move her to the back chair?" EMT and PHN escorted the client to the zero gravity chair. The client stated, "I''m feeling a little hot, and dizzy. My heart is racing. I think it''s just psychological." Client alert and oriented times four. Vital signs taken at 1552 (blood pressure 148/90, heart rate 75, oxygen 95%). Client stated, "I''m afraid of needles. I ate a little before right before coming to my appointment." Client denied SOB. Vital signs taken at 1602 (blood pressure 122/84, heart rate 69, oxygen 96%). At 1602, client stated, "I don''t feel dizzy anymore." Vital signs taken at 1612 (blood pressure 122/84, heart rate 70, oxygen 96%). Client is allergic to Codeine, "and some foods." Client stated, "I''m missing some organs. I don''t have my thyroid or spleen anymore." Client is currently taking Thyroxine. Vital signs taken at 1622 (blood pressure 130/86, heart rate 66, oxygen 96%). PHN provided education to the client on when to seek emergency services, and to follow up with her primary care provider. At 1623, client stated. "I feel fine," and left the facility unassisted with a steady gait.


VAERS ID: 1438568 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Heart rate decreased
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: After administration of the vaccine, the patient got light headed and clammy. The patient never loaded consciousness. His heart rate is normally in the 80s according to his mom, who is a nurse practitioner. His heart rate dropped to 69. The mom did not want an ambulance called. Monitored the patient for 20 minutes. He was completely alert and held a conversation the entire time.


VAERS ID: 1438575 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-06-25
Onset:2021-06-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Age discrepancy - vaccine given despite age under 18 by accident. No adverse events reported


VAERS ID: 1438579 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dizziness, Heart rate decreased, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: She was a little faint and dizzy and weak, No EMS was called for her, she said she had not eaten or hydrated well., Has low blood pressure, has low heart rate and low blood pressure the patient stated. Pt was observed for over an hour. When she had experienced the lightheadedness and dizziness she was assisted to the cot and her legs were elevated. She continued to feel lightheaded, she refused to have ems called and vitals were taken several times. At 12:50 she started to feel better she did not complain of any discomfort and was encouraged to walk before discharged.


VAERS ID: 1438580 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Chest pain, Dizziness
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: not known
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was light headed within a few minutes of injection. We gave him water and had him lay on floor with feet elevated. He said he had chest pain and was 2 on a scale of 1-10. We took his blood pressure. it was 110/80. We asked him at least 3 times if he wanted us to call an ambulance. He said no. After 30 minutes, he was feeling much better. 5 minutes later he left with his girlfriend driving. I called him about 7:30pm, he felt back to normal.


VAERS ID: 1438583 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotonia, Loss of consciousness, Snoring
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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? No
Hospitalized? No
Previous Vaccinations: patient stated fainting from shots and blood draws in the past
Other Medications:
Current Illness: None reported
Preexisting Conditions: Patient mentioned fainting from other vaccines and blood draws in the past
Allergies: None Reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported history of syncope with shots/blood draws in the past. After shot was given, patient stated that she felt light headed and bent over on the chair with her head between her knees. She began to snore and so I rubbed her back to wake her up and she came to almost immediately. She then alternated between sitting upright and hunched over on the chair while I continued to fan her as she was feeling warm. After 15 minutes she started feeling better and was able to call a friend to come pick her up at the pharmacy. She also asked for some water. At this point, she was sitting upright and was on her phone for another 15-20 minutes before her friend arrived and she left on her own strength


VAERS ID: 1438790 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-28
Onset:2021-06-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Shoulder injury related to vaccine administration
SMQs:, Arthritis (broad)

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

Write-up: Intense shoulder pain, NOT muscle soreness. Suspect SIRVA


VAERS ID: 1438791 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Ten minutes after patient received vaccine, patient parents informed the pharmacy that he was not feeling well. Patient was visibly sweating, holding his stomach and then started vomiting. Father then informed the pharmacy that the patient had experienced vomiting after a previous vaccine but had cleared it with pediatrician to get the COVID vaccine. After several minutes patient stated he was feeling better and left accompanied by parents.


VAERS ID: 1438794 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Decreased appetite, Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Injection site warmth, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: At site of injection, developed a red raised/hard circle about 3 inches in diameter. Warm to the touch and painful. Looks to be ?covid arm? . Also Experiencing loss of appetite, chills, low grade fever, body aches.


VAERS ID: 1438796 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Eye movement disorder, Facial paralysis, Feeling abnormal, Grip strength decreased, Hypotonia, Malaise, Miosis, Mydriasis, Pallor, Peripheral coldness, Posture abnormal, Somnolence, Staring, Throat tightness, Tremor, Unresponsive to stimuli, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta and Hydralazine
Current Illness: Depression and High blood pressure
Preexisting Conditions: Depression and High blood pressure for 12 plus years
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came with husband to receive first dose Moderna at vaccine clinic. Patient was foreign speaking, LVN translated on her behalf. Patient stated that she was hot and thirsty prior to vaccine administration and was given water by Lead, RN. RN informed Team that was going to a nearby store to get more water to team and patients. Upon registering patient into vax system, patient stated she had blood drawn (not Covid related) in March where they took 8 tubes of blood in which afterwards she felt sick. Patient was given the 1st dose of Moderna and was seated in observation area for 15 minutes. While patient''s husband was receiving his shot of Moderna, patient stated that she was not feeling well. Nurse, RN stood beside her in the observation area to continue to monitor her. Patient began to place both hands on her head and stated, "I no feel good." She then turned to RN with a blank stare. RN then held patient by her shoulders and asked if she was okay, while LVN translated. Patient began to close her eyes and dropped her head back. RN began to hold onto patient while LVN got water and attempted to arouse patient. Upon pouring cold water patient opened her eyes and said she was okay but then went limp against RN. RN instructed EMT to call 911 and proceeded to arouse patient again, while LVN performed a sternal chest rub on patient. RN was reported back to clinic site and was informed by team that patient is currently undergoing a reaction. RN witnessed patient''s face which was ashen in color and began preforming vital signs on patient. BP: 228/106; HR: 108; O2: 73. RN continue to ask patient to state name and where patient was located, patient was able to verbalize understanding and state name and location. RN proceeded to ask patient (while LVN translated) if she had taken any medications, in which patient''s husband stated yes: to Cymbalta and Hydralazine. Patient began to have minor shakes to the body while her head and eyes rolled back. RN held patient''s head as we continued to pour water on her. Patient stated to LVN that she wanted to lie down and go to sleep. LVN informed patient that she will remain in current position that she is in. Patient would become unresponsive for about 5 to 10 seconds, and when she became responsive stated that she would like more water poured on her. Patient''s husband informed us that patient battles with depression and anxiety. While still waiting on EMS who was now on site, but at the front of clinic gate, patient stated that she felt her throat was "closing up." While observing patient RN held patients hands and asked patient to squeeze both hands. Patient was capable of squeezing left hand, but could not fully squeeze her right. RN began to assess and observed patients right eye was drooped and right side of patient''s body became flaccid. Areas of patient''s body that were dry, were cool to touch, and pupils began to constrict then dilate . RNs continued to have patient talk while awaiting for EMS. RN performed another set of vitals on patient: BP: 206/137; HR: 155; O2: 76. Upon EMS arrival patient was coherent enough to ask Nurses if we could accompany her to the hospital. Team informed patient that EMS would be taking her to the nearest hospital. EMS took down patients information and placed patient on Oxygen. RN updated EMS on patients reaction and performed one last set of vitals before transporting patient to hospital. BP: 93/75; HR: 76; O2: 97. Patient remained still weak but able to get from chair to stretcher. Patient left clinic site and was transported by EMS in stable condition.


VAERS ID: 1438798 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

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

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

Write-up: I gave the Pfizer COVID-19 vaccine, instead of the Moderna COVID-19 vaccine, for the patient''s second dose.


VAERS ID: 1438800 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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: I gave this patient, as well as her twin sister the Pfizer COVID-19 vaccine, when it should have been the Moderna vaccine. I did make them both aware of my mistake. I also explained that they would not be receiving a third vaccine dose and that in 2 weeks, they would be considered fully vaccinated. I will call them in the next couple of days to check on them.


VAERS ID: 1438802 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-21
Onset:2021-06-30
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure during pregnancy, Intermenstrual bleeding, Ultrasound antenatal screen abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow)

Life Threatening? No
Birth Defect? Yes
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: Ultra sound 5/27 and 6/14
CDC Split Type:

Write-up: Miscarriage And pocket of blood in uterus - 6/4 2nd dose - 6/18 Bleeding in between cycle - 6/30


VAERS ID: 1438950 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 AR / SYR

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

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

Write-up: Lips become puffy/inflamed. Visited ER based on phone nurse recommendation to get evaluated.


VAERS ID: 1438952 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-26
Onset:2021-06-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Chest pain


VAERS ID: 1438956 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Headache, Nausea, Pain, 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: Daily: Quillivant XR Lexapro Melatonin Flintstone Vitamins
Current Illness: NONE
Preexisting Conditions: Autism Repaired Tetralogy of Fallot Left Ear Hearing Loss ADHD
Allergies: Sevofluorine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intense nausea and vomiting starting at 5 AM, intense achiness and headache. Vomiting intermittent throughout the day, with 20-30 occurrences between 5 AM and 10PM. Ondansetron 4mg RX administered at approx 9 AM and 8 PM. No improvement after morning dose, contents promptly thrown back up. Brief period of improvement late afternoon until early evening on 06/29/2021. Water and crackers and toast administered during improvement. Child was vomiting bile by 10PM. As of this report, not yet resolved.


VAERS ID: 1439326 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-27
Onset:2021-06-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain 3 days after 2nd Pfizer Covid vaccination. Worse lying down, improved sitting up High Sensitivity Troponin 2340 ng/l


VAERS ID: 1439791 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-29
Onset:2021-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram abnormal, Myocarditis, Pyrexia, Tachycardia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocarditis. 1d after vaccine with fever, tachycardia, chest pain. Abnormal ekg, elevated troponin. Admitted


VAERS ID: 1440220 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Patient experienced syncopal episode within 5 minutes of administration of second dosage of Moderna Covid-19 vaccination, patient was unconscious less than 30 seconds, spontaneously awoken, and was fully recovered within 15 minutes.


VAERS ID: 1440221 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Seizure-Mild, Additional Details: Patient received vaccine (2nd dose) on left arm, felt dizzy while waiting in the observation area. Suddenly peed himself, and walked away. When we talked to him afterwards, he reports he thinks he might have had a seizure. Patient did not fall, said he had no history of seizure in the past. Patient declined to be sent to the ER or urgent care. Unsure exactly if it was a seizure or not. He said he did not have any reaction when he got his first dose.


VAERS ID: 1440222 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

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

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

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


VAERS ID: 1440224 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / IM

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

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

Write-up: Site: Itching at Injection Site-Mild, Additional Details: pt had s few rash and was itchy on both arms


VAERS ID: 1440225 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Incorrect product formulation administered
SMQs:, Medication errors (narrow)

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1440230 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole; Humira
Current Illness: None
Preexisting Conditions: Crohn''s Disease
Allergies: Sulfa-meds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain/Soreness at injection site.


VAERS ID: 1440235 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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:
CDC Split Type:

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1440236 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-06-28
Onset:2021-06-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 AR / IM

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

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

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


VAERS ID: 1440237 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Head injury, Headache, Hypotension, Injection site erythema, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Headache-Medium, Systemic: Hypotension-Medium, Additional Details: Patient recieved covid shot, and fainted within 8-15 minutes. He bumped his head while falling and had redness at the site. We called the ambulance to make sure patient will be okay. Paramedics mentioned that his blood pressure was low.


VAERS ID: 1440238 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 RA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1440242 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: pain and pressure on chest and back-Medium


VAERS ID: 1440244 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypoaesthesia, Seizure, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Seizure-Mild, Systemic: Weakness-Mild


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